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Complete esophageal obstruction from cricopharyngeal achalasia.

A patient with complete esophageal obstruction from cricopharyngeal achalasia in whom adequate cricopharyngeal myotomy failed to alleviate the dysphagia is described. The importance of pre-operative radiological evaluation of patients with neurologically related dysphagia is discussed, specifically, the degree of obstruction, range of tongue movement, and presence of aspiration. These factors have a predictive value in assessing the benefits of planned cricopharyngeal myotomy.

Adult↗

Computed tomographic evaluation of laryngeal neoplasms.

Nineteen patients with laryngeal lesions each underwent diagnostic studies consisting of laryngoscopy and computed tomography (CT). Sixteen patients had linear tomography and coronal and sagittal reconstruction of their transaxial CT images. The results of each examination were compared with the surgical and pathological findings to assess their relative value. The results confirmed previous reports of the accuracy and value of transaxial CT and direct laryngoscopy, but indicated that coronal and sagittal reconstruction as well as linear tomography added no significant information.

Carcinoma, Squamous Cell↗

X-ray study of a professional soprano's postural strategy for increasing laryngeal mobility.

This paper presents a case study of a professional soprano with reduced laryngeal mobility caused by substantial calcification of the laryngeal cartilage. Unlike other singers, she lowers her head when singing high notes. A cephalometric analysis revealed a compensatory posture in the upper register consisting of moving the occipital bone backwards and upwards in such a way that the styloid and mastoid processes are also tipped in those directions. This in turn causes the hyoid bone, which is connected to the styloid and mastoid processes by the lesser cornua, to move up and back. Becoming more vertical, it pulls on the superior cornua of the thyroid cartilage to which it is connected by the hyothyroid membrane. This considerably tilts the thyroid cartilage on the cricoid. In reality, this soprano does not lower her head to sing in the upper register; she moves her occipital bone upwards and backwards in order to achieve greater and thus more effective tilting of the thyroid cartilage.

Cephalometry↗

Reexamination of the origin and early development of the human larynx.

The respiratory primordium buds off the primitive foregut and grows caudally, on a lengthening stalk; the cephalic end of the stalk develops into the glottis and infraglottis, and the rest becomes the trachea. Compression by pharyngeal mesoderm cephalic to the respiratory diverticulum obliterates the foregut lumen ventrodorsally as far cranially as the 4th pharyngeal pouches, forming an epithelial lamina with a narrow pharyngoglottic duct along its dorsal border. The mesoderm also raises an epiglottic and two arytenoid swellings in the pharyngeal floor at the level of the 4th pouches; the triangular 'cecum', bounded by these swellings, grows caudally along the ventral border of the epithelial lamina to just above the glottis. Beginning at stage 21, the epithelial lamina separates cephalocaudally, bringing the cecal lumen into continuity with the pharyngoglottic duct to form the laryngeal vestibule; when the separation is complete, the vestibule is continuous with the infraglottic cavity. Meanwhile, bilateral pouches arising from the caudal end of the cecum form the ventricles, the lower lips of which become the vocal folds, and the pharyngeal mesoderm surrounding the laryngeal cavity gives rise to the laryngeal cartilages and intrinsic musculature. The cricoid chondrifies bilaterally from a single center in the ventral arch of a precartilaginous template that encircles the infraglottic cavity, and on meeting forms the dorsal lamina. Each arytenoid chondrifies from a single center, and each half of the thyroid cartilage chondrifies from two. Anlagen for the intrinsic muscles appear during stage 17, sites of individual muscles are recognizable by stage 23, and myofibrils are present by the 12th week.

Cartilage↗

Spread and mode of metastases of supraglottic laryngeal carcinoma.

A report is given of the follow-up and behavior of 149 supraglottic squamous carcinomas treated by combined radiosurgical therapy. In 27 cases supraglottic laryngectomy and in 4 cases epiglottectomy was performed. The other cases underwent laryngectomy. The 3-year survival rate was 60% and the 5-year survival rate 51.2%. 64% of the patients without nodular metastases and 45% of the patients with histologically ascertained nodular metastases and 45% of the patients with histologically ascertained nodular metastases survived the 3-year interval. The main localizations of the supraglottic tumors are compared with the tendency to spread into unilateral, homolateral, contralateral or bilateral sites, respectively. A comparative study by serial sectioning of 51 supraglottic squamous carcinomas shows that the tendency to nodular metastases increases with decreasing differentiation of the tumor.

Carcinoma, Squamous Cell↗

Chondrometaplasia of the larynx.

A case of chondrometaplasia of the larynx is reported. The clinicopathological appearances are discussed with a review of the literature. The importance of distinguishing this lesion from cartilaginous tumors is emphasized.

Chondroma↗

Suspension laryngoscopy revisited.

Every critical advancement in direct laryngoscopic surgical technique has enhanced its precision. Among the most notable was Killian's seminal description of suspension laryngoscopy 90 years ago, which allowed for bimanual direct laryngoscopic surgery. Because of the technical difficulties encountered while performing suspension laryngoscopy, Brünings and Seiffert designed fulcrum laryngoscope holder-stabilizers for spatula laryngoscopes from Killian's original instrument design. Their devices, which were easier to use and better tolerated by patients, were supported from the laryngeal cartilage framework or chest wall. Laryngoscope holder-stabilizers were retrofitted to tubular laryngoscope specula in the 1940s and 1950s, whereupon they became very popular. Suspension laryngoscopy should have become more common subsequent to the introduction of general endotracheal anesthesia with paralysis in the 1960s. However, laryngoscope holder-stabilizers were entrenched as the device preferred by most, and they remain so today. This entrenchment occurred despite the fact that suspension laryngoscopy allows for positioning a larger examining speculum, which in turn allows for enhanced exposure and endolaryngeal procedural precision. The applied vector forces on the mandible, maxilla, oral cavity, pharynx, and larynx associated with suspension laryngoscopy are preferable to those associated with holder-stabilizers. A prospective assessment of 120 cases revealed effective use of suspension laryngoscopy in all. We believe that only a minority of surgeons has actually seen true suspension laryngoscopy and that its merits are worthy of reexamination.

History, 19th Century↗

Comparison of human, canine, and ovine laryngeal dimensions.

Geometric measurement of the laryngeal skeleton is a fundamental step in laryngeal studies, especially in biomechanical modeling. Traditionally, canine larynges have been used as models of the human larynx because of their similarity in size and gross structure, but the search continues for an alternative model because of the diminishing availability of the canine species for research in the United States. In this report, a revised method for defining and labeling laryngeal framework parameters is proposed. Ovine laryngeal cartilages were measured, and the measurements were compared to those of human and canine cartilages previously reported in the literature. The ovine cricoid, thyroid, and arytenoid cartilages were significantly different from the human and canine cartilages. Also, the lack of a definite border between the true and false vocal folds revealed that the ovine model may not always be suitable for a direct comparison to the human larynx in phonation.

Animals↗