Elastic cartilaginous metaplasia of vocal cord nodules.
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Adult↗
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Results for “LARYNGEAL CARTILAGES”
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Calcified neurilemoma of the larynx.
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Aged↗
Multiple postintubation complications.
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Adult↗
Congenital laryngeal defects in the adult.
Two types of congenital laryngeal defects in the adult are presented. The first case is a patient with a laryngeal cleft who became symptomatic at 42 years of age. Dysphagia, dyspnea, hoarseness and aspiration progressed in severity until surgery was necessary at the age of 48 years. The second case presented is a 21-year-old male with nonfusion of the thyroid laminae. He was asymptomatic except for persistence of a high-pitched voice after puberty. The case histories and radiographic studies are reviewed, emphasizing that the diagnosis of these defects was more difficult than their management. The surgical repair is described and illustrated. Briefly, this involved repair of the laryngeal cleft using techniques similar to those of a hernoiorrhaphy. The nonfusion of the thyroid laminae and resultant defective anterior glottis was repaired using bipedicled muscle flaps and a silicone keel.
Adolescent↗
Laryngeal spasm: a neurophysiologic redefinition.
Within the limits of standard neurophysiologic techniques, we have attempted to redefine laryngeal spasm as distinct from the glottic closure reflex. This distinction is based upon the observation that laryngeal spasm is solely mediated by the superior laryngeal nerve. Stimulation of other afferent nerves, capable of eliciting the glottic closure reflex, produces little adductor after-discharge activity that is characteristic of laryngeal spasm. In this regard, modification of output function from the adductor motoneuron aggregate by means of temporal and spatial summation of sensory input data has been described, and its characteristics further defined in response to varying ventilatory states and barbiturate levels.
Anesthesia, Intravenous↗
Evaluation of computerized tomography, cinelaryngoscopy, and laryngography in determining the extent of laryngeal disease.
A prospective study of over 100 cases comparing computerized tomography (CT) and correlating these studies with photographic motion picture studies of the larynx, conventional tomography and contrast laryngography has been performed. The authors give illustrative examples of cases in which the CT scan has been documented as providing equal and often times greater information concerning not only tumors, but also cystic lesions and traumatic lesions. With the newer technology, the reduced radiation (which is less than one half that of conventional tomography), and the decreased expense (now comparable to that of laryngography alone), eliminates the need for conventional laryngography and tomography examinations. The incorporation of motion picture documentation of the lesions allowing future comparative studies between the original lesion and the CT are recommended for a more accurate retrospective classification and assessment of therapeutic results.
Adult↗
Acute cricoarytenoid arthritis: local periarticular steroid injection.
Acute cricoarytenoid arthritis is a frequent complication of rheumatoid arthritis and the most frequent otolaryngologic manifestation of the disease. Over 25% of rheumatoid arthritis cases have discomfort from this problem. Other etiologies can produce cricoarytenoid arthritis. Symptoms range from mild discomfort through hoarseness to complete airway obstruction requiring emergency tracheotomy. Chronic cricoarytenoid arthritis may result in joint ankylosis and vocal fold fixation. Single periarticular triamcinolone injections may bring rapid and dramatic relief of the symptomatology of nonankylosed acute cricoarytenoid arthritis for periods of up to one year if other medical management is adequate. Six cases illustrate the problem and the efficacy of this treatment methodology. Findings, pathology and pertinent literature are discussed. Specific criteria for considering this technique are outlined. This form of therapy has not been described previously.
Acute Disease↗
Histologic and histochemical study of effects of anabolic steroids on the female larynx.
The larynges of 30 unmated, mature female albino mice were examined histologically and histochemically after injecting them with 19-nandrolone phenylpropionate. Permanent irreversible changes, in the form of parakeratosis and squamous metaplasia of the epithelium, and hypertrophy of the muscle fibers, were observed together with persistence of increased alkaline phosphatase enzyme intensity in the endothelium of capillaries and increased activity of nonspecific esterase in the muscles. Similar changes may be responsible for the alteration in the human female's voice after prolonged treatment with anabolic steroids.
Anabolic Agents↗
Surgical correction of dysphonia due to bowing of the vocal cords.
This report reviews laryngoplastic techniques for correction of bowing of the vocal cords, with special consideration to the anatomic details of the anterior commissure. I present a new technique in which the glottic gap is closed by bilateral medialization. This technique may be superior to those described previously, since the correction achieved at the time of surgery is maintained by the placement of Silastic.
Adult↗
Transmucosal electrical stimulation of laryngeal muscles.
A new technique is described that enables discrete activation of individual laryngeal muscles by electrical stimulation across overlying mucosa. In 15 dogs, we defined six distinct motor points by transmucosal stimulation at 3 mA while observing the resulting characteristic position of the arytenoid and true vocal cord. Five dogs were then paralyzed with succinylcholine in order to simulate bilateral vocal cord paralysis. Application of a 3-mA stimulus at each motor point yielded no motion of the cords, but when the current was increased to 20 mA, characteristic responses were elicited. In five other dogs, botulinum toxin was injected directly into laryngeal muscles. Stimulation was used in an attempt to quantify the degree of neuromuscular blockade. In the last group of five dogs, we simulated cricoarytenoid arthritis by scarifying the joint. The extent and nature of the joint's impairment could be demonstrated by stimulation. Transmucosal stimulation appears promising as a clinical technique for correlating particular vocal cord movements and thresholds of activation with specific laryngeal disorders. Additionally, such a technique may be useful in clarifying how each laryngeal muscle acts upon the cricoarytenoid joint.
Animals↗
Injection and removal of Teflon for unilateral vocal cord paralysis.
For over 70 years, reinnervation attempts have been unsuccessful in restoring motion to paralyzed vocal cords, in spite of occasional claims to the contrary. Fortunately, the major defect of unilateral vocal cord paralysis, a soft and breathy voice, can be eliminated if the edge of the paralyzed vocal cord is moved to the midline. This permits the mobile vocal cord to adduct and therefore to vibrate firmly against the edge of the paralyzed vocal cord during phonation, eliminating the air leak between the vocal cords. Teflon injection of the paralyzed vocal cord does this effectively. It is accomplished most easily and reliably via indirect laryngoscopy under local anesthesia, so the effect on the voice can be monitored during the injection. Teflon can be easily removed from the vocal cord via direct laryngoscopy. The disadvantages of trying to medialize the edge of a paralyzed vocal cord via a window in the thyroid cartilage (laryngeal framework surgery) will be discussed.
Humans↗
Experimental blunt injury to the larynx.
This article deals with the fracture line distribution and severity of laryngeal trauma. Laryngeal trauma was experimentally inflicted on 100 human laryngeal specimens with the impact of a 2.0-kg weight falling by gravity from a height of 100 cm. According to the previous pilot experiment and clinical experiences, the author classified the severity of fracture into four grades. The results showed no significant sex difference in the severity of fracture with reference to age distribution, especially severe injury in older age groups. The pattern of fracture lines of the laryngeal cartilage was observed and traced in four selected locations, including the thyroid notch, central zone of the thyroid cartilage, cricothyroid region, and cricoid. The distributions of fracture lines are illustrated. The experiment is described in detail.
Adolescent↗
Silastic medialization and arytenoid adduction: the Vanderbilt experience. A review of 116 phonosurgical procedures.
From April 1987 to April 1992, 116 phonosurgical procedures were performed to treat glottal incompetence. The initial numbers of these surgical procedures included the following: 29 primary Silastic medializations, 3 primary Silastic medializations with arytenoid adduction, 53 secondary Silastic medializations, 4 secondary Silastic medializations with arytenoid adduction, and 11 bilateral Silastic medializations. These procedures are useful in treating unilateral true vocal cord paralysis, scarring, bowing, or paresis, as well as bilateral true vocal cord bowing. Of the initial 100 patients, 16 later underwent a revision with either a larger implant's being placed or an arytenoid adduction. Primary Silastic medialization is the placement of an implant under general anesthesia in the same surgical setting in which laryngeal innervation is sacrificed. Secondary Silastic medialization is the placement of an implant under local anesthesia for a preexistent vocal cord malfunction. In either case, overall voice results for unilateral paralysis are very good. Primary Silastic medialization significantly decreases the postoperative rehabilitation period in skull base patients because of the immediate postoperative glottal competence and decreased use of perioperative tracheotomy. Bilateral implants yielded good results in 6 patients with presbylaryngis, but 6 other patients with bowing from other causes experienced only moderate improvement in speech quality. There were no implant extrusions; however, 1 implant was removed secondary to a persistent laryngocutaneous fistula in a patient who had previously undergone laryngeal irradiation. This was the only complication in this series.
Adult↗
Relative prognostic importance of histologic invasion of the laryngeal framework by hypopharyngeal cancer.
This study assessed the relative prognostic importance of histologic invasion of the laryngeal framework by hypopharyngeal cancer. The laryngeal specimens and medical records of 55 patients found to have primary hypopharyngeal cancer between 1962 and 1988 were reviewed. Full 3-year follow-up information was obtained for 51 patients. The overall 3-year survival rate was 43% A(22/51). The 3-year survival rate was 55% (17/31) without histologic invasion versus 25% (5/20) with invasion (p < .05). To assess how invasion affected survival rates in conjunction with clinical predictors, we divided the cohort into two groups (mild versus severe illness) based on the presence or absence of anemia and comorbidity. Only in the group with mild illness did histologic invasion provide additional prognostic information. These results demonstrate that the inclusion of clinical variables in predictions of prognosis can strikingly alter the prognostic importance of invasion of the laryngeal framework.
Anemia↗
Vocal function following vertical hemilaryngectomy: comparison of four reconstruction techniques in the canine.
The goals of laryngeal reconstruction have been prevention of aspiration, production of a functional voice, and maintenance of an adequate airway for decannulation. A number of procedures for partial laryngeal reconstruction have accomplished these objectives. However, few studies have attempted to compare patients' vocal characteristics following different reconstruction procedures. In this study, an in vivo canine model was used to compare acoustic and aerodynamic measures of vocal function for the following vertical hemilaryngectomy reconstruction techniques: 1) a superiorly based sternohyoid muscle flap, 2) a modified epiglottic laryngoplasty, 3) a new procedure using a layered vascularized buccal mucosal flap and a transversely oriented sternohyoid muscle flap, and 4) hemilaryngeal transplantation combined with arytenoid adduction. Hemitransplantation provided the most efficient phonation of the four techniques. The vascularized buccal mucosa flap produced the best phonation of the autologous tissue techniques examined. Both vascularized buccal mucosa flap and hemilaryngeal transplantation subjects demonstrated a mucosal wave on stroboscopy. The results indicate that vocal function will improve as the layered structure of the vocal fold is more accurately replicated in a reconstructed hemilarynx. Endoscopic findings and whole organ sections are presented.
Animals↗
Microcauterization in reconstructive surgery of the larynx.
The increased interest in microcauterization is related to its simplicity, accuracy, and economy. Because of its intrinic nature, microcauterization has been found to be a suitable method in the removal of cicatricial bands from the larynx, even in those patients whose larynges are difficult to expose. Some endolaryngeal suturing techniques have been developed and successfully used in combination with microcauterization in the conservative management of difficult laryngeal problems, including a congenital interarytenoid cleft. A combination of this technique has also been successfully employed in the prompt rehabilitation of a meaningful group of patients afflicted with bilateral abductor paralysis of the vocal cords.
Adult↗
Deglutition after conservation surgery for cancer of the larynx and hypopharynx.
Conservation surgery for cancer of the larynx results in deglutition problems. Rehabilitation of swallowing function can successfully be managed by a team including a surgeon, a dietitian, and a nurse. This report details surgical reconstruction to prevent or treat aspiration, postsurgical dietetic management, and the nursing approach to deglutition training in a group of patients.
Deglutition Disorders↗
Magnetic resonance imaging of the larynx: a correlation with histologic sections.
To date, high-resolution computed tomographic (CT) scanning has proved to be the most valuable preoperative study for the evaluation of the anatomic extent of head and neck cancers. Now, with the development of magnetic resonance (MR) imaging, the prospect of having an equally reliable test without associated radiation exposure has emerged. This study is designed to compare MR images of the larynx with corresponding histologic sections obtained by step-serial sectioning of whole organ specimens. Images were generated by a 0.3 Tesla permanent magnet MR imager. Additional correlation with CT scans was obtained when possible. CT resolution proved to be slightly superior in the axial plane but markedly inferior to MR imaging in the coronal and sagittal planes. Overall, MR imaging appeared to have good resolution of the larynx.
Epiglottis↗