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PubMedDate not supplied

The cricothyroid muscle after cricothyroidotomy. A porcine experimental study.

Cricothyroidotomy in elective use or emergency situations has been discussed by several authors during recent years. The main complication reported has been subglottic stenosis. We have used this method for several years and among our patients there has been no case of stenosis. The major complication in our material has been voice dysfunction. Some of the patients had a change in voice quality consistent with dysfunction in the cricothyroid muscles (diminished voice range and a lowered pitch). The aim of this study was to investigate whether cricothyroidotomy and insertion of a tracheostomy tube caused physiological or morphological changes in the cricothyroid muscle, by direct injury or secondary to a peripheral nerve lesion. In the six animals that were cricothyroidotomized during 7-9 days and examined after 9-15 weeks, we found neither changes in the EMG nor in the muscle morphology indicating injury to the muscle or its peripheral nerve supply.

Animals↗
PubMedDate not supplied

[The glosso-crico-arytenoid unit as a phonatory organ in sub-total reconstructive laryngectomy using the Labayle technic].

The present study was carried out in order to assess characteristics of vicarious voice in patients undergoing Labayle's reconstructive sub-total laryngectomy. This type of surgery, which permits air passage for both respiration and phonation, makes it possible to preserve pneumophonic coordination. During phonation the expiratory air column is used and sound is generated as it passes through a vibrating structure having a sphincteric function. In the opinion of the authors this structure is not only made up of the cricoid orifice, against which the base of the tongue presses like an operculum, but also of the mobile residual arytenoid and, at times, of the lateral walls of the pharynx. Thus a single dynamic unit is formed involving several structures and their synergism guarantees the neoglottic occlusion required for a speaking voice. In the present study, glottography gave no significant results. In phonation a rapid vibration of the neoglottid mucosa is obtained thus producing a phonetically valid acoustic phenomenon. However, this does not result in an electroglottographic recording of adduction. On the other hand, interesting data were recorded when comparing the morpho-functional aspects of the neoglottis with characteristics of the vibrating voice, as recorded by spectrography. Spectrographic tracings are markedly better in cases of valid occlusion of the glosso-pharyngeal-arytenoid unit and this may be achieved regardless of the mobility of the remaining arytenoid. It is thus clear that several patients with a fixed arytenoid, but having valid sphincteric action of the other structures (i.e. base of the tongue or pharynx), had excellent speech quality and intelligibility. Therefore, Labayle's surgery, which reconstructs a pharyngo-tracheal continuity and consequently restores natural breathing, makes speech continuity possible. Such subjects have mixed vocal output (periodic components together with noise) although, on the whole, the voice produced has the fundamental requirements for intelligibility (i.e. intensity, pitch, harmonic structure, emission time) and may thus be considered valid for interpersonal verbal communication.

Arytenoid Cartilage↗
PubMedDate not supplied

Porous hydroxylapatite-perichondrium graft in cricoid reconstruction.

Composite grafts of hydroxylapatite-perichondrium were used for reconstructing defects in the cricoid of young rabbits. The alloplastic material showed no signs of resorption; it was firmly attached to the surrounding tissues by ingrowing connective tissue; only a moderate foreign body reaction was observed. The perichondrium formed new cartilage around the hydroxylapatite.

Animals↗
PubMed1987

[Development of the larynx and trachea following division of the cricoid cartilage and segmental resection of the trachea in the growth stage. An animal experiment study].

Laminotomy as described by Réthi, and segmental tracheal resection with end-to-end anastomosis have proved useful in the adult for the treatment of stenoses of the larynx. In children, the question arises why these may interfere with the growth of the larynx and trachea. A vertical split of the cricoid cartilage followed by stabilization of the larynx by the temporary introduction of a Montgomery silicone T-tube was carried out on four kittens aged four to six weeks. A segmental tracheal resection with end-to-end anastomosis was performed on other animals of the same age. When the animals had stopped growing, the larynx and trachea were investigated both endoscopically and histologically. Following laminotomy the larynx underwent remodelling, resulting in an oval shape, the lumen being wide and the function of the vocal cords normal. Following segmental resection of the trachea, a circular stenosis was found, as a result of irregular growth of the sutured tracheal cartilages. In none of the animals, however were either functional disorders or respiratory distress to be observed. Thus, laminotomy or segmental resection of the trachea can be employed during the formative years without fear of clinically relevant growth disorders.

Age Factors↗