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[Coloboma cartilaginis thyreoideae].
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Intralaryngeal arytenoidectomy. A report of six cases.
Six cases of bilateral abductor palsy with stridor are presented. Following unilateral intralaryngeal arytenoidectomy, four had adequate airways and reasonable voices. Two required bilateral arytenoidectomy, one acquired an adequate airway at the expense of a weakened voice, and the other still requires a tracheostomy. There was only one minor complication. Decannulation and discharge from hospital were usually rapid.
[The execution of the modified Thornell operation].
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Cricoarytenoid arthritis as a cause of acute upper airway obstruction.
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[Measurements, form and form variants of the thyroid and cricoid cartilages].
Different measurements of the height and oblique landmarks are given. There are included the shape of the tubercula and the distances to landmarks and the cornua. On the cricoid cartilage, there are measured the height of arcus and lamina and its antero-posterior length, also the distances to the inferior horn, the inferior tubercle, and the inferior-anterior border of the thyroid cartilage.
Surgical alteration of the vocal pitch.
Vocal pitch can be changed surgically without distorting the vocal quality. It can effectively be lowered by thyroplasty III, that is anteroposterior shortening of the thyroid ala by vertical strip excision of the cartilage. The pitch lowering was dramatic in six, but fair in three where the vocal cords were atrophic or scarred. Vocal pitch can be elevated by various surgical techniques: 1) cricothyroid approximation, 2) A-P expansion of the thyroid ala, 3) longitudinal incisions in the cords, 4) intrachondral injection of the steroid, and 5) evaporation of the cords by CO2 laser. Cricothyroid approximation, performed on 11 patients, generally produced substantial rise in pitch, which was limited, however, when the cords were very thick. The intrachordal surgeries, 3-5, should be performed conservatively, because it may interfere with the vocal cord vibration.
Diagnosis and therapy for acute laryngeal and tracheal trauma.
A laryngeal fracture should be suspected when there is hemoptysis and subcutaneous emphysema following blunt injury to the neck. Computed tomography of the neck should be used to define the extent of the injury. Cervical vertebral fractures and dislocations, perforation of the pharynx and esophagus, and vascular injuries must be excluded. Establishment of a secure airway by tracheotomy, avoidance of flexion or extension of the neck until cervical vertebral injuries are excluded, and evaluation for recurrent laryngeal paralysis are of great importance. The repair of the fractured larynx requires prompt repair of lacerations of the mucous membrane, reduction of cartilaginous fractures, and internal splinting for six weeks. Anastomosis of the transected trachea is carried out prior to repair of the recurrent laryngeal nerve injury. Although suturing of the transected nerve is controversial, there is general agreement that implantation of the avulsed recurrent laryngeal nerve in the posterior cricoarytenoid muscle is appropriate.
[Asymptomatic crico-arytenoid arthritis].
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[Sequestration of the arytenoid cartilage in sheep (author's transl)].
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[Significance of the circumferential involvement of the superior horn tip of the thyroid cartilage in pharyngo-laryngeal cancer].
UNLABELLED: The term "laryngopharyngeal carcinoma" indicates an advanced tumor involving both the supraglottic larynx and the pharynx in which the lesion origin may be difficult to assess. In 1981, Larsson et al. reported on the CT signs useful to distinguish the laryngeal/hypopharyngeal origin of advanced laryngopharyngeal carcinoma. We describe a new CT sign which may serve this purpose, namely the involvement of the thyroid cartilage superior horn tip. The thyroid cartilage superior horn, in fact, is involved early in the lesions originating in the pyriform sinus because of its close anatomic relationship with the posterolateral wall of the hypopharynx. MATERIALS AND METHODS. To assess the significance and specificity of this sign, we examined 15 patients with advanced laryngopharyngeal carcinoma with clinical, endoscopic and surgical evidence suggestive of tumors originating in the pyriform sinus. All CT examinations were performed with contiguous 4 mm slices before and after i.v. administration of iodinated contrast agents. Eighteen patients with surgically confirmed advanced supraglottic carcinoma were also examined. RESULTS: The thyroid cartilage superior horn tip was involved only in 3/18 supraglottic carcinoma patients; transcommissural infiltration of the larynx, involving both pyriform sinuses, was found in 2 of these cases and extensive invasion of the whole thyroid cartilage and of the cricoid ring in 1 case. CONCLUSIONS: The thyroid cartilage superior horn tip is a reliable sign of the pyriform sinus origin of advanced laryngopharyngeal cancer which is both sensitive (100%) and specific (83%). Moreover, this sign could play a major role because it represents, in most cases, the only and earliest sign of cartilage involvement. Finally, the encasement of the thyroid cartilage superior horn tip by abnormal tissue indicates tumor spread beyond the posterior pharyngeal wall. Therefore, these data can be very important for its early detection and useful for subsequent surgical planning.
PULMONARY FUNCTION BEFORE AND AFTER ARYTENOIDECTOMY.
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CRICO-PHARYNGEAL ACHALASIA.
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[Modifications of the technic of endolaryngeal extirpation. The author's own functional technic of laryngectomy].
A brief summary of the original technique will be made incorporating the following modifications and additions: glottis substituted by neoglottis muscles, sternohyoid or external perichondrium. Supraglottis substituted by remaining tissues of the epiglottis or neoepiglottis. Hypopharynx, section medium line of the pharynx constrictor. Suturing of cartilage with homologous donor cartilage. An evaluation will be made of the functional results.
NEUROPHYSIOLOGIC OBSERVATIONS OF NORMAL DEGLUTITION. II. ITS RELATIONSHIP TO ALLIED PHENOMENA.
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[Projection of vocal cord ligaments to thyroid cartilage in man].
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FRACTURES OF THE LARYNX.
It is advised that in significant laryngeal trauma open exploration be done as soon as the general condition of the patient permits. The authors believe that the exact nature and severity of a laryngeal injury cannot otherwise be known, and that no method of closed reduction and fixation will accomplish as good results as open repair. Conservative expectant treatment will in many cases result in a much greater morbidity and a poor ultimate result.