Surgical and Functional Outcome After Endoscopic Resection Via Transthyrohyoid for Early Glottic Cancer.

Transthyrohyoid access to the larynx for endoscopic resection (TTER) for early-stage glottic cancer in patients with difficult laryngeal exposure (DLE) has recently been developed. However, little is known about the postoperative conditions of patients. Twelve early-stage glottic cancer patients with DLE who received TTER were retrospectively reviewed. Clinical information was collected during the perioperative period. Functional outcome was evaluated using Voice Handicap Index-10 (VHI-10) and Eating Assessment Tool-10 (EAT-10) preoperatively and 12 months after surgery. None of the patients experienced serious complications after TTER. The tracheotomy tube was removed in all patients. The 3-year local control rate was 91.6%. The VHI-10 score decreased from 18.92 to 11.75 (p < .001), and the EAT-10 scores of the 3 patients changed slightly. Thus, TTER may be a good option for early-stage glottic cancer patients with DLE.

The Thermal Damage of Canine Vocal Fold by CO2 Laser Under Different Laser Emission Mode.

OBJECTIVE: The purpose of this study is to review the differences between continuous wave (CW) and UltraPulse (UP) on thermal damage of the laser with different power. METHODS: Four adult beagle dogs underwent transoral laser microsurgery (TLM) using CO2 laser. The laser emission mode and power was CW (3 W, 5 W, and 8 W) and UP (3 W and 5 W), respectively. The tissue from 4 animals was evaluated histologically on postoperative days 1 and 3. The thermal damage of the laser was measured using slide scan system via SlideViewer version 1.5.5.2 software. RESULTS: All dogs underwent TLM uneventfully. Under microscope examined, the laser damage area was composed of 2 parts: the vaporized zone (VPZ) and thermal damage area. The thermal damage area can be divided into thermal coagulative necrosis area (TCN) and hydropic degeneration area. The width of VPZ and TCN in UP mode was less than that in CW mode (P < .01). The data indicate that lower laser power created less thermal damage (P < .01). In addition, the width of VPZ on postoperative day 3 was less than that on postoperative day 1 (P < .01). CONCLUSION: CO2 laser with UP and lower power could decrease the laser thermal damage and may offer more prompt wound healing.

Tracheal rupture after vocal cord polyp resection: A case report.

INTRODUCTION: Transoral laser microsurgery (TLM) is one of the most common operations performed for glottic lesions. Several protection measures are taken to prevent tracheal damage. However, some protection measures and common postoperative complications may still cause delayed tracheal rupture in certain situations. Cases of tracheal rupture after surgery are extremely rare, and there are no previous reports of TLM of the glottis causing tracheal rupture. PATIENT CONCERNS: A middle-aged woman who underwent TLM for bilateral vocal cord polyps developed sudden neck pain, followed by cough and subcutaneous emphysema. DIAGNOSIS: She underwent head, neck, and chest computed tomography (CT), which revealed a 4-cm membranous tracheal tear located 4.5 cm distal to the glottis, pneumomediastinum, and subcutaneous emphysema extending from the base of skull to the chest. INTERVENTIONS: The patient underwent an emergency surgical surgical chest exploration and tracheal repair. OUTCOMES: One month after the surgery, the patient fully recovered with no tracheal stenosis or respiratory dysfunction. CONCLUSIONS: Conventional protective measures and common postoperative complications of TLM may also cause tracheal rupture.

Development and Validation of a Low-Cost and Simple Simulator for Microlaryngeal Surgery.

OBJECTIVES: The simulation of microlaryngeal skills is rarely seen in surgical training, but it is particularly important in phonomicrosurgery. This study described and validated the laryngeal surgical simulator through surgical training. METHODS: A simple and low-cost simulator was developed for the fixation of the suspension laryngoscope and porcine larynges. Twenty participants with work skills and experience did preparation before training, and performed suture and carbon dioxide (CO2) laser cordectomy for simulator evaluation. The results were proposed by the aspects of time taken for each procedure, the global rating scale, a procedure-specific assessment, and a post-simulation questionnaire. RESULTS: All participants completed the preparation within 9 minutes and reached the conclusion that the microlaryngeal surgical simulator was helpful in improving their surgical skills. The performance of experts was superior to that of novices in both suture and CO2 laser cordectomy. CONCLUSION: This simulator could be easily assembled and was successfully validated by microlaryngeal surgical training both subjectively and objectively. It may be helpful to clinicians in microlaryngeal skills.

Comparative Anatomy of Pig Arytenoid Cartilage and Human Arytenoid Cartilage.

OBJECTIVE: This study aims to investigate the feasibility of pig arytenoid cartilage as an animal model for simulating arytenoidectomy under microlaryngoscope by comparing the similarities and differences between pig arytenoid cartilage and human arytenoid cartilage. STUDY DESIGN: This is a methodological study on the excised pig arytenoid cartilage and human arytenoid cartilage. METHODS: Five excised human adult cadaver larynges and five adult excised porcine larynges were dissected and all the soft tissue and mucous membrane attached to the arytenoid and cricoarytenoid joint were removed. The anatomical structure and morphology of the arytenoid cartilage were observed and measured with a vernier caliper. Measurements included cricoarytenoid articular facet major and minor diameter, cricoarytenoid articular facet center distance, cricoarytenoid facet major and minor diameter, length of vocal process and muscular process, and distance between tip of vocal process, muscular process, and junction/apex of arytenoid cartilage. Data were then compared across these major anatomic markers using student t test. RESULTS: The gross anatomy of the pig arytenoid cartilage was similar to the human. However, the size of the pig larynx arytenoid cartilage was obviously larger in total, and there was statistical significance for almost all measurements (P < 0.05), except the mean value of cricoarytenoid articular facet center distance, the cricoarytenoid facet minor diameter, and the length of vocal process of pig and human, without statistically significant difference (P > 0.05). Moreover, the biggest differences between the pig arytenoid cartilage and the human arytenoid cartilage were that the pig arytenoid cartilage apex had the angle winding structure toward the back, and that the posterior part of the bilateral arytenoid cartilages was partially connected. Whereas after the angle winding was removed from the junction, pig arytenoid cartilage and human arytenoid cartilage were shaped both like a triangular pyramid. CONCLUSION: The data of this metric comparative study indicate that pig arytenoid, after resecting the angle winding structure and incising the interarytenoid cartilage, is similar to the human's. Therefore, pig larynx is an appropriate experimental model for endoscopic arytenoidectomy. In addition, regarding the pig laryngeal angle winding structure, we still require further basic and clinical research to clarify its physiological function and significance.

G protein-coupled estrogen receptor 1 expression in human vocal fold.

OBJECTIVES/HYPOTHESIS: Besides the classical sexual receptors, the expression of a recently clarified transmembrane G protein-coupled receptor (GPR30) has not been reported in the vocal fold so far. We aimed to study whether GPR30 is expressed in the human vocal fold. STUDY DESIGN: Experimental study using pathologic human vocal fold tissues. METHODS: Reverse-transcription polymerase chain reaction and immunohistochemistry were used to detect the GPR30 expression in a total of 83 vocal fold samples. RESULTS: A total of 66% of the specimens tested were GPR30 mRNA positive, and 54% of the sections were revealed to be GPR30 immunostaining positive in the plasma membrane as well as the nucleus in the epithelial cells. CONCLUSIONS: The GPR30 expression both in mRNA and protein level could be detected in the human vocal fold.

A pilot study of macrophage responses to silk fibroin particles.

Silk fibroin (SF) shows promise for tissue engineering and other biomedical applications due to its excellent biocompatibility, unique biomechanical properties, and controllable biodegradability. The particulate form of SF materials may have many potential uses, including the use as a filler for tissue defects or as a controlled-release agent for drug delivery. However, many past in vivo and in vitro studies evaluating the biocompatibility and biodegradability of SF have involved bulk implants. It is essential to evaluate the inflammatory effects of SF particles before further use. In this study, two different sizes of SF particles were evaluated to assess their impact on the release of tumor necrosis factor (TNF)-α, interleukin (IL)-1ß, and IL-6, in comparison with lipopolysaccharide positive control stimulation. The inflammatory processes were characterized using real-time reverse transcription polymerase chain reaction, enzyme-linked immunosorbent assay, and light microscopy evaluations. The results indicated that small silk fibroin particles and large silk fibroin particles, in culture with RAW 264.7 murine macrophage cells for 24 h, caused up-regulation of mRNA coding for TNF-α, which indicated that both size of particles have potential inflammatory effects. There was a statistically significant increase in this up-regulation under small silk fibroin stimulation. However, the immunosorbent assay suggested that there was virtually no observed release of IL-1ß, IL-6, or TNF-α, relative to the control group. The results suggest that SF particles of the chosen dimensions may have good biocompatibility in culture with RAW 264.7 murine macrophages.

[Reconstruction of tissue defects in external nose].

OBJECTIVE: To discuss and sum up the methods and experience of aesthetic reconstruction of tissue defects in external nose. METHOD: By respective repair based on aesthetic subunits principle of the nose proposed by Yotsuyanagi et al, 47 tissue defects in external nose were reconstructed using random flap of nasolabial groove, local rhomboid flap, the insular skin flap of forehead,the insular skin flap of nasolabial groove with retrograde facial artery and forearm flap with pedicle etc. RESULT: Satisfactory resconstructive effects were obtained in all cases. CONCLUSION: Good aesthetic result can be achieved using local flaps or forearm flap with pedicle.