ABSTRACT
OBJECTIVE: To perform laryngeal framework surgery for unilateral vocal fold paralysis and obtain favorable voice improvement, it is necessary to accurately determine the vocal fold and arytenoid cartilage positions. Thus, the position and angle of the paralyzed vocal folds and arytenoid cartilage projected onto the affected thyroid plate were measured using computed tomography (CT) before and after surgery. METHODS: Forty-six male patients with thyroid cartilage ossification observed on preoperative CT and vocal fold paralysis were included. Using Adobe Illustrator®, the thyroid plate on the affected side was reconstructed from the continuous images of the sagittal section of the CT examination during participant's quiet breathing (reconstructed affected thyroid plate [RATP]). RESULTS: The anterior commissure mean position was slightly cranial to the midpoint of the thyroid cartilage midline. The paralyzed vocal fold angle was not parallel to the baseline. The average unaffected vocal fold angle during vocalization projected onto the affected thyroid plate was 13.83°, which differed significantly from the average paralyzed vocal fold angle before surgery (19.05°). However, no significant difference was observed in comparison with the average angle of the paralyzed vocal fold after arytenoid adduction. The average distance from the inferior notch of the affected side thyroid cartilage to the affected arytenoid cartilage was 16.7 mm. CONCLUSION: By understanding the positional relationship between the thyroid cartilage plate and internal structure from preoperative CT images, more effective surgery can be performed according to individual differences. LEVEL OF EVIDENCE: IV Laryngoscope, 134:4088-4094, 2024.
Subject(s)
Thyroid Cartilage , Tomography, X-Ray Computed , Vocal Cord Paralysis , Vocal Cords , Humans , Male , Thyroid Cartilage/diagnostic imaging , Thyroid Cartilage/surgery , Vocal Cord Paralysis/surgery , Vocal Cord Paralysis/diagnostic imaging , Vocal Cord Paralysis/physiopathology , Vocal Cords/diagnostic imaging , Vocal Cords/surgery , Vocal Cords/physiopathology , Middle Aged , Adult , Aged , Arytenoid Cartilage/surgery , Arytenoid Cartilage/diagnostic imagingABSTRACT
Changes to the voice are prevalent and occur early in Parkinson's disease. Correlates of these voice changes on four-dimensional laryngeal computed-tomography imaging, such as the inter-arytenoid distance, are promising biomarkers of the disease's presence and severity. However, manual measurement of the inter-arytenoid distance is a laborious process, limiting its feasibility in large-scale research and clinical settings. Automated methods of measurement provide a solution. Here, we present a machine-learning module which determines the inter-arytenoid distance in an automated manner. We obtained automated inter-arytenoid distance readings on imaging from participants with Parkinson's disease as well as healthy controls, and then validated these against manually derived estimates. On a modified Bland-Altman analysis, we found a mean bias of 1.52 mm (95% limits of agreement -1.7 to 4.7 mm) between the automated and manual techniques, which improves to a mean bias of 0.52 mm (95% limits of agreement -1.9 to 2.9 mm) when variability due to differences in slice selection between the automated and manual methods are removed. Our results demonstrate that estimates of the inter-arytenoid distance with our automated machine-learning module are accurate, and represents a promising tool to be utilized in future work studying the laryngeal changes in Parkinson's disease.
Subject(s)
Arytenoid Cartilage , Larynx , Parkinson Disease , Humans , Arytenoid Cartilage/diagnostic imaging , Larynx/diagnostic imaging , Parkinson Disease/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: To differentiate arytenoid subluxation and vocal fold paralysis by CT cine mode scanning combined with three-dimensional (3D) reconstruction image. METHODS: Seventy-six patients with suspected vocal fold dyskinesia were collected. All patients were examined being asked to inhale deeply and then make "Yi" sound continuously during CT scanning with cine mode. The optimal maximum opening and minimum closing phases of glottis were selected and 3D reconstruction images were performed. The length of vocal fold, the width of glottis, and the subglottal convergence angle, anteversion angle, elevation angle, valgus angle, and varus angle of cricoarytenoid joints were measured. Vocal fold deformation was divided into three types: type I, type II, and type III. Kappa test was used to compare the consistency between CT diagnosis and clinical diagnosis. Single-factor analysis of variance was used to analyze the statistical differences among arytenoid subluxation, vocal fold paralysis, and normal vocal fold. RESULTS: There was high consistency between CT diagnosis and clinical diagnosis (k = 0.731, P < 0.05), as well as significant differences in the opening width of glottis between type I and type III, the valgus and varus angles of cricoarytenoid joints between type I and type II or type III, and the subglottal convergence angles among the three types of vocal fold deformation. CONCLUSIONS: CT scanning with cine mode combined with 3D reconstruction can display the changes of larynx structures in vocal fold dyskinesia, and can be used for the differential diagnosis of arytenoid cartilage subluxation and vocal fold paralysis.
Subject(s)
Dyskinesias , Joint Dislocations , Vocal Cord Paralysis , Humans , Arytenoid Cartilage/diagnostic imaging , Vocal Cords/diagnostic imaging , Four-Dimensional Computed Tomography , Diagnosis, Differential , Vocal Cord Paralysis/diagnostic imaging , Dyskinesias/diagnosisABSTRACT
OBJECTIVE: To determine whether arytenoid cartilage position and dynamics change with advancing duration and severity (as graded by MDS-UPDRS part III scores) in Parkinson's disease, in a cross-sectional study design, we performed laryngeal four-dimensional computed tomography (4D-CT) in people with Parkinson's disease and controls. METHODS: 31 people with Parkinson's disease covering a range of disease duration and severity and 19 controls underwent laryngeal 4D-CT whilst repeatedly vocalizing. We measured on each CT volume the glottic area (GA), inter-arytenoid distance (IAD), IAD-Area index (IAI) and arytenoid cartilage velocity ([Formula: see text]). RESULTS: People with Parkinson's disease had reductions in the mean/effective minimum IAD when compared to controls, while mean/effective minimum GA and mean/effective maximum IAI were increased. Arytenoid cartilage velocities showed no difference. On Spearman correlation analyses, advancing disease duration and severity of PD showed moderately strong and significant correlations with increasing mean/effective minimum GA, increasing mean/effective maximum IAI and decreasing effective minimum IAD. Linear mixed models which considered the effects of intra and inter-individual variation showed that both disease duration (b = -0.011, SEb = 0.053, 95% CI [-0.022, 0], t(27) = -2.10, p = 0.045) and severity (b = -0.069, SEb = 0.032, 95% CI [-0.14,-0.0039], t(27) = -2.17, p = 0.039) were significant predictors for IAD, and also for transformed values of the GA and IAI. CONCLUSIONS: There are progressive alterations in phonatory posturing as Parkinson's disease advances. The increases in GA despite reductions in IAD are concordant with prior observations of vocal fold bowing. Our study provides a basis for using laryngeal 4D-CT to assess disease progression in Parkinson's disease.
Subject(s)
Four-Dimensional Computed Tomography/methods , Parkinson Disease/diagnostic imaging , Vocal Cords/pathology , Aged , Arytenoid Cartilage/diagnostic imaging , Arytenoid Cartilage/pathology , Case-Control Studies , Cross-Sectional Studies , Disease Progression , Female , Humans , Male , Middle Aged , Parkinson Disease/pathology , Vocal Cords/diagnostic imagingABSTRACT
La laringe es un órgano impar situado en la línea mediana del cuello, compuesto por cartílagos, músculos y ligamentos. La TC y la RM se realizan como técnicas de imagen de primera elección en el estudio de la laringe, no obstante, no están exentas de limitaciones. La ecografía es un método accesible, de alta resolución y presenta una relativa buena visualización de las diferentes estructuras de la laringe. El objetivo del trabajo fue determinar las características de estructuras anatómicas de la laringe identificables ecográficamente. En este trabajo de carácter observacional descriptivo de corte transversal prospectivo se estudiaron 20 pacientes, sin patología laríngea con edades entre 20 y 35 años, ambos sexos. Se realizó ecografía laríngea utilizando transductor ecográfico Phillips® con sonda lineal de 4 a 12 MHz, preset de partes blandas.En todos los casos se pudo identificar y medir los cartílagos tiroides, cricoides y epiglotis; y en gran porcentaje de estos las cuerdas vocales, bandas ventriculares y comisura anterior. El cartílago aritenoides solo fue visible en un 85% de los casos.La ecografía se presenta como un método auxiliar útil en el estudio de la anatomía de la laringe, proponiendo el seguimiento y realización de estudios ulteriores que puedan complementar este estudio y su validez.
The larynx is an odd organ located in the midline of the neck, composed of cartilage, muscles and ligaments. CT and MRI are performed as first-choice imaging techniques in the larynx study; however, they are not without limitations. Ultrasound is an accessible, high-resolution method with a relatively good visualization of the different structures of the larynx. The objective of the work was to determine the characteristics of ultrasoundly identifiable larynx anatomical structures.In this prospective cross-sectional descriptive observational work, 20 patients were studied, without laryngeal pathology aged between 20 and 35 years, both sexes. Laryngeal ultrasound was performed using Phillips® ultrasound transducer with linear probe from 4 to 12 MHz, soft parts presetThyroid cartilage, cricoids and epiglotis could be identified and measured in all cases, and in a large percentage of these the vocal cords, ventricular bands and anterior corner. Aritenoid cartilage was only visible in 85% of cases.Ultrasound is presented as a useful auxiliary method in the study of the anatomy of the larynx, proposing the follow-up and conduct of further studies that may complement this study and its validity
Subject(s)
Humans , Male , Female , Adult , Young Adult , Larynx/anatomy & histology , Larynx/diagnostic imaging , Paraguay , Arytenoid Cartilage/anatomy & histology , Arytenoid Cartilage/diagnostic imaging , Thyroid Cartilage/anatomy & histology , Thyroid Cartilage/diagnostic imaging , Cross-Sectional Studies , Prospective Studies , Ultrasonography , Cricoid Cartilage/anatomy & histology , Cricoid Cartilage/diagnostic imagingABSTRACT
A 83-year-old man underwent thyroplasty with arytenoid adduction for right recurrent laryngeal nerve palsy 1 year ago. He had been suffering from hemosputum and cough for last 2 months, and was referred to our hospital for medical examination. Laryngoscopy and neck computed tomography showed subglottic nodule. No evidence of malignancy was noted by a transbronchial biopsy of subglottic nodule. Since subglottic nodule grew rapidly during 2 months observation period, subglottic nodule resection was performed by bronchoscope. Histopathologic examination revealed that the tumor was suture granuloma with no evidence of malignancy. Cervical abscess as a complication of subglottic suture granuloma resection was occurred, because of suture material for arytenoid adduction and the injury of mucous membrane for removing the granuloma with the fenestration of thyroid cartilage for thyroplasty.
Subject(s)
Laryngoplasty , Abscess/diagnostic imaging , Abscess/etiology , Abscess/surgery , Aged, 80 and over , Arytenoid Cartilage/diagnostic imaging , Arytenoid Cartilage/surgery , Granuloma , Humans , Male , SuturesABSTRACT
Advancements in thoracoscopic surgery have provided us with a deeper anatomical understanding of recurrent laryngeal nerve paralysis (RLNP), which is likely to occur after lymph node dissection. Taking a novel approach to researching the diagnosis of RLNP, we evaluated movement of the vocal cords and arytenoid cartilages using ultrasonography in patients who underwent thoracoscopic esophagectomy. RLNP occurred in six of the 24 patient cohort. The rate of hoarseness and difficulty in discharging sputum was significantly higher in the paralyzed group than in the non-paralyzed group. The diagnostic accuracy of RLNP by ultrasonography had a sensitivity of 83.3% (5/6), a specificity of 88.8% (16/18), a false positive rate of 5.6% (1/18), and a false negative rate of 0% (0/6). Although it is not completely accurate, our findings indicate that ultrasonography is quite effective for diagnosing RLNP, more so in combination with clinical symptoms. Ultrasonography may also be effective for identifying patients who are amenable to laryngoscopy for diagnosing RLNP, or for evaluating the recovery status of nerve paralysis.
Subject(s)
Esophagectomy , Vocal Cord Paralysis , Arytenoid Cartilage/diagnostic imaging , Esophagectomy/adverse effects , Humans , Recurrent Laryngeal Nerve/diagnostic imaging , Ultrasonography , Vocal Cord Paralysis/diagnostic imaging , Vocal Cord Paralysis/etiology , Vocal CordsABSTRACT
ABSTRACT: Osteoblastoma is a benign bone tumor with a slow growing and local aggressive nature. This tumor type is usually localized in the cervical vertebra and rarely involves laryngeal cartilage structures. Very few osteoblastoma cases have been reported in the literature. Here we present laryngeal osteoblastoma originating from arytenoid cartilage in a patient with a history of cordectomy due to glottic squamous cell carcinoma.
Subject(s)
Laryngeal Neoplasms , Larynx , Osteoblastoma , Arytenoid Cartilage/diagnostic imaging , Arytenoid Cartilage/surgery , Glottis , Humans , Laryngeal Neoplasms/diagnostic imaging , Laryngeal Neoplasms/surgery , Osteoblastoma/diagnostic imaging , Osteoblastoma/surgeryABSTRACT
Chondrosarcoma of the larynx is rare accounting for approximately 1% of laryngeal cancers; clear cell subtype is a rare variant. Given the low risk of occult nodal disease, they present a unique opportunity to maximise tissue preservation in order to optimise both recovery and long-term functional outcomes. We present a case of laryngeal clear cell chondrosarcoma causing critical airway obstruction. An emergency tracheostomy was performed and mapping biopsies were taken. The tumour originated from the cricoid and extended into both arytenoid superstructures precluding cricotracheal resection. A modified narrow-field laryngectomy was performed, preserving all pharyngeal mucosa and neurovascularly intact infrahyoids. Organ preservation surgery is preferred in the management of laryngeal chondrosarcoma. If laryngectomy is required, the surgeon must ensure that all uninvolved, functional tissue is preserved carefully to improve swallow and voice outcomes postoperatively. We describe a novel technique used to achieve this outcome.
Subject(s)
Airway Obstruction/etiology , Airway Obstruction/surgery , Chondrosarcoma/complications , Chondrosarcoma/surgery , Laryngeal Neoplasms/complications , Laryngeal Neoplasms/surgery , Airway Obstruction/diagnostic imaging , Arytenoid Cartilage/diagnostic imaging , Arytenoid Cartilage/surgery , Biopsy , Chondrosarcoma/diagnostic imaging , Cricoid Cartilage/diagnostic imaging , Cricoid Cartilage/surgery , Humans , Laryngeal Neoplasms/diagnostic imaging , Laryngectomy , Magnetic Resonance Imaging , Male , Middle Aged , Tomography, X-Ray Computed , TracheostomyABSTRACT
OBJECTIVES/HYPOTHESIS: Glottic stenosis is a discrete cause of airway compromise. We aimed to determine the surgical outcomes of transverse cordotomy with anteromedial arytenoidectomy (TCAMA), performed in the setting of isolated glottic stenosis resulting from two discrete etiologies: bilateral vocal fold paralysis (BVFP) and posterior glottic stenosis (PGS). STUDY DESIGN: Retrospective, analytic cohort study. METHODS: Twenty-six patients with isolated glottic stenosis were treated with TCAMA between 2006 and 2019. A retrospective analysis determined decannulation rates and intervals, voice outcomes, swallowing outcomes, and reoperation rates postoperatively. Outcomes between the two etiologic cohorts were compared. RESULTS: Of the 26 patients, 16/26 patients were diagnosed with PGS and 10/26 with BVFP. Eighteen patients required tracheotomies during their clinical course (11/16 PGS, and 7/10 BVFP), and 100% were ultimately decannulated. The PGS cohort required two-sided interventions more frequently than the BVFP cohort (45.5% vs. 0%, P = .066). Trach-dependent PGS patients required a longer time to achieve decannulation than BVFP patients by a factor of 2.38, although the difference was not statistically significant (102.3 days vs. 42.9 days, respectively, P = .113). Patients demonstrated a significant change in maximum phonation time but no statistically significant differences with preoperative versus postoperative voice outcomes like voice-related quality of life. All patients ultimately returned to their baseline swallow function postoperatively. CONCLUSION: TCAMA is an effective treatment for surgical rehabilitation of glottic stenosis caused by both BVFP and PGS. Patient-reported outcomes of postoperative vocal function remain consistent following surgical intervention. Additional, prospective studies with greater power are warranted to validate the contrasting outcomes observed when applying this discrete surgical technique across two distinct diagnostic cohorts in this retrospective study. LEVEL OF EVIDENCE: 4. Laryngoscope, 131:2305-2311, 2021.
Subject(s)
Arytenoid Cartilage/surgery , Constriction, Pathologic/surgery , Glottis/surgery , Laryngectomy/methods , Vocal Cord Paralysis/surgery , Adult , Aged , Arytenoid Cartilage/diagnostic imaging , Combined Modality Therapy/methods , Constriction, Pathologic/diagnosis , Constriction, Pathologic/etiology , Constriction, Pathologic/physiopathology , Deglutition/physiology , Female , Glottis/diagnostic imaging , Humans , Laryngoscopy/methods , Male , Middle Aged , Patient Reported Outcome Measures , Quality of Life , Reoperation/statistics & numerical data , Retrospective Studies , Stroboscopy/methods , Treatment Outcome , Vocal Cord Paralysis/diagnosis , Vocal Cord Paralysis/physiopathology , Voice Quality/physiologyABSTRACT
OBJECTIVE: This study aimed to investigate the treatment outcomes of arytenoid dislocation by a multidimensional evaluation. METHODS: From April 2010 to May 2018, the records of 57 patients with a history of arytenoid dislocation were reviewed. All the patients were treated with closed reduction under local anesthesia. Arytenoid motion, grade, roughness, breathiness, asthenia, strain, maximum phonation time, self-assessed Voice Handicap Index, and acoustic voice analysis were used to evaluate the clinical outcomes. RESULTS: Following closed reduction, 57 patients were divided into "recovered" (nâ¯=â¯24), "improved" (nâ¯=â¯15), and "ineffective" (nâ¯=â¯18) groups. There were no major complications resulting from surgical intervention. CONCLUSION: Closed reduction under local anesthesia continues to be an effective and well-tolerated method for treating arytenoid dislocation. The trichotomy of the treatment results of arytenoid dislocation by a multidimensional evaluation may be more accurate to evaluate the results of arytenoid dislocation.
Subject(s)
Joint Dislocations , Voice , Acoustics , Arytenoid Cartilage/diagnostic imaging , Arytenoid Cartilage/surgery , Humans , Joint Dislocations/diagnostic imaging , Joint Dislocations/surgery , Treatment OutcomeABSTRACT
Respiratory function in the horse can be severely compromised by arytenoid chondritis, or arytenoid chondropathy, a pathologic condition leading to deformity and dysfunction of the affected cartilage. Current treatment in cases unresponsive to medical management is removal of the cartilage, which can improve the airway obstruction, but predisposes the patient to other complications like tracheal penetration of oropharyngeal content and dynamic collapse of the now unsupported soft tissue lateral to the cartilage. A tissue engineering approach to reconstructing the arytenoid cartilage would represent a significant advantage in the management of arytenoid chondritis. In this study, we explored if decellularized matrix could potentially be incorporated into the high motion environment of the arytenoid cartilages of horses. Equine arytenoid cartilages were decellularized and a portion of the resultant acellular scaffolds was implanted in a full-thickness defect created in the arytenoids of eight horses. The implantation was performed bilaterally in each horse, with one side randomly selected to receive an implant seeded with autologous bone marrow-derived nucleated cells (BMNCs). Arytenoids structure and function were monitored up to 4 months. In vivo assessments included laryngeal ultrasound, and laryngeal endoscopy at rest and during exercise on a high-speed treadmill. Histologic evaluation of the arytenoids was performed postmortem. Implantation of the cartilaginous graft had no adverse effect on laryngeal respiratory function or swallowing, despite induction of a transient granuloma on the medial aspect of the arytenoids. Ultrasonographic monitoring detected a postoperative increase in the thickness and cross-sectional area of the arytenoid body that receded faster in the arytenoids not seeded with BMNCs. The explanted tissue showed epithelialization of the mucosal surface, integration of the implant into the native arytenoid, with minimal adverse cellular reaction. Remodeling of the scaffold material was evident by 2 months after implantation. Preseeding the scaffold with BMNCs increased the rate of scaffold degradation and incorporation. Replacement of arytenoid portion with a tissue-engineered cartilaginous graft preseeded with BMNCs is surgically feasible in the horse, is well tolerated, and results in appropriate integration within the native tissue, also preventing laryngeal tissue collapse during exercise.
Subject(s)
Cartilage Diseases , Larynx , Animals , Arytenoid Cartilage/diagnostic imaging , Arytenoid Cartilage/surgery , Horses , Larynx/surgery , Tissue Engineering , UltrasonographyABSTRACT
PURPOSE: To estimate the incidence of "innocent" arytenoid adduction asymmetry (AAA) among patients presenting at a laryngology clinic, identify its association with demographic characteristics, symptomatology and various clinical/pathological conditions and thereby determine its clinical significance. METHODS: A prospective comparative observational clinical study was conducted. Group 1 included patients presenting at the Department of Laryngology, identified with a primary diagnosis and coexisting "innocent" AAA i.e., an overriding arytenoid with normal vocal fold mobility on laryngoscopy. Group 2 included an equal number of randomly selected patients fulfilling the same criteria, without AAA. Demographic and clinical details were recorded and analyzed. RESULTS: 110 cases were included in each group. The incidence of innocent AAA was 12.7%. Males were predominant in both Groups, with the gender difference significant in Group 1. Patients in Group 1 were significantly younger than in Group 2. Professional voice users, namely singers, were significantly greater in Group 1. Symptoms associated with Group 1 (i.e. AAA) were high pitch strain while singing (p = 0.01) and unilateral throat pain (p = 0.01), and the associated diagnoses were Singing Voice Dysphonia (p = 0.005), Vocal Process Granuloma (p = 0.04) and Ventricular Band Dysphonia (p = 0.047). As a definitive diagnosis was made in all patients, the presenting complaints were not attributed to AAA. Right sided preponderance of AAA was significant. Among the diagnoses with a laterality (e.g. vocal process granuloma), AAA was observed contralateral to the pathology in 70.7% and ipsilaterally in 29.3% (p = 0.0058). CONCLUSION: Innocent AAA is common among males in the 3rd-4th decades, in singers among professional voice users, and in those with the muscle tension dysphonia spectrum and vocal process granuloma, thereby suggesting that it is an acquired habit/response to greater vocal demand. The observation of AAA contralateral to laryngeal lesions, highlights its compensatory nature, attempting to optimize glottic closure.
Subject(s)
Dysphonia , Voice Quality , Arytenoid Cartilage/diagnostic imaging , Dysphonia/surgery , Humans , Laryngoscopy , Male , Prospective StudiesSubject(s)
Arthritis, Rheumatoid/diagnostic imaging , Arytenoid Cartilage/diagnostic imaging , Cricoid Cartilage/diagnostic imaging , Laryngeal Edema/pathology , Aged , Antibodies, Monoclonal, Humanized/therapeutic use , Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , Arthritis, Rheumatoid/pathology , Arthritis, Rheumatoid/physiopathology , Female , Glucocorticoids/therapeutic use , Hoarseness/physiopathology , Humans , Laryngeal Edema/drug therapy , Laryngoscopy , Methotrexate/therapeutic use , Positron Emission Tomography Computed Tomography , Prednisolone/therapeutic use , Pyriform Sinus/pathologyABSTRACT
OBJECTIVE: To investigate the incidence of acute epiglottitis (AE) and the clinical features of patients with AE complicated by peritonsillar abscess (PTA), considering that PTA, especially inferior-type PTA, is often a comorbidity of AE. METHODS: We retrospectively reviewed the medical records of patients who were diagnosed as having AE by otolaryngologists and referred to our hospital between January 2009 and December 2017. All the patients underwent laryngeal endoscopy and contrast-enhanced computed tomography (CT) for examination of the severity of AE and its complications by other infections, including PTA. The clinical characteristics of patients with PTA were compared with those of patients without PTA. RESULTS: A total of 139 patients were enrolled, of whom 21 (15%) were found to have PTA. Among the 21 patients, only one had a superior-type PTA and the others had an inferior-type PTA. The patients with complicated AE by an inferior Cap-type PTA frequently showed unilateral arytenoid swelling. CONCLUSION: PTA is a comorbidity of AE, and unilateral arytenoid swelling is considered to suggest the presence of inferior-type PTA.
Subject(s)
Epiglottitis/complications , Peritonsillar Abscess/complications , Acute Disease , Adult , Arytenoid Cartilage/diagnostic imaging , Arytenoid Cartilage/pathology , Endoscopy , Epiglottitis/diagnosis , Female , Humans , Male , Peritonsillar Abscess/diagnosis , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
OBJECTIVES: To evaluate thyroid, arytenoid, and cricoid cartilage invasion on computed tomography (CT) imaging in patients undergoing total laryngectomy for both primary and recurrent laryngeal carcinoma. Secondary endpoint was to compare laryngeal cartilage invasion between primary and recurrent tumours. METHODS: Pre-treatment CT of 40 patients who had undergone total laryngectomy was retrospectively evaluated and compared with histology. Focal erosions of thyroid cartilage were accounted for neoplastic invasion of the inner cortex. Full-thickness thyroid cartilage invasion was defined as a tumour-like tissue replacing thyroid cartilage or extended in extra-laryngeal soft tissues. Sclerosis and erosion of arytenoid and cricoid cartilages were assessed as signs of neoplastic invasion. RESULTS: CT erosion showed perfect agreement for thyroid inner cortex and cricoid cartilage invasion and almost perfect agreement (87%) for arytenoid cartilage invasion. For tumours in contact with thyroid cartilages, the absence of CT erosion underestimated inner cortex infiltration. CT showed perfect agreement in predicting full-thickness thyroid cartilage invasion only in the case of extra-laryngeal neoplastic extension. Arytenoid sclerosis showed poor correlation with neoplastic invasion. For primary tumours, CT demonstrated good (inner cortex 75%; full-thickness 85%), substantial (67.5%), and perfect (100%) accuracy in thyroid, arytenoid, and cricoid cartilage invasion, respectively. No CT differences were observed between primary and recurrent laryngeal tumours. CONCLUSION: Tumour-like tissue extension in the extra-laryngeal soft tissues was accurate in predicting thyroid cartilage full-thickness invasion. Erosions of arytenoid, cricoid, and thyroid cartilages' inner cortex on CT were highly indicative of neoplastic infiltration. No CT difference in cartilage infiltration between primary and recurrent tumours was observed.
Subject(s)
Laryngeal Cartilages/diagnostic imaging , Laryngeal Neoplasms/diagnostic imaging , Multidetector Computed Tomography/methods , Neoplasm Recurrence, Local/diagnostic imaging , Aged , Aged, 80 and over , Arytenoid Cartilage/diagnostic imaging , Arytenoid Cartilage/pathology , Contrast Media/administration & dosage , Cricoid Cartilage/diagnostic imaging , Cricoid Cartilage/pathology , Female , Humans , Iohexol/administration & dosage , Iohexol/analogs & derivatives , Laryngeal Cartilages/pathology , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/surgery , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Recurrence, Local/pathology , Retrospective Studies , Sensitivity and Specificity , Thyroid Cartilage/diagnostic imaging , Thyroid Cartilage/pathologyABSTRACT
PURPOSE: To review the current management of arytenoid subluxation/dislocation (AS/AD) focusing on diagnostic, therapeutic, and prognostic controversies. METHODS: The international literature of the last 20 years has been considered. After the application of inclusion criteria, 20 studies were selected (471 AS/AD cases in total). RESULTS: All the included investigations were retrospective case series. AS/AD was often iatrogenic occurring at least in 0.01% of patients undergone endo-tracheal intubation. The most common symptom was persistent hoarseness. The diagnosis was made by video-laryngoscopy and neck computed tomography in most reports, while some used also laryngeal electromyography. Laryngeal electromyography was fundamental to rule out unilateral vocal fold paralysis, the main differential diagnosis. The surgical relocation of AS/AD under general or local anesthesia was achieved in about 80% of patients. CONCLUSION: AS/AD is a mechanical disorder of the larynx that can be successfully treated if promptly diagnosed. Clinical trials and multi-centric studies are necessary to set management guidelines.
Subject(s)
Larynx , Vocal Cord Paralysis , Arytenoid Cartilage/diagnostic imaging , Arytenoid Cartilage/surgery , Hoarseness , Humans , Laryngoscopy , Retrospective Studies , Vocal Cord Paralysis/diagnostic imaging , Vocal Cord Paralysis/etiologyABSTRACT
OBJECTIVE: To investigate the feasibility of dynamic computed tomography in recording and describing the spatial motion characteristics of the arytenoid cartilage. METHODS: Dynamic computed tomography recorded the real-time motion trajectory of the arytenoid cartilage during inspiration and phonation. A stationary coordinate system was established with the cricoid cartilage as a reference and a motion coordinate system was established using the movement of the arytenoid cartilage. The Euler angles of the arytenoid cartilage movement were calculated by transformation of the two coordinate systems, and the spatial motion characteristics of the arytenoid cartilage were quantitatively studied. RESULTS: Displacement of the cricoid cartilage was primarily inferior during inspiration. During phonation, the displacement was mainly superior. When the glottis closed, the superior displacement was about 5-8 mm within 0.56 s. During inspiration, the arytenoid cartilage was displaced superiorly approximately 1-2 mm each 0.56 s. The rotation angle was subtle with slight rotation around the XYZ axis, with a range of 5-10 degrees. During phonation, the displacement of the arytenoid cartilage was mainly inferior (about 4-6 mm), anterior (about 2-4 mm) and medial (about 1-2 mm). The motion of the arytenoid cartilage mainly consisted of medial rolling, and there was an alternating movement of anterior-posterior tilting. The arytenoid cartilage rolled medially (about 20-40 degrees within 0.56 s), accompanied by anterior-posterior tilting (about 15-20 degrees within 0.56 s). CONCLUSION: Dynamic computed tomography recordings of arytenoid cartilage movement can be combined with Euler transformations as a tool to study the spatial characteristics of laryngeal structures during phonation. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:E646-E653, 2020.
Subject(s)
Arytenoid Cartilage/diagnostic imaging , Cricoid Cartilage/diagnostic imaging , Tomography, X-Ray Computed/methods , Arytenoid Cartilage/physiology , Calibration , Cricoid Cartilage/physiology , Feasibility Studies , Female , Glottis/diagnostic imaging , Glottis/physiopathology , Humans , Larynx/diagnostic imaging , Larynx/physiology , Male , Medical Illustration , Middle Aged , Motion , Phonation/physiology , RotationABSTRACT
OBJECTIVES/HYPOTHESIS: Medialization thyroplasty (MT) has become a prominent method for treating glottal insufficiency. This study aimed to visualize the biomechanical influence of a medialization implant on arytenoid cartilage, particularly on the length and level of paralyzation in the vocal fold, in patients with unilateral vocal fold paralysis. STUDY DESIGN: Prospective study. METHODS: We recruited 15 patients (10 men, 5 women) with unilateral vocal fold paralysis that underwent MT with a Montgomery® thyroplasty implant. We performed high-resolution computed tomography of the arytenoid cartilage before and after MT and analyzed the three-dimensional images. To visualize the movement of the arytenoid and to measure the lengthening of the vocal fold, we superimposed pre- and postoperative 3D images with MIMICS software. RESULTS: On the affected side, the implant pushed the arytenoid backwards. In addition, the vocal process of the arytenoid was inwardly rotated. These movements resulted in an elongated, augmented vocal fold on the affected side. CONCLUSION: MT led to an elongated, medialized vocal fold on the treated side. After the intervention, the vocal folds on both sides were the same length in the phonatory position.