Clinical anatomy of superior laryngeal artery via transoral approach.

Objective: Hemorrhage is the most common complication caused by transoral laryngopharyngeal surgery. It is believed that proper management of the superior laryngeal artery (SLA), the main feeding artery for the larynx and pharynx, may reduce intra- and postoperative hemorrhage incidence. The aim of this study was to illustrate the anatomy of the SLA via transoral endoscopic approach. Methods: Fourteen sides of SLA from heads of seven fresh-frozen and silicone-injected cadavers were dissected. Transoral dissections were performed for the intra-laryngeal segment of SLA, and transcervical dissections were performed to confirm the anatomical measurements. Results: SLA had a slightly descending course from the origin to the larynx, and there was a major branch supplying the epiglottis, named pharyngo-epiglottic artery (PEA). Parallel with the internal superior laryngeal nerve (ISLN), SLA passed through the thyrohyoid membrane and ended into the hypopharynx. The distance from SLA to the superior horn of thyroid cartilage (SHTC) was (9.11 ± 0.58)mm on the left and (9.01 ± 0.37)mm on the right; the distance from SLA to the inferior margin of the hyoid bone (IMHB) was (2.00 ± 0.11)mm on the left and (1.95 ± 0.08)mm on the right; the distance from SLA to ISLN was (5.98 ± 0.48)mm on the left and (5.78 ± 0.36)mm on the right. No significant difference was found between bilateral sides (p > 0.05). Moreover, the distance from SLA to superior margin of thyroid cartilage (SMTC) was (5.52 ± 0.24)mm on the left and (5.80 ± 0.15)mm on the right. A significant difference was also found between bilateral sides (p = 0.03), which might suggest the SLA is located further from the SMTC on the right side. Conclusion: SHTC, SMTC, and IMHB could be regarded as anatomical landmarks to locate SLA when applying a transoral approach. Moreover, a complete understanding of the detailed anatomy of the superior laryngeal artery may improve the detection of hemostasis in transoral laryngeal or hypo-pharyngeal surgery.

Clinical Effects of Radiofrequency Coblation for Adult Laryngopharyngeal Vascular Lesions.

OBJECTIVE: To explore the feasibility and efficacy of transoral radiofrequency coblation surgery (TRS) in the treatment of adult laryngopharyngeal vascular lesion (LVL). METHODS: A total of 15 patients with LVL were retrospectively studied, including 11 capillary lesions and five cavernous lesions (there was one case with two separate lesions). All of the lesions were treated with TRS alone (capillary lesion) or with a combination of TRS and sclerotherapy (cavernous lesion). The treatment efficacy was evaluated according to the modified Achauer criteria: grade 1, no change in size; grade 2, a decrease of < 50% in size; grade 3, a decrease of ≥ 50% but < 100%; and grade 4, the disappearance of the lesion with no recurrence for at least 6 months. RESULTS: The surgical procedures were successfully completed in all patients. According to the modified Achauer criteria, the treatment outcomes were grade 4 for 10 capillary lesions and one cavernous lesion; grade 3 for one capillary lesion and one cavernous lesion; grade 2 for one cavernous lesion; and grade 1 for two cavernous lesions, respectively. No complications related to the surgery, including bleeding, dysphagia, and infections, occurred after treatment. CONCLUSION: The TRS is an effective treatment option for LVL, especially for patients with laryngopharyngeal capillary lesions. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:566-570, 2021.

Knowledge of laryngopharyngeal reflux disease among otolaryngologists in 3A hospitals in Beijing.

OBJECTIVE: This study aimed to evaluate knowledge of laryngopharyngeal reflux disease (LPRD) among otolaryngologists in 3A hospitals in Beijing. METHODS: A cross-sectional questionnaire survey of LPRD knowledge was conducted with otolaryngologists in 40 3A hospitals in Beijing. A response rate of <80% was obtained from one hospital, so data from 331 valid questionnaires from the other 39 hospitals were analysed. RESULTS: The most common source of LPRD knowledge was academic lectures (80.1%). The most commonly known risk factors, symptoms, clinical signs and associated diseases were unhealthy eating habits (49.2%), foreign body sensation in the pharynx (71.0%), hyperaemia (42.3%) and pharyngolaryngitis (63.7%), respectively. Only 57.7% of otolaryngologists knew about 24-hour pH monitoring as a gold standard diagnostic test for LPRD. The most commonly known treatment option was medication (93.1%). Most physicians (86.7%) had made a clinical diagnosis of LPRD; however, only 59.9% of them had followed up the treatment outcomes. The most common treatment provided was medication (82.6%). CONCLUSIONS: Knowledge of LPRD among otolaryngologists in 3A hospitals in Beijing was insufficient. Educational programs are needed to increase the knowledge of LPRD among otolaryngologists.