scholarly journals Onco-surgical significance of anatomomorhological specificity of glottic region of the larynx

2004 ◽  
Vol 51 (1) ◽  
pp. 13-16
Author(s):  
P. Stankovic ◽  
Vojko Djukic ◽  
Zeljko Petrovic ◽  
A. Mikic ◽  
Vladimir Djordjevic ◽  
...  
Keyword(s):  
Anterior Commissure ◽  
Thyroid Cartilage ◽  
Striated Muscles ◽  
Vocal Cords ◽  
Tumor Spread ◽  
Vocal Process ◽  
Cancer Spread ◽  
Medium Level ◽  
Elastic Cone ◽  
Staining Methods

Glottis is a medium level of the larynx, involving the vocal cords, vocal process of arytenoid cartilage, and the anterior and posterior commissures. This region of heterogeneous histomorhological structure has specific characteristics: the internal striated muscles, the outer and inner perichondrium, atypical intra-cartilaginous areas of ossification, and unusual muscular insertion to cartilage. Microtomy of 3 thick successive sections was performed at the level of the upper surface of vocal cords. Standard histological staining methods were used. Microphotographs were taken by light microscope under different magnification along with histomorphometric measurements. Cancer spread is partially restricted by anatomic barriers: vocal ligament and tendon of the anterior commissure, and subsequently by the elastic cone. Easier tumor extension may be due to absence of the internal perichondrium and ossification of thyroid cartilage. Microvascularization of the anterior commissure is significant for tumor spread in glottis and paraglottic space. The role of commissural lymph network in local spread of the cancer is completely vague. It is certain that there are causes, still unrecognized, which have an effect on the pathways and direction of malignant tumor spread.

An Anatomic Study of the External Laryngeal Framework with Surgical Implications

1992 ◽  
Vol 106 (3) ◽  
pp. 235-240 ◽  
Author(s):  
Lawrence Z. Meiteles ◽  
Pi-Tang Lin ◽  
Eugene J. Wenk
Keyword(s):  
Vocal Fold ◽  
Anterior Commissure ◽  
Thyroid Cartilage ◽  
Oblique Line ◽  
Type I ◽  
Anatomic Study ◽  
True Vocal Cord ◽  
Precise Knowledge ◽  
Human Cadavers ◽  
Superior Border

Precise knowledge of the level of the vocal fold as projected on the external thyroid cartilage is of critical importance for the performance of thyroplasty type I and supraglottic laryngectomy. Measurements of the external laryngeal framework were made on the larynges of 18 human cadavers in order to identify landmarks that will aid the surgeon in determining endolaryngeal anatomy. On the basis of our results, the following guidelines are recommended: (1) Thyroid cartilage incision for supra-glottic laryngectomy should be made on a line joining the juncture of the upper one third and lower two thirds of the midline length and the juncture of the upper one third and lower two thirds of the oblique line. This will ensure a position above the level of the anterior commissure and the true vocal cord; (2) In thyroplasty type I, the superior border of the thyroid cartilage window should be made at a line joining the midpoint of the midline length and the juncture of the upper two thirds and lower one third of the oblique line. Formation of the cartilage window according to this guideline will ensure its placement lateral to the vocalis muscle.

Effects of nasal positive-pressure hyperventilation on the glottis in normal awake subjects

1995 ◽  
Vol 79 (1) ◽  
pp. 176-185 ◽  
Author(s):  
V. Jounieaux ◽  
G. Aubert ◽  
M. Dury ◽  
P. Delguste ◽  
D. O. Rodenstein
Keyword(s):  
Tidal Volume ◽  
Positive Pressure Ventilation ◽  
Anterior Commissure ◽  
Minute Ventilation ◽  
Intermittent Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Vocal Cords ◽  
Diaphragmatic Muscle ◽  
Inspiratory Resistance ◽  
Cyclic Changes

We have recently observed obstructive apneas during nasal intermittent positive-pressure ventilation (nIPPV) and suggested that they were due to hypocapnia-induced glottic closure. To confirm this hypothesis, we studied seven healthy subjects and submitted them to nIPPV while their glottis was continuously monitored through a fiber-optic bronchoscope. During wakefulness, we measured breath by breath the widest inspiratory angle formed by the vocal cords at the anterior commissure along with several other indexes. Mechanical ventilation was progressively increased up to 30 l/min. In the absence of diaphragmatic activity, increases in delivered minute ventilation resulted in progressive narrowing of the vocal cords, with an increase in inspiratory resistance and a progressive reduction in the percentage of the delivered tidal volume effectively reaching the lungs. Adding CO2 to the inspired gas led to partial widening of the glottis in two of three subjects. Moreover, activation of the diaphragmatic muscle was always associated with a significant inspiratory abduction of the vocal cords. Sporadically, complete adduction of the vocal cords was directly responsible for obstructive laryngeal apneas and cyclic changes in the glottic aperture resulted in waxing and waning of tidal volume. We conclude that in awake humans passive ventilation with nIPPV results in vocal cord adduction that depends partly on hypocapnia, but our results suggest that other factors may also influence glottic width.

Simultaneous Malignant and Benign Nonepithelial Neoplasms of the Larynx—A Case Report and Literature Review

2020 ◽  
pp. 014556132092556
Author(s):  
Przemyslaw Krawczyk ◽  
Antoni Bruzgielewicz ◽  
Kazimierz Niemczyk
Keyword(s):  
Case Report ◽  
Benign Tumor ◽  
Malignant Tumors ◽  
Treatment Options ◽  
Thyroid Cartilage ◽  
Simultaneous Occurrence ◽  
Malignant Neoplasms ◽  
Tumor Localization ◽  
Striated Muscles ◽  
Histopathological Evaluation

Nonepithelial tumors of the larynx are relatively rare neoplasms of the head and neck. The chondrosarcoma, which develops commonly from cricoid and thyroid cartilage, stands for 0.2% of the laryngeal malignant neoplasms. The rhabdomyoma is even more uncommon benign tumor developing from the laryngeal striated muscles. The clinical manifestation and the treatment options depend on the histopathological evaluation, tumor localization, and its size. In presented case, the simultaneous occurrence of benign and malignant tumors of mesenchymal origin in the patient’s larynx was provoking hoarseness, globus sensation, and dysphagia. To the best of authors’ knowledge, no other case of the concomitance of rhabdomyoma and chondrosarcoma of the larynx have been reported in the literature.

scholarly journals Evaluation of transmitted glow point at a priori chosen depth (1 cm below vocal cords) for lightwand intubation: a prospective observational study

2020 ◽  
Vol 48 (12) ◽  
pp. 030006052097424
Author(s):  
Eunyoung Cho ◽  
Hyun-Chang Kim ◽  
Jung-Man Lee ◽  
Ji-Hoon Park ◽  
Najeong Ha ◽  
...  
Keyword(s):  
Observational Study ◽  
Confidence Interval ◽  
Success Rate ◽  
Prospective Observational Study ◽  
Cricoid Cartilage ◽  
A Priori ◽  
Thyroid Cartilage ◽  
Suprasternal Notch ◽  
Vocal Cords ◽  
Laryngeal Injury

Objective When performing lightwand intubation, an improper transmitted glow position before tube advancement can cause intubation failure or laryngeal injury. This study was performed to explore the transmitted glow point corresponding to a priori chosen depth for lightwand intubation. Methods Before lightwand intubation, we marked the transmitted glow point from a bronchoscope on the neck when it reached 1 cm below the vocal cords. Lightwand intubation was then performed using this marking point. The distances from the mark to the upper border of the thyroid cartilage, upper border of the cricoid cartilage, and suprasternal notch were measured. Results In total, 107 patients were enrolled. The success rate of lightwand intubation using the mark was 93.5% (95% confidence interval, 88.7%–99.2%) at the first attempt. The marking point was placed 12.0 mm (95% confidence interval, 10.6–13.4 mm) below the upper border of the cricoid cartilage. Conclusion Anaesthesiologists should be aware of the appropriate point of the transmitted glow on the patient’s neck when performing lightwand intubation. We suggest that this point is approximately 1 cm below the upper border of the cricoid cartilage. Trial registration: ClinicalTrials.gov NCT03480035

Thyroid cartilage invasion in early-stage squamous cell carcinoma involving the anterior commissure

Head & Neck ◽  
2011 ◽  
Vol 34 (10) ◽  
pp. 1476-1479 ◽  
Author(s):  
Dana M. Hartl ◽  
Guillaume Landry ◽  
Stéphane Hans ◽  
Patrick Marandas ◽  
Odile Casiraghi ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Early Stage ◽  
Anterior Commissure ◽  
Thyroid Cartilage ◽  
Cartilage Invasion

Office-Based Treatment of Laryngeal Papillomatosis with Percutaneous Injection of Cidofovir

2002 ◽  
Vol 126 (6) ◽  
pp. 642-648 ◽  
Author(s):  
Dinesh K. Chhetri ◽  
Joel H. Blumin ◽  
Nina L. Shapiro ◽  
Gerald S. Berke
Keyword(s):  
Laser Ablation ◽  
Direct Laryngoscopy ◽  
Retrospective Review ◽  
Anterior Commissure ◽  
Case Series ◽  
Adult Patients ◽  
Injection Technique ◽  
Laryngeal Papillomatosis ◽  
Vocal Cords ◽  
Percutaneous Injection

OBJECTIVE: Our aim was to report our experience with office-based treatment of severe laryngeal papillomatosis with percutaneous injection of cidofovir in a case series of 5 patients. STUDY DESIGN AND SETTING: We conducted a retrospective review of a case series in a tertiary academic care voice disorders clinic. Adult patients with papillomas of the vocal cords and anterior commissure received percutaneous injection using a point-touch technique. Clinical improvement or remission of the papillomatosis was noted. RESULTS: Before initiation of office treatments, patients required direct laryngoscopy and CO2 laser ablation of papillomas on average every 2.8 months. There were no complications related to the injection technique. During a treatment period of 7 to 16 months (mean 12 months), a significant reduction in the volume of papillomatosis was achieved in all patients. One patient received 2 treatments and another received 1 treatment in the operating room for final clearance of papillomas. CONCLUSION: Office-based treatment of adult patients with anterior laryngeal papillomatosis using percutaneous injection of cidofovir reduces the need for repeated direct laryngoscopy and laser ablation under general anesthesia. SIGNIFICANCE: Percutaneous injection treatment with cidofovir is a useful adjunct to direct laryngoscopy and laser ablation in the treatment of laryngeal papillomatosis.

Injection and Removal of Teflon for Unilateral Vocal Cord Paralysis

1992 ◽  
Vol 101 (1) ◽  
pp. 81-86 ◽  
Author(s):  
Herbert H. Dedo
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Thyroid Cartilage ◽  
Indirect Laryngoscopy ◽  
Air Leak ◽  
Vocal Cords ◽  
Laryngeal Framework Surgery ◽  
The Voice ◽  
Major Defect ◽  
Unilateral Vocal Cord Paralysis

For over 70 years, reinnervation attempts have been unsuccessful in restoring motion to paralyzed vocal cords, in spite of occasional claims to the contrary. Fortunately, the major defect of unilateral vocal cord paralysis, a soft and breathy voice, can be eliminated if the edge of the paralyzed vocal cord is moved to the midline. This permits the mobile vocal cord to adduct and therefore to vibrate firmly against the edge of the paralyzed vocal cord during phonation, eliminating the air leak between the vocal cords. Teflon injection of the paralyzed vocal cord does this effectively. It is accomplished most easily and reliably via indirect laryngoscopy under local anesthesia, so the effect on the voice can be monitored during the injection. Teflon can be easily removed from the vocal cord via direct laryngoscopy. The disadvantages of trying to medialize the edge of a paralyzed vocal cord via a window in the thyroid cartilage (laryngeal framework surgery) will be discussed.

scholarly journals Case Report: Ultrasound Guided Mucosal Fold Lateralization for Laryngeal Webs

2021 ◽  
Vol 8 ◽  
Author(s):  
Sohit Paul Kanotra
Keyword(s):  
Case Report ◽  
Recurrence Rate ◽  
Ultrasound Guidance ◽  
Anterior Commissure ◽  
High Recurrence Rate ◽  
Ultrasound Guided ◽  
Vocal Cords ◽  
Mucosal Flap ◽  
Mucosal Surfaces ◽  
Mucosal Fold

The surgical management of Laryngeal webs is challenging and is associated with a high recurrence rate due the presence of opposing raw mucosal surfaces of the vocal cords, especially near the anterior commissure which causes re-scarring. We describe an endoscopic technique of mucosal flap lateralization (MFL) with ultrasound guidance, which prevents the apposition of the anterior raw surfaces of the vocal cords after web incision, thus avoiding recurrence.

scholarly journals Relationship between the morphologic alterations of vocal cords from adult autopsies and the cause of death

2004 ◽  
Vol 59 (2) ◽  
pp. 63-66 ◽  
Author(s):  
Ana Karina Marques Salge ◽  
Eumenia Costa da Cunha Castro ◽  
Mara Lúcia Fonseca Ferraz ◽  
Marlene Antônia dos Reis ◽  
Vicente de Paula Antunes Teixeira
Keyword(s):  
Vocal Cord ◽  
Cause Of Death ◽  
Respiratory Diseases ◽  
Periodic Acid ◽  
Basal Membrane ◽  
Vocal Cords ◽  
Periodic Acid Schiff ◽  
White Ethnicity ◽  
Staining Methods ◽  
Hematoxylin Eosin

PURPOSE: The purpose of this study was to identify the possible alteration in the thickness of the epithelium basal membrane of the vocal cords and correlate it with the cause of death. METHOD: Larynxes collected from adult autopsies during the period of 1993 to 2001 were utilized. We used the hematoxylin-eosin and periodic acid-Schiff staining methods for the morphological and morphometric analysis. RESULTS: Sixty-six vocal cords were analysed; increased thickness was identified in 14 cases (21.2%), with equal proportions between the genders. Increased vocal-cord thickness was more frequent in patients of the white ethnicity (12 cases, 85.7%). Respiratory alterations were found in 10 (71.4%) of the cases with increased vocal-cord thickness. Of the patients that were maintained with mechanical ventilation before death, 7 (18.4%) had thickening of the basal membrane. Among the smokers, 9 (19.63%) had basal membrane thickening. CONCLUSION: No statistically significant differences were found between the cases in which the cause of death was related to respiratory diseases as compared to non-respiratory diseases and the thickening of the basal membrane of the vocal cords. However, new studies are needed in order to verify the etiopathogenesis of this thickening.

Midline Lateralization Thyroplasty for Adductor Spasmodic Dysphonia

2000 ◽  
Vol 109 (2) ◽  
pp. 187-193 ◽  
Author(s):  
Nobuhiko Isshiki ◽  
Yukiko Yamamoto ◽  
Domingos H. Tsuji ◽  
Yasukimi Iizuka
Keyword(s):  
Anterior Commissure ◽  
Thyroid Cartilage ◽  
Composite Graft ◽  
Spasmodic Dysphonia ◽  
Type Ii ◽  
Postoperative Course ◽  
Adductor Spasmodic Dysphonia ◽  
The Voice

Midline lateralization thyroplasty was successfully performed on a patient with adductor spasmodic dysphonia. The thyroid cartilage was incised at the midline, and a 3 × 2-mm perforation was made at the anterior commissure to widen it. The perforation was closed with a free composite graft taken from the upper edge of the thyroid ala, and the incised thyroid cartilage edges were kept separated 4 mm apart with silicone wedges. A part of the sternohyoid muscle was rotated to seal any leak from the perforation. The postoperative course was uneventful. The voice has been restored to normal, and there is no sign of recurrence of the symptom so far, as of 1 year 5 months postoperative. Although a longer follow-up is needed, this case indicates that midline type II thyroplasty could be a useful treatment for adductor spasmodic dysphonia.

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