A dissection based study of the dimensions of the thyroid cartilage in Anatolian population

Objective To measure anatomic data related to the thyroid cartilage and cricoid cartilage and to analyze their implications for anterior spine surgery. Methods From January 2015 to February 2017, Cervical spine CT image data of 309 normal adults (195 males, 114 females) in our department were retrospectively analyzed. The transverse diameters of the thyroid cartilage and the cricoid cartilage was measured at three different levels as follows: the superior border of the thyroid cartilage(SBTC), the inferior border of the thyroid cartilage(IBTC), and the inferior border of the cricoid cartilage(IBCC). At those levels, the corresponding level and transverse diameter of the cervical vertebra or intervertebral disc were also determined. Differences of anatomic parameters for each gender and level, and the relationship between the transverse diameter and height and weight were analyzed. Results The transverse diameters of the thyroid cartilage or cricoid cartilage and the corresponding cervical vertebra or intervertebral disc were associated significantly with height and weight. The transverse diameters of the thyroid cartilage or cricoid cartilage gradually decreased from the level of SBTC (44.30±4.97 mm) to the level of IBTC (41.39±4.62 mm), and the latter to the level of IBCC (26.36±3.79 mm), but increased from the level of SBTC (27.47±2.66 mm) to the level of IBTC(29.00±3.15 mm), and the latter to the level of IBCC (31.48±3.49 mm) for the cervical vertebra or intervertebral disc. Differences of the transverse diameters of the thyroid cartilage or cricoid cartilage and the cervical vertebra or intervertebral disc on three levels had statistical significance. The transverse diameters of each level had individual differences, while men were greater than those for women. The thyroid cartilage was routinely located above the C5 (56.9% for male, 86.0% for female). Differences of the frequency between men and women on three levels had statistical significance. Conclusion The Individual and sex differences in the location of the thyroid cartilage and the size of the thyroid cartilage and the cricoid cartilage provided anatomical basis for predicting the difficulty of intraoperative exposure, incidence of esophageal injuries and early postoperative dysphagia. Key words: Thyroid cartilage; Cricoid cartilage; Anatomy, regional; Spinal fusion; Deglutition disorders

Objective To provide anatomical basis for clinical esophageal cancer surgery protect the recurrent laryngeal nerve.Methods 40 formalin-fixed adult cadavers,anatomical observation of the shape of the recurrent laryngeal nerve and its branches,running way,departments and diameter of the recurrent laryngeal nerve,recurrent laryngeal nerve ministries to adjacent anatomical landmarks distance.Results (1) the recurrent laryngeal nerve (RLN) in the tracheoesophageal groove upstream vertical upward,inward from the outside on the oblique and irregular in shape,the recurrent laryngeal nerve branch shape stem-like or loop-like; (2) the RLN ministries (the starting point,The first branch point,into the tracheoesophageal groove point,into the larynx point) diameter,the left side of (2.29 ± 0.91) mm,(0.98 ± 0.60) ram,(1.49 ±0.57) mm,(1.27±0.53) mm; the right side of(1.89±0.72) mm,(0.96±0.50) mm,(1.56±0.61) mm,(1.23±0.58) mm; (3) left and right RLN ministries to adjacent anatomical landmarks (the esophageal central line,the jugular notch,the ipsilateral venous angle,the prominentia laryngea,the inferior horn of thyroid cartilage) the distance is not the same; (4) the RLN starting point to the point into the throat,the distance of the subclavian artery and have their own characteristics,point into the throat to ipsilateral venous angle left and right,respectively (40.17 ± 6.58) mm and (43.11 ±7.06)mm.Conclusion Esophageal cancer surgery should be carefully observed,and mastery of the recurrent laryngeal nerve anatomy is important to reduce iatrogenic injury and better development of the surgical treatment of esophageal cancer. Key words: Rcurrent laryngeal nerve; Eophageal cancer; Applied anatomy ; Operation damage

Purpose: The larynx plays a role in swallowing, respiration, and voice production. All three functions change during ontogeny. We investigated ontogenetic shape changes using a mouse model to inform our understanding of how laryngeal form and function are integrated. We understand the characterization of developmental changes to larynx anatomy as a critical step toward using rodent models to study human vocal communication disorders.Method: Contrast-enhanced micro computed tomography image stacks were used to generate three-dimensional reconstructions of the CD-1 mouse (Mus musculus) laryngeal cartilaginous framework. Then, we quantified size and shape in four age groups: pups, weanlings, young, and old adults using a combination of landmark and linear morphometrics. We analyzed postnatal patterns of growth and shape in the laryngeal skeleton, as well as morphological integration among four laryngeal cartilages using geometric morphometric methods. Acoustic analysis of vocal patterns was employed to investigate morphological and functional integration.Results: Four cartilages scaled with negative allometry on body mass. Additionally, thyroid, arytenoid, and epiglottic cartilages, but not the cricoid cartilage, showed shape change associated with developmental age. A test for modularity between the four cartilages suggests greater independence of thyroid cartilage shape, hinting at the importance of embryological origin during postnatal development. Finally, mean fundamental frequency, but not fundamental frequency range, varied predictably with size.Conclusion: In a mouse model, the four main laryngeal cartilages do not develop uniformly throughout the first 12 months of life. High-dimensional shape analysis effectively quantified variation in shape across development and in relation to size, as well as clarifying patterns of covariation in shape among cartilages and possibly the ventral pouch.Supplemental Material S1. Methods.Riede, T., Coyne, M., Tafoya, B., & Baab, K. L. (2020). Postnatal development of the mouse larynx: Negative allometry age-dependent shape changes, morphological integration and a size-dependent spectral feature. Journal of Speech, Language, and Hearing Research. Advance online publication. https://doi.org/10.1044/2020_JSLHR-20-00070

Objective To investigate the clinical relevant factors causing laryngeal stenosis after partial laryngectomy and the its nursing intervention. Methods A retrospective study was carded out to review the history clinical data from 138 patients of partial laryngectomy in the First Affiliated Hospital of Sun Yat-Sen University between January 1994 to October 2004. The clinical relevant factors causing laryngeal stenosis included age,sex,TNM stage, original position tumor, resects extension of thyroid cartilage, resects extension of larynx parenchyma, repair model, larynx pattern, duration of using bacteriophage postoperative, postoperative radiotherapy, lung infection postoperative, gastroesophageal reflux, diabetes. Multivariate stepwise logistic regression model was used for the analysis. Results Among 138 cases after partial laryngectomy, stenosis developed in 25 cases, incidence rate was 18.12%. In multivariate analysis,it was confirmed that the following variable correlated to laryngeal stenosis, resects extension of thyroid cartilage, postoperative radiotherapy, lung infection postoperative, and gastroesophageal reflux. Conclusions The clinical relevant factors causing laryngeal stenosis after partial laryngectomy were various. Statistical analysis showed that resects extension of thyroid cartilage, postoperative radiotherapy, lung infection postoperative, gastroesophageal reflux were risk factors which may cause laryngeal stenosis. The prophylactic nursing interventions should be taken to cut down the rate of laryngeal stenosis after partial laryngectomy and improve the quality of life. Key words: Laryngectomy; Laryngeal stenosis; Risk factor; Postoperative nursing care

This study was undertaken to identify the variations in the physiologic ossification of human laryngeal cartilages by evaluating the lateral cephalometric radiographs of healthy males and females referred to our facility. Lateral cephalometric radiographs of 359 patients (141 male and 218 female; ages 10 to 59 years) referred from various specialty clinics between April 1998 and March 2000 were used. Frequencies and confidence intervals were obtained and tabulated for both thyroid and cricoid ossifications as seen on these cephalometric radiographs. The interobserver agreement was strong for both thyroid (kappa = .986) and cricoid (kappa = .982) observations. Overall, thyroid cartilage was more frequently ossified compared with cricoid. Various degrees of thyroid and cricoid cartilage ossification were found in 186 patients (120 female and 66 male) in the third decade and beyond. Among 173 patients in the first 2 decades (98 females and 75 male), evidence of thyroid ossification was found in 2 male patients aged 14 and 18, and ossification was detected in the cricoid cartilage in 12 patients. There was a preponderance of laryngeal cartilage ossification in men compared with women. Radiographically detectable laryngeal ossification increased with age starting in the third decade. There is a general trend of increase in the ossification of laryngeal cartilages as the age advanced.

Objective To explore the prevention of recurrent laryngeal nerve injury through the exposure recurrent laryngeal nerve by different ways in thyroid operation. Methods The patients with thyroid surgery were selected as study objects, and they were randomly divided into the inferior horn of thyroid cartilage and the inferior thyroid artery group according to the digital table.The operation time, amount of bleeding and the time of postoperative hospitalization were compared between the two groups, and the incidence of recurrent laryngeal nerve injury was analyzed. Results The differences were not statistically significant in the operation time, amount of bleeding and the time of postoperative hospitalization between the two groups (t=1.294, 0.967, 1.008, all P>0.05). The incidence rate of recurrent laryngeal nerve injury in the inferior thyroid artery group(4.61%) was higher than that in the thyroid cartilage angle group(1.54%)(χ2=4.203, P 0.05). Conclusion The exposure recurrent laryngeal nerve through the inferior horn of thyroid cartilage in thyroid operation can protect the recurrent laryngeal nerve, and can not increase the operation time, bleeding volume and the hospitalization time after surgery, which is worthy of further application. Key words: Thyroid gland; Recurrent laryngeal nerve; Operation mode

Objective To investigate exposure and locating of parathyroid glands(PTGs),and its function protecting during thyroidectomy.Methods In our hospital,from January 2008 to November 2009,228 cases of patients had their PTGs located,exposed and pmtocted during thyroidectomy and postoperative hypoparathyroidism were studied retrospectively.Results There was no PTGS found in 5 cases(2.19%),289 superior PTGs were found,of which 268(92.73%)located constantly on the posterior side of the thyroid and on the level of the lower edge of the thyroid cartilage.359 inferior PTGs were found.and the locations were more variable.167(46.51%)in the thyroid gland on the back of lower 1/3 part,108(30.08%)located near the bottom of the lateral lobe close to where the inferior thyroid arteries entered the thyroid gland.Postoperative hypocalcemia occurred in 23 cases,1 cage underwent unilateral total lobectomy(for the secondary surgery).2 cases underwent unilateral total lobectomy plus contralateral subtotal lobectomy,5 cases underwent total thyroidectomy.4 cases underwent total thyroidectomy plus centralcompartment neck lymph node dissection,5 cases underwent total thyroidectomy plus unilateral neck lymph node dissection,6 patients underwent total thyroidectomy plus bilateral neck lymph node dissection,4 cases suffered permanent hypoparathyroidism.Conclusions In total thyroidoctomy or thyroid surgery combined with neck lymph node dissection,parathyroid glands are easy to be damaged and resulted in hypocalcemia.To prevent postoperative hypoparathyroidism,the PTGs should be protected in situ through meticulous dissection without jeopardizing their blood supplies,or parathyroid autotransplantation could be performed to avoid permnant hypoparathyroidism. Key words: Parathyroid gland; Hypoparathyroidism; Hypecalcaemia

Zuckerkandl tubercle is the extension of thyriod gland. For the past few years, more and more surgeons and anatomists have become interested in it. Clinically, surgeons usually rely on specified anatomical landmarks to avoid injuries to the recurrent laryngeal nerve, including the laryngeal branches and the superior parathyroid in thyroid surgery, such as the bottom corner of the thyroid cartilage, the inferior thyroid artery, lower pole of thyroid, tracheoesophageal groove, suspensory ligament of thyroid gland and so on. As the specified landmarks, they have several common characteristics:on the one hand, their location should be constant; on the other hand, they should be easy to observe and touch, meanwhile convenient and practical.As a new anatomical landmark, Zuckerkandl tubercle is in accordance with the above characteristics and prevalent in the population. Therefore, Zuckerkandl tubercle could become an important landmark to identify the the recurrent laryngeal nerve, including the laryngeal branches and the superior parathyroid in thyroid surgery. This essay aims to briefly analyze the role of Zuckerkandl tubercle in thyroid surgery. Key words: Recurrent lyrangeal nerve; Tubercle; Anatomy; Zuckerkandl tubercle

The main points of surgical procedures were as follows: thyroidectomy were performed via an Chest-breast approach. Under the direct view, ultrasonic scalpel was used to establish subcutaneous surgical space below the jugular broad muscle, with outer edge of the sternoclavus muscle on both sides and upper edge of thyroid cartilage. Cervical linea alba was dissected by using ultrasonic scalpel. The front, lower and outer sides of the thyroid gland were separated through loose space between dorsal membrane of thyroid. The anterior cervical muscle groups were pulled by using endoscopic hook to expand surgical space. To fully expose and to separate anterior trachea space, then to cut off isthmus. Thyroid lobes were exposed by delicate dissection along the thyroid membrane to avoid damage to the parathyroid gland. Four steps of neural detection were used to search and monitor the recurrent laryngeal nerve signal. Make sure a 3 mm distance between surgical plane and nerve when using ultrasonic scalpel. After the lobe dissociate completely, the superior thyroid artery were cliped and cutted off, to prevent late bleeding. The resected specimens were taken out for pathological examination by using specimen bag. The anterior cervical muscle groups was sutured with absorbable lines . Finally, drainage tube was placed. Key words: Thyroidectomy; Endoscopy; Chest-breast Approach

Introduction: Larynx cancer represent about 30% of head and neck tumors, and 90% are squamous cell carcinomas. Discrepancies have been reported in clinical and pathological TNM staging in larynx cancer in several studies.Methods: Retrospective analysis of 179 patients undergoing laryngectomy between January 2009 and December 2014 in IPOFG of Coimbra. Results: With regard to the extent of the tumor (T), the restaging rate was 43.7%. The sensitivity in the detection of thyroid cartilage invasion or pre-epiglottic space was 55.6% and specificity of 83.4%. With regard to the cervical lymph nodes metastasis the re-staging rate was 36.7%. The sensitivity in the detection of cervical metastases was 85.1% and specificity of 78.5%.Conclusion: Similar to values from other consulted studies, we consider that the reclassification rate is high. The combination of CT data with those from MRI in cases of doubt may improve results. In cases of doubt we consider prudent to opt for surgical treatment so we have a more accurate staging. We emphasize the importance of follow-up taking into account the existence of significant false negatives.

To explore the therapeutic effect of sternum-hyoid muscle transposition and arytenoid adduction for unilateral vocal cord paralysis (UVCP). Included in this study were 19 patients with UVCP lasted for 12 months to 15 years. The surgical technique was as follows. The thyroid cartilage was engaged with a skin hook and gently rotated anteriorly. The lateral-inferior corner of the thyroid cartilage was exposed and the muscular process of the arytenoid was identified. Then, the thyroid lamina on the involved side was parasagittally separated 5 mm off the midline. The inner perichondrium was carefully freed from the overlying thyroid cartilage. The lamina was retracted laterally, and a 3-0 prolene suture was placed through the muscular process and tied to the cricoid cartilage at the origin of the lateral cricoarytenoid muscle. A bipedicled strap muscle flap was then transposed into the space between the lamina and the inner perichondrium. Pre- and postoperative voice evaluations measured mean fundamental frequency, jitter, shimmer, harmonic ratio and maximal phonation time, as well as assessments of voice quality. Vocal improvement was obtained in 100% (19 of 19) of patients. Immediately after the operation, the ingression could be observed in vocal cord membrane and vocal process, vocal cord volume was amplified. There was a significant difference (P < 0.05) in all parameters (fundamental frequency, jitter, shimmer, harmonic ratio and maximal phonation time) between pre- and postoperative voice evaluations measured mean. There was no significant difference (P > 0.05) in voice evaluations measured mean between 2 months and 12 months after operation in all patients. No major complications were noted in any patient. Sternum-hyoid muscle transposition and arytenoid adduction for unilateral vocal cord paralysis is simple and convenient, no immune rejection, and the long-term result is stable.

Objective To evaluate the efficacy of ultrasound-guided laryngeal mask airway (LMA) in children. Methods ASA Ⅰ and Ⅱ children (aged 1 to 6 years) scheduled for orthopedic surgery of limbs were recruited in this study. A LMA was inserted after induction of general anesthesia. After mechanical ventilation for 5 minutes, the air-filled cuff was deflated and then inflated with saline. Ultrasonography was then performed by a high frequency linear-array transducer to confirm the correct placement of the LMA. Results The LMA can be easily recognized on the transverse view of the thyroid cartilage notch, appearing as a circle around the glottis, which was called the dumbbell sign. On the sagittal view of the thyroid cartilage, the LMA has an archlike appearance which ended below the thyroid cartilage. Oblique scan over the cricoid cartilage shows the tip of LMA is located at the upper portion of the esophagus. Conclusions Filling the LMA cuff with saline instead of air allows better LMA visualization by ultrasound. This method enhances correct positioning of the LMA, which is crucial to ensure safe ventilation. Key words: Ultrasonography; Laryngeal masks; Position

Background: Deposition of monosodium urate crystals in joint and soft tissue finally forms tophi in chronic gout cases. The tophaceous deposits were most commonly found around the fingers or the big toe, however in unsual cases, they could be found over other sites, such as the ears, spinal cord, pancreas, thyroid cartilage, tongue, eyes, breast and nose Aim and Objectives: We present a case with tophi formation surrounding her nasal silicone prosthesis, and this is the first case as known to the present literatures. Materials and Methods: A 54-year-old woman who had received nasal silicone implant for augmentation more than 10 years ago, came with the chief complaint of painful hump over the middle third of the nasal ridge for 6 months. Infection of prosthesis was impressed. The prosthesis was removed, and the mass of nasal hump was then removed through curettage and dissection. Cannelures were found over the silicone prosthesis. Result: Histopathologic examination revealed deposits of amorphous material, and typical birefringence of urate crystal was shown. Post operative colchicine and allopurinol were prescribed. At the last follow, which was 1 year post operation, neither wound infection nor recurrence of tophi was found. Conclusion: Implantation of prosthesis for cosmetic reason became more and more popular in modern society. As the lifestyle changes, more and more patients would confront with hyperuricemia and its series of chronic symptoms. Plastic surgeons should always take hyperuricemia into consideration, as nasal prosthesis may be a risk factor for tophi deposition.

Aim and Objectives: The present research was carried out with an objective to study the level of bifurcation and its anatomical variations of common carotid artery (CCA). Methods: Fifty human cadavers (24 males and 26 females) were dissected and the level of bifurcation and its anatomical variations of CCA were noted and results were analyzed statistically. Results: The level of bifurcation of CCA at the superior border of thyroid cartilage was noted in 68 % of cases while higher and lower level of bifurcation was seen in 22% and 10% of the specimens respectively. High and low level bifurcation of CCA was highly significant on right side compare to left. Conclusion: The bifurcation of common carotid artery need not always be at the level of upper border of thyroid cartilage. It can be at either higher or lower in origin, higher being more common. The awareness in the variation of bifurcation level is necessary to avoid undue complications during the surgeries and procedures done in head and neck region.

Complete Decapitations are not uncommon in routine Forensic Autopsies. In this study Complete Decapitations were found in 0.67% of Autopsies of which 96.15% [n-25] were Homicidal and 3.85% [n-1] due to Suicide. Only in 26.92% [n-07] of cases Decapitations were done during the process of death and in 73.08% [n-19] of Decapitations were done Postmortem. The Majority of the Victims belonged to 3rd [n-11] and the 4th [n-10] Decade. The Male to Female Ratio was 2:1. In 21[84%] cases the Head was recovered from the River/riverside Bush, away from the place of residence and in 04 [16%] cases the Head was recovered along with the Torso around the Place of Residence. Major number of cases [n-24] were due to Gang related violence and in 2 cases Love and Sex dominated the incident. In 92.31% [n-24] of cases the C2-3 was involved and in two cases other cervical vertebra were involved. The Thyroid was least affected [n-5] and major number of Decapitations [n-15] were carried out above the Thyroid cartilage and in 6 cases below the thyroid Cartilage. A decapitation was the Proximate Cause of Death in 07 cases, though associated with other nonfatal or near fatal injuries. Decapitations demonstrated extreme degree of violence and Mutilation. It is also a result of high degree of Offensive, Defensive and aggression. Public Display of Head in Complete Decapitation is a method to impose a sense of Fear, it is a mean to Propaganda and Intimidation.