Arytenoid Cartilage Research Articles

Stereotactic body radiotherapy for T1 glottic cancer: dosimetric data in 27 consecutive patients.

Because the clinical feasibility of stereotactic body radiotherapy (SBRT) for early glottic cancer (T1) is controversial, we report dosimetric results in 27 consecutive patients from a prospective phase I and II study that started in 2017. In our approach, only the parts of the true vocal cord containing cancer and those immediately adjacent are planned to be treated to 36 Gy and 30 Gy, respectively, in 3 fractions. Several dosimetric metrics for both target volumes and organs at risk were extracted from individual plans and results were compared to those achieved by other authors in a similar setting. Proper coverage was reached at planning in 2/3 of planning treatment volume 30 Gy, but only 4 planning treatment volume 36 Gy; conversely, the maximum dose objective was met for most of the patients on either arytenoid cartilage, but this was not the case for 51.9% and 96.3% of cricoid and thyroid cartilages, respectively. Our dosimetric results are similar to if not better than those achieved by others. SBRT in 3 fractions for T1 glottic lesions is dosimetrically challenging. Clinical validation is awaited.

Description and evolution of the larynx of the Physalaemus olfersii species group, with remarks on the laryngeal anatomy of the P. cuvieri clade (Amphibia: Anura: Leiuperinae).

The anuran larynx is an organ of great evolutionary interest because it impacts male reproductive success in courtships. However, little is known about the diversity of the larynx's anatomy, evolutionary history and systematics importance. Here, we describe and compare the anatomy of the larynx of 10 Physalaemus species of the P. cuvieri clade, focusing on the P. olfersii species group. We also reconstructed the ancestral states and tested the phylogenetic signal for the anatomical features. In all the species, the larynx has a general globular shape with the arytenoid cartilages covering almost its entire dorsal surface, while the anterior process of the cricoid cartilages covers most of the ventral surface. The size of the secondary fibrous mass, the thickness of the vocal membrane, and the attachment position of the vocal membrane's free edge considerably differ among the species. Moreover, only four species of a single clade in the P. olfersii species group have the primary fibrous mass well-developed with a suspended region in the dorsolateral passage. We found a significant phylogenetic signal for all these characters. Ancestral reconstructions pointed to reduction tendencies in the thickness of the vocal membrane and the size of the secondary fibrous mass, and a shift of the ventral attachment of the vocal membrane, increasing the angle of its free edge along the phylogeny. This latter trait can diagnose the entire Physalaemus olfersii group, which has the ventral ends of the arytenoids positioned posteriorly, giving this group the steepest angles for the vocal membrane's free edge in relation to the frontal plane. Based on our results, the larynges can contribute to the Physalaemus olfersii species group's systematics and could be elucidative to understand the evolution of the genus. High levels of anatomical and bioacoustical complexity and diversity observed in the group support the expected correlation between vocal anatomy and bioacoustical signal.

Prognostic imaging variables for recurrent laryngeal and hypopharyngeal carcinoma treated with primary chemoradiotherapy: A systematic review and meta-analysis.

BackgroundIn this systematic review, we aim to identify prognostic imaging variables of recurrent laryngeal or hypopharyngeal carcinoma after chemoradiotherapy.MethodsA systematic search was performed in PubMed and EMBASE (1990–2020). The crude data and effect estimates were extracted for each imaging variable. The level of evidence of each variable was assessed and pooled risk ratios (RRs) were calculated.ResultsTwenty‐two articles were included in this review, 17 on computed tomography (CT) and 5 on magnetic resonance imaging (MRI) variables. We found strong evidence for the prognostic value of tumor volume at various cut‐off points (pooled RRs ranging from 2.09 to 3.03). Anterior commissure involvement (pooled RR 2.19), posterior commissure involvement (pooled RR 2.44), subglottic extension (pooled RR 2.25), and arytenoid cartilage extension (pooled RR 2.10) were also strong prognostic factors.ConclusionPretreatment tumor volume and involvement of several subsites are prognostic factors for recurrent laryngeal or hypopharyngeal carcinoma after chemoradiotherapy.

Судебно-медицинское определение возраста по рентгеноморфометрическим особенностям черпаловидных хрящей гортанного комплекса человека

The aim of the study was to develop a method for age evaluation based on the mineralization signs of the larynx arytenoid cartilage (AC) during the destroyed human corpse expertise. X-ray images of isolated AC preparations from both sexes (male – 264, female – 106) aged from 19 to 91 years were studied. Morphometry was conducted on: the area (in mm2) and the degree (%) of mineralization of both AC separately and united, a total of 6 features. Results. There is no correlation between the signs of AC mineralization and the length of the human body (r = 0.01-0.201). The correlation of these signs with age is high in men, (r = 0.741-0.781), and moderate in women (r = 0.470-0.508). There is a pronounced correlation between all age-dependent signs of AC (r = 0.948-0.985). According to the discriminant analysis results, the correct classification of the age groups 19-44 and 45-91 years is 82.9% in men, 77.03% in women. Practically reliable and probable diagnostics of men age is possible in 32.58 and 33.33%, of women age – in 5.41 and 37.84% of cases. According to the regression analysis, the age diagnostics in the range from 19 to 91 years in men is possible with an accuracy of ± 10.02 years (R = 0.799; R2 = 0.635), in women – ± 18.864 years (R = 0.506; R2 = –0.249). Forensic determination of the women age by regression models is excluded.

Diagnosis and endoscopic treatment of blunt laryngeal trauma with arytenoid injury

Objective: To investigate the clinical characteristics, diagnosis, endoscopic surgical procedures, and therapeutic effect of blunt laryngeal trauma with arytenoid injury. Methods: We retrospectively reviewed 12 patients who suffered blunt laryngeal trauma with laryngeal mucosa avulsion and arytenoid region injury at the Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital from April 2007 to December 2018. Among the 12 patients, 10 were males, 2 were females, aged from 7 to 48 years old, with a median age of 21 years old. All patients were performed with transoral endoscopic laryngeal microsurgery under general anesthesia. Clinical characteristics, laryngoscopic signs, laryngeal CT, endoscopic surgical findings and procedures, and therapeutic effect were analyzed. The subjective and objective parameters of the voice quality of patients before and after surgery were compared using SPSS 22.0 statistical software by paired T test. Results: All patients had a history of obvious dysphonia immediately after trauma, accompanied by throat pain and hemoptysis without obvious dyspnea and dysphagia. Slight subcutaneous emphysema was found in 3 patients by physical examination. Laryngoscope revealed that 14 sides of vocal folds immobilized, arytenoid and/or ventricular region and posterior glottis mucosa were avulsed in 4 patients within 48 h of injury, and arytenoid cartilage was exposed in 4 sides. The arytenoid and ventricular regions were covered with thick pseudo-membrane or granulation, with abnormal structure in 8 patients with damage of more than 48 h. Intraoperative exploration revealed that there were 17 sides of arytenoid region (bilateral 5 cases, unilateral 7 cases) with varying degrees of injury. There was only limited laceration on three sides of the vocal folds. The lateral ventricular and vocal fold mucosae were avulsed vertically from the arytenoid region and arytenoid cartilage was exposed in 14 sides, among which 6 sides had abnormal arytenoid cartilage morphology and 8 sides had fracture displacement. Laryngeal CT showed irregular thickening of lateral glottis and/or supratroglottic structures in patients with vocal folds immobility, among which asymmetry of arytenoid cartilage structure on both sides in 3 cases and displacement in 2 cases were found. Restoration and microsuture of the fractured arytenoid, perichondrium and avulsion laryngeal mucosa under the direct laryngoscope were performed. The degree of dysphonia was significantly improved immediately after laryngeal microsurgery, the voice significantly improved in G, R, B, A, jitter, shimmer, NHR, and MPT three months after surgery(t=12.792, 12.792, 10.340, 3.276, 2.865, 3.781, 3.173, 3.090, respectively, P<0.05). Except for 1 patient with scar on vocal fold, all the other patients had normal laryngeal morphology and normal vocal fold movement. No laryngeal stenosis was found during the follow-up period. Conclusions: For patients with blunt laryngeal trauma, the injury of arytenoid region and arytenoid cartilage should be evaluated if there is obvious hoarseness, vocal fold immobility, avulsion of ventricular/vocal folds mucosa, or structural abnormality of arytenoid region under laryngoscopic examination. For highly suspected cases, microrphonosurgery under the direct laryngoscope should be performed as soon as possible, which can effectively reduce the occurrence of vocal fold movement disorders and laryngeal scar/stenosis, reconstruct the normal laryngeal structure, and restore the vocal function.

Histomorphology of the lower respiratory tract in the Indian crested porcupine (Hystrix indica).

The Indian crested porcupine (Hystrix indica) (ICP) is widely distributed in Asia; however, compared with other rodents, little is known about the structures of its respiratory system. The aim of this study was to evaluate the histomorphology of the lower respiratory portion of the ICP to provide a basis for the identification of the normal structure of this organ. The larynx, trachea and lungs of four carcasses of adult Indian crested porcupines (two males and two females) were dissected and fixed in 10% neutral-buffered formalin. The gross anatomy and histology of all specimens were evaluated. A macroscopic evaluation showed unique structures in the ICP respiratory system, including the presence of a chamber-like structure at the origin of the bronchi and a difference in epiglottis shape between males and females. Histologically, the stratified squamous epithelium covered the epiglottis and arytenoid cartilage, and the pseudostratified ciliated columnar epithelium covered the internal part of the thyroid and cricoid cartilages. Histomorphological studies showed a few goblet cells in the tracheal epithelium. In the bronchi and larger bronchioles, pseudostratified ciliated columnar epithelia were observed. Bronchi were surrounded by segments of cartilage. Distal bronchioles had a simple cuboidal/columnar epithelium with club (Clara) cells, lacked cartilaginous tissue in their walls and had a complete smooth muscle layer. These results revealed histomorphological differences between the ICP and other rodents.

Evaluation of Overground Endoscopy Findings in Colombian Criollo Paso Horses

The dynamic upper airway functional (URT) problems of Colombian paso horses (CPH) have not been investigated in literature up to date. These horses perform special walking gaits with high poll flexion of the neck. Our goal is to evaluate the upper airway mechanics in CPH, showing abnormal respiratory sounds and poor performance during exercise. Resting and overground endoscopy was performed in 40 CPHs. Statistical analyses were performed using the sciPy package. One-tailed Fisher exact tests were used to check for positive contingency between each pair of upper respiratory tract disorder (P < .05). Arytenoid cartilage collapse was observed in 35 of 40 cases during exercise. Among these, dynamic laryngeal collapse (DLC) was the most significant finding, but ventromedial luxation of the apex of the corniculate process of the arytenoid and recurrent laryngeal neuropathy was also observed. Dorsal displacement of the soft palate was only detected in 4 of 40 cases. DLC was significantly associated with vocal cord collapse, nasopharyngeal collapse, and medial collapse of the margins of the epiglottis, and medial collapse of the margins of the epiglottis was associated with nasopharyngeal collapse. DLC is only a typical feature in some special breeds worldwide. We suggest that the extensive poll flexion and the relatively small laryngeal lumen and high intensitivity workload are the most important predisposing factors of DLC. Ventromedial luxation of the apex of the corniculate process of the arytenoid was over-represented in our caseload, compared with other studies. Whereas, despite the intensive workload, dorsal displacement of the soft palate was relatively uncommon. We presume that this could also be tailored to the high poll flexion performed during the special gaits.

Lipomatous hemangiopericytoma of the larynx: An extremely rare tumor at an unusual location

Hemangiopericytoma (HPC) arising from the contractile pericyte of Zimmerman comprises less than 1% of the vascular tumors with approximately 200 cases documented in the literature, out of which only 11 cases are reported in the larynx. Lipomatous hemangiopericytoma (LHPC) is an uncommon histological variant composed of a mixture of HPC and mature lipomatous component with around 50 cases reported so far, and majority have been found in the deep soft tissue of the lower extremities and retroperitoneum. HPCs are closely related to solitary fibrous tumors, and the LHPC was designated as a separate entity according to recent the World Health Organization classification of soft tissue tumors in 2002. To the best of our knowledge, even on extensive search of literature, LHPC of the larynx has not been reported till date. We report an extremely rare case of LHPC in a middle-aged female presented with a mass in the arytenoid cartilage of the larynx.

Sexual dimorphism of morphometric parameters of arytenoid cartilages as a criterion for establishing human sex

The objective of the study is to determine sexual dimorphism of morphometric features of adult arytenoid cartilages (AC) as applied to forensic medical examination of personality identification. The SC of 254 males and 106 females who died of mechanical strangulation asphyxia between the ages of 19 and 91 years were studied using the set of 14 parameters. All the parameters have a normal distribution according to Pearson's χ2 test. Their means were significantly higher in men than in women. Sex differences in the coefficients of variation of the parameters are insignificant. All AC parameters correlate closely with sex (r=0.775-0.830), but there is almost no correlation with age and body length. The same dimensions of the right and left AC have a high correlation (r=0.8-0.9) and are subject to separate analysis. The morphometric parameters of AC are highly informative and present a valuable option for a forensic determination of the sex of an adult human.

Экспресс-диагностика заболеваний гортани с помощью ультразвукового сканирования при профилактических осмотрах детей и подростков

The purpose of our work was to the express diagnosis of laryngeal diseases by ultrasound scanning on children and adolescents during preventive examinations. Patients and methods: As part of a routine medical examination, 392 preschoolers and 622 senior pupils were examined in the children’s city polyclinic No. 3 in Irkutsk. All children underwent examination of ENT organs and ultrasound scanning (USS) of the larynx in the transverse direction on a portable Aloka SSD-500 apparatus with a 5 MHz sensor. We evaluated the echogenicity of the laryngeal lumen, the mobility of the vocal folds, and measured the vocal fold length from the anterior commissure to the echogenic arytenoid cartilages. Results: Dysphonia was detected in 35 (9%) preschoolers and 20 (3,2 %) high school students. With USS, all the subjects with dysphonia, except one, the larynx lumen remained echo negative, as in normal, and the mobility of the folds was symmetrical, which made it possible to exclude laryngeal tumors and laryngeal paresis. Later, during laryngoscopy, preschoolers with voice impairment were diagnosed with functional dysphonia in 23 cases and nodules of the vocal folds in 12 cases, in 15 high school students – a voice mutation, in 4 – hypotonic dysphonia. USS of the larynx made it possible to diagnose paralysis of the left half of the larynx in 2 twin girls of 6 years old without dysphonia, who had a history of heart surgery, and a volumetric formation of the left vocal fold (recurrent laryngeal papillomatosis) in a 15-year-old teenage girl. The length of the vocal folds in adolescents with a voice mutation was more than 2 cm, which corresponded to the size of the adult larynx. Conclusion: Dysphonia was detected in 9% of preschoolers and 3,2% of senior pupils. Ultrasound scanning can be used as a rapid diagnostic method of the larynx during preventive examinations. It allows detection of impaired mobility of the vocal folds and laryngeal tumors.

Обширное инородное тело пищевода с распространением на гортаноглотку и гортань

Foreign bodies of the respiratory tract and esophagus remain one of the pressing problems in medicine, which is associated with the possibility of developing complications that can end in death. We present our clinical observation that demonstrates the long-term presence of a large foreign body fixed in the area of the pharyngeal narrowing of the esophagus and extending into the larynx and the vestibule of the larynx. Patient T., 57 years old, went to the emergency department of the Karachay-Cherkessia Republican Clinical Hospital with complaints of severe sore throat, inability to swallow, excessive salivation, increased body temperature to 37,5 °C, difficulty breathing, mixed shortness of breath, which persist for 3 days. The examination revealed: the epiglottis is mobile, the mucous membrane of the larynx is hyperemic, edematous, with an abundance of saliva, at the level of the vestibular part of the larynx, in the area of the arytenoid cartilage and aryepiglottic folds, an irregular shape was visualized, with smooth edges, a thin, hard whitish plate. Computed tomography of the cervical spine: in the esophagus, at the level of C4-C5 vertebrae, a foreign body with a metallic density of +2900 hU units, elongated, irregular shape, measuring 2.2 by 3.3 cm, with perifocal air bubbles is determined. A preliminary diagnosis was made: Foreign body of the esophagus, laryngopharynx with a spread to the vestibule of the larynx. 3 days after the retention of the foreign body under intubation anesthesia, it is captured using forceps with serrated cups and removed during direct laryngoscopy. There were no complications during the manipulation. The combination of X-ray and endoscopic examinations with the help of innovative medical and diagnostic equipment made it possible to establish a diagnosis in a short time, choose the most effective treatment tactics and remove a foreign body through natural pathways.

Laryngeal Reconstruction Using Tissue-Engineered Implants in Pigs: A Pilot Study.

There are currently no treatments available that restore dynamic laryngeal function after hemilaryngectomy. We have shown that dynamic function can be restored post hemilaryngectomy in a rat model. Here, we report in a first of its kind, proof of concept study that this previously published technique is scalable to a porcine model. Animal study. Muscle and fat biopsies were taken from three Yucatan minipigs. Muscle progenitor cells (MPCs) and adipose stem cells (ASCs) were isolated and cultured for 3 weeks. The minipigs underwent a left laterovertical partial laryngectomy sparing the left arytenoid cartilage and transecting the recurrent laryngeal nerve. Each layer was replaced with a tissue-engineered implant: 1) an acellular mucosal layer composed of densified Type I oligomeric collagen, 2) a skeletal muscle layer composed of autologous MPCs and aligned oligomeric collagen differentiated and induced to express motor endplates (MEE), and 3) a cartilage layer composed of autologous ASCs and densified oligomeric collagen differentiated to cartilage. Healing was monitored at 2 and 4 weeks post-op, and at the 8 week study endpoint. Animals demonstrated appropriate weight gain, no aspiration events, and audible phonation. Video laryngoscopy showed progressive healing with vascularization and re-epithelialization present at 4 weeks. On histology, there was no immune reaction to the implants and there was complete integration into host tissue with nerve and vascular ingrowth. This pilot study represents a first in which a transmural vertical partial laryngectomy was performed and successfully repaired with a customized, autologous stem cell-derived multi-layered tissue-engineered implant. NA Laryngoscope, 131:2277-2284, 2021.

The hyolaryngeal apparatus of three species of Scinax (Scinaxinae: Hylidae: Anura) and comparison with other Hylidae species

AbstractThe hyolaryngeal apparatus includes the arytenoid, cricoid and hyoid cartilages, and varied sizes and shapes can be distinguished between species. Although the larynx is an important morphological structure for sound production in frogs, few studies describe the structures and processes of its parts in hylids. We studied the hyolaryngeal anatomy of both males and females of Scinax ruber (Laurenti, 1768), using clearing and double staining methods, comparing it with that of Scinax wandae (Pyburn and Fouquette, 1971), Scinax kennedyi (Pyburn, 1973) and other hylid species. We found that S. ruber has the largest arytenoid cartilage of any species of the subfamily Scinaxinae studied to date. We described both the laryngeal differences among three Scinax species and the interspecific variability in the shapes of the projections of the arytenoid in the males of these species. The taxonomic characters (presence/absence of processes of the cartilage of Santorini, oesophageal process or bronchial processes) described here can play a key role in differentiating these species from Scinax species and from other species. In addition, we want to contribute to the natural history and comparison of the larynges in Scinax and within the genus and the Hylidae.

Clinical and Pathological Features in Horses With Advanced Arytenoid Chondritis.

Equine arytenoid chondritis causes airway obstruction and abnormal upper airway noise due to a space-occupying lesion(s) and decreased abduction. Our objective was to compare clinical scores and ultrasonographic findings with gross and microscopic lesions of naturally occurring arytenoid chondritis, in order to guide surgical treatment. Seventeen naturally affected horses with advanced/severe chronic arytenoid chondritis and 4 control arytenoid cartilages were evaluated after partial arytenoidectomy. Cartilages were sectioned caudal to the corniculate process and the body of each arytenoid was measured. We assessed total gross area (TA), percentage of viable cartilage (VC), percentage of viable cartilage on the lateral wall, and medial expansion. Retrospectively, the gross lesions were used to suggest 2 preferred surgical management (SM) groups: those requiring partial arytenoidectomy and those amendable to focal medial resection (a conservative SM). TA of horses with arytenoid chondritis was significantly larger than controls (P = .005), due to a layered lesion composed of cavitation, granulation tissue, fibrosis, inflammation, hemorrhage, and edema, with relatively equal medial and lateral expansion that distorted the geometry of the affected cartilage. The increased TA paralleled the presence of immature cartilage with disorganized primitive mesenchymal cells. TA and SM were positively correlated (P = .01). All cases showed varying degrees of cartilage degeneration or necrosis, more severe medially; those appearing amenable to focal medial resection arytenoid group had significantly more viable cartilage on the lateral wall (P = .02). The gross and histopathologic findings suggest a new surgical approach-focal medial resection-that may save the lateral wall of the arytenoid.

Co-transplantation of Schwann cells and neural stem cells in the laminin-chitosan-PLGA nerve conduit to repair the injured recurrent laryngeal nerve in SD rats.

The objective of this paper is to investigate the possibility and efficacy of recurrent laryngeal nerve repair by transplantation of co-cultured Schwann cells and neural stem cells (NSCs) in laminin-chitosan-poly-lactic-co-glycolic acid (laminin-chitosan-PLGA) nerve conduits in rats. A laminin-chitosan-PLGA conduit was used in a rat recurrent laryngeal nerve transection model. The rat recurrent laryngeal nerve was dissected to generate a 5 mm defect. Then, a laminin-chitosan-PLGA nerve conduit with or without Schwann cells and NSCs in the lumen was transplanted into the defect. A total of 96 female rats were randomised into six groups: co-culture of NSCs and Schwann cells in the nerve conduit group (CO), Schwann cells only in the nerve conduit group (SC), neural stem cells only in the nerve conduit group (NSC-only), nerve conduit group (null), autologous nerve graft group (autograft) and sham operation group (sham). Regenerated nerves were evaluated by histological and functional assessment at 8 and 12 weeks after surgery. The diameter and area of the regenerated myelin sheath, as well as the secretion of brain-derived neurotrophic factor and glial cell-derived neurotrophic factor in laryngeal muscle or regenerated nerve tissue in the CO group, were significantly better than they were in the SC, NSC-only and null groups (all P values < 0.05). Immunofluorescence showed that the CO group had significantly more neurofilament-200 immunoreactive and S-100 immunoreactive fibres than the SC, NSC-only and null groups (all P values < 0.05). The performance of the CO groups and autograft groups was found to be similar by laryngoscopy. Arytenoid cartilage motion recovery in these two groups was significantly better than it was in the other groups (all P values < 0.05). Our results indicated that co-culture of Schwann cells and NSCs in laminin-chitosan-PLGA conduits might promote injured nerve regeneration. This method might be a promising alternative for defective nerve repair.

Evaluation of the time to desensitization of the larynx of cats following topical lidocaine application.

The objective of this study was to evaluate the time to decreased reactivity of the arytenoid cartilages in cats after application of topical lidocaine. One hundred and ten mixed-breed cats were randomly assigned to one of five groups based on the time between application of lidocaine and stimulation of the larynx: 5 (T5), 15 (T15), 30 (T30), 45 (T45) or 60 (T60) s. Cats were premedicated with dexmedetomidine, ketamine and buprenorphine. Anesthesia was induced with propofol to effect. Lidocaine 2% (2 mg/kg) was applied topically to the vocal cords using a catheter attached to a syringe under direct laryngoscopy. After lidocaine application, the designated time elapsed and the vocal cords were stimulated with the patient end of an endotracheal tube. Severity of reaction was reported as none, mild, moderate or severe. All cats were intubated after the reactivity score was recorded. Anesthesia was maintained with isoflurane and 100% oxygen while cats were spayed or castrated. Cats were monitored in recovery for signs of respiratory complications and pain. There was a significant difference in overall reactivity score between T5 and T45 (P = 0.0038). Also, there was a significant difference in the number of cats with no reaction compared with cats with any reaction between T5 and T30 (P = 0.03), as well as between T5 and T45 (P = 0.0028). No cat had a severe reactivity score at T45 or T60. All cats were successfully intubated. There were no complications during intubation, maintenance of anesthesia or recovery. As the lowest overall reactivity score occurred at T45, it is recommended to wait at least 45 s after application of topical lidocaine before attempting tracheal intubation.

Surgery of the Larynx - Part 2b: Transcervical Surgical Therapy ofMalignant Lesions

Transoral endoscopic laryngeal surgery (TEC) is typically used as a cervical tissue-sparing and function-preserving surgical procedure. Transoral robotic surgery (TORS) in particular has been pushing the boundaries towards transoral resection in recent years. Nevertheless, there are still limitations to this approach. Transcervical surgery is then the therapy of choice. It is used in case of insufficient visibility of the entire larynx and especially the tumor-bearing region, cartilage infiltration, a lack of mobility of both arytenoid cartilages or a lack of patient compliance. Even with the transcervical approach, from an oncological point of view, the procedure must be as radical as necessary on the one hand and as function-preserving as possible on the other. In case of a transcervical appraoch, however, additional requirements, side effects and consequences must be considered during planning, implementation and follow-up treatment. In addition to our previous publications, this article is intended to provide an overview of transcervical surgery for malignancies of the larynx.

A study on structure and functions of organs involved in the formation of Mongolian Khuumii sound

Khuumii (throat or overtone singing) is a unique form of art derived from the nomadic population of Central Asia, which is a type of singing in which the singer manipulates the resonances (or formants) created as air travels from the lungs, past the vocal folds, and out of the lips to produce a melody. A total of 60 participants, aged 18-60 years (54 men and 6 women), were selected by non-random sampling method using cross-sectional study. X-ray, endoscopy, and sound research method were used in the study, and the composition of blood gas was analysed. X-ray examination determined the state during each different types of Khuumii; Shakhaa and Kharkhiraa. As the basic timbre of Shakhaa Khuumii went up progressively the larynx grew and the compression strength increased, while the basic timbre went down, and the larynx became lower. In the case of Kharkhiraa Khuumii, the larynx position was elevated to a relatively small extent compared to Shakhaa Khuumii and the distance between the sublingual bone and the larynx was large. The sublingual bone trunk lowered during Shakhaa Khuumii, while it was slightly elevated during Kharkhiraa Khuumii. The laryngeal endoscopy evaluated the movement of true and false vocal chords, glottal volume, movements of epiglottis and arytenoid cartilage, and mucosa. Furthermore, the sound frequency is 2-4 times higher than that of normal speech, and sound volume is 0.5-1 times higher. The blood gas composition test showed partial pressure (pO2), and saturation of oxygen (SaO2) decreased after performing Khuumii. In the case of Shakhaa and Kharkhiraa Khuumi, it is appropriate to divide Khuumii into two main types according to structural and functional changes in the organs involved.

Application of 4D-CT Scanning in Differential Diagnosis of Arytenoid Subluxation and Vocal Fold Paralysis

To differentiate arytenoid subluxation and vocal fold paralysis by CT cine mode scanning combined with three-dimensional (3D) reconstruction image. 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. 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. 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.

ASPIRATION OF NASAL RING IN YOUNG HEALTHY FEMALE ADULT

SESSION TITLE: Medical Student/Resident Procedures Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Unlike in children and Elderly, foreign body aspiration rare in adults1. With headscarf pin and dental prosthesis being the most reported objects. A common complication of nasal piercing is a local infection and skin reaction2. However, aspiration of foreign objects (FB) could cause recurrent pneumonia. Here we describe a rare case of aspiration of nasal piercing in a young healthy adult. CASE PRESENTATION: A 26-year-old healthy female who presented to the emergency department with a chief complaint of FB stuck in her throat. She stated that she had a nose ring (NR), and while she was removing it, she got the urge to sneeze and inhaled sharply, which caused her to inhale her NR. She complained of mild foreign body sensation in the back of her throat and minor nonproductive cough but denied any hemoptysis or shortness of breath and no wheezing was noted on physical exam. X-ray neck was clear, but an X-ray chest showed curvilinear FB suspected in the region of the right main bronchus. During our assessment, all her vitals were stable and within normal limits. Handstand with back tapping was unsuccessful. Therefore, she was taken to the operating room for flexible fiberoptic bronchoscopy for FB retrieval under general anesthesia. The airway was secured by a laryngeal mask airway (LMA). The bronchoscope found NR located in the right main bronchus. Alligator jaw forceps were used to bring the NR above the vocal cords since NR size was small enough (1 cm in diameter) to pass through the LMA, but the NR got snared by the arytenoid cartilage. Glidoscope was used to visualize the ring and Forceps were used to safely remove it. Post-procedurally she was discharged home in stable condition. DISCUSSION: Generally rigid bronchoscopy is the tool of choice to manipulate the airway in these situations by an interventional pulmonologist or by a surgeon3, however, if they are not readily available at bedside, flexible bronchoscopy is a fairly safe way to remove FB under general anesthesia. CONCLUSIONS: Although it is extremely rare for aspiration of NR, it could potentially cause serious complications such as recurrent pneumonia. A certified clinician to use flexible bronchoscopy should be aware that flexible bronchoscopy is a fast and relatively safe tool to retrieve small FB. Reference #1: 1.Oliveira Matos C, Sousa MM. Foreign Body Aspiration in the Elderly. Acta Med Port 2016;29:340-3. Reference #2: 2.Hackenberg B, Grosse-Buning S, Hammes S, Strieth S. [Complications of cosmetic piercings and tattoos in the head and neck region]. HNO 2020;68:131-40. Reference #3: 3. Acharya K. Rigid Bronchoscopy in Airway Foreign Bodies: Value of the Clinical and Radiological Signs. Int Arch Otorhinolaryngol. 2016;20(3):196-201. DISCLOSURES: No relevant relationships by Mutsumi Kioka, source=Admin input No relevant relationships by Marwan Mashina, source=Web Response