Fold Position Research Articles

Quantitative Assessment of True Vocal Fold Movement by the Lateral-Approach Laryngeal Ultrasonography: A Pilot Study

Background/ObjectivesUltrasonography is a new method for subjective and qualitative assessment of true vocal fold movement, and true vocal fold visualization with the lateral approach could be better than that with the anterior approach. Our aim was to explore the feasibility of the lateral-approach ultrasonography in objective and quantitative assessment of true vocal fold movement. MethodsThe lateral-approach laryngeal ultrasonography was performed during calm breathing and breath-holding in young healthy adult volunteers. The morphology and anatomical position of false vocal fold, true vocal fold and arytenoid cartilage were observed and measured through the ultrasonic self-contained measurement function. All parameters, including the distance from false vocal fold to thyroid cartilage lamina, true vocal fold length, and the distance from true vocal fold to thyroid cartilage lamina, were obtained at the end of the calm inspiratory and breath-holding phases. Data were analyzed using a t test (P <0.05). ResultsForty healthy adult volunteers (age 20-34 years, Body Mass Index 19.5-23.8 kg/m2, 20 males and 20 females) with satisfactory ultrasonic images were included in the study. There were no significant differences in all laryngeal parameters between the left and right sides in either phase (P > 0.05). From the end of the calm inspiratory phase to the breath-holding phase, changes in all laryngeal parameters were significantly different (P < 0.05), regardless of gender. ConclusionsThis study demonstrated that the lateral-approach laryngeal ultrasonography seemed feasible to quantify and objectively assess true vocal fold movement, utilizing differences between laryngeal parameters before and after true vocal fold movement.

Investigation of the Position and Angle of the Vocal Fold Projected onto the Thyroid Cartilage.

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. 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]). 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. 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. IV Laryngoscope, 134:4088-4094, 2024.

Cricothyroid Muscle Dysfunction Affects Aerodynamic Performance in Patients with Unilateral Vocal Fold Paralysis.

Emerging evidence has revealed that cricothyroid (CT) muscle dysfunction in unilateral vocal fold paralysis (UVFP) further impairs patients' voices. Given that CT muscle dysfunction does not influence vocal fold position, the mechanism of voice dysfunction induced by dysfunction of CT muscle in UVFP patients remains controversial. This study compares aerodynamics between UVFP patients with and without CT muscle involvement. This cross-sectional study recruited patients with UVFP manifesting dysphonia, and UVFP was confirmed with videolaryngoscopy and laryngeal electromyography (LEMG). Voice analysis and aerodynamic tests were further performed. Patients with (CT+ group) and without (CT- group) CT muscle involvement were compared. A total of 175 patients (40 in the CT+ group and 135 in the CT- group) with UVFP were analyzed. The CT+ group showed lower maximal sound pressure level (SPL) (P=0.039), mean SPL (P=0.042), peak air pressure (P<0.001), mean peak air pressure (P<0.001) and aerodynamic power (P=0.004) than the CT- group. The decrease in SPL, peak air pressure, and aerodynamic power in UVFP patients with CT muscle dysfunction suggests that the effect of CT muscle dysfunction is mediated by a change in aerodynamics.

Registration and inpainting of biological slice images based on Bendlet transform and interval Shannon–Cosine wavelet

The fold that appeared in the micro-slice images needs to be inpainted exactly so that it can meet the requirements of the scientific experiments. The biological slice image usually consists of piecewise smooth regions with the closed loop contour which can be represented by the Bendlet function proposed in recent years. Therefore, a novel image inpainting method based on Bendlet and interval Shannon–Cosine wavelet is proposed. Since the deformation of the locust slice image is flexible, it is necessary to obtain as many feature points as possible to ensure the accuracy of the inpainting, so we introduce the curvature as a new registration element for registration. First, the homography matrix is obtained by calculating the correct feature points by our proposed registration method. Second, the fold position is located by homography matrix and inpainted by Shannon–Cosine interval wavelet interpolation. Finally, the pixel difference is eliminated through adaptive fusion. The results indicate that, in comparison to the SURF and ORB algorithms, our registration method significantly enhances the extraction of feature points, achieving a more even distribution. Furthermore, when compared to four other methods (K-SVD, BSCB, TV and Criminisi), as well as various interpolation methods such as cubic polynomial interpolation, cubic spline interpolation, and nearest neighbor interpolation, our approach consistently achieves the highest PSNR and SSIM values.

Spatiotemporal remodeling of extracellular matrix orients epithelial sheet folding.

Biological systems are inherently noisy; however, they produce highly stereotyped tissue morphology. Drosophila pupal wings show a highly stereotypic folding through uniform expansion and subsequent buckling of wing epithelium within a surrounding cuticle sac. The folding pattern produced by buckling is generally stochastic; it is thus unclear how buckling leads to stereotypic tissue folding of the wings. We found that the extracellular matrix (ECM) protein, Dumpy, guides the position and direction of buckling-induced folds. Dumpy anchors the wing epithelium to the overlying cuticle at specific tissue positions. Tissue-wide alterations of Dumpy deposition and degradation yielded different buckling patterns. In summary, we propose that spatiotemporal ECM remodeling shapes stereotyped tissue folding through dynamic interactions between the epithelium and its external structures.

A New design of deployable pedestrian bridge deck based on origami theory

As one of the basic civil engineering structures, bridges greatly impact people’s daily life. However, many bridge accidents are caused by boat crashes because of the driver’s carelessness or other climatic and hydrological factors. Besides, some pedestrian bridges are not frequently used and thus make a waste of water space. This design will overcome the challenge and tackle the problem successfully based on the origami and kirigami theory by using a connector composed of a slider and a revolute joint. The bridge can be folded up and down via a particular folding method. The basic structure units have two degrees of freedom (DOF). The whole mechanism can be folded and unfolded by sliding and rotating the connector. According to the structural folding position analysis results shown in the diagrams, the new deployable bridge deck structure design can validly tackle the problems of clearance limitation under the bridge via the special-designed cross-section of the bridge deck. I hope the design model will be widely applied in the river-crossing bridge and bring convenience to all pedestrians and boat drivers.

The influence of compressive stresses on folding in the Middle Kura depression and the Turkmen shelf

&#x0D; &#x0D; &#x0D; On the basis of the morphology of the folds, their three-dimensional position, the types of faults and the development of mud volcanism, the features of the spread of compres- sive stresses and their influence on the oil and gas bearing of the Kura and Gabirri interfluve, the Yevlakh-Agjabedi depression and the Godin massif were studied. For this purpose, maps of isomorphs and morphological schemes, positions of local folds on the plan of each of these structural elements were compiled. It has been established that within the depressions, the process of folding took place due to the mechanisms of longitudinal and latitudinal bending, which led to the formation of mostly linear and brachiform folds within them. The high intensity of compressive stresses with- in the Kura and Gabirri interfluve contributed to the development of mud volcanism here, and the increase in their intensity at the end of the Miocene led to the emergence of disharmony here in the structural plans between the Cretaceous-Eocene and Oligocene-Quater- nary complexes of sediments. For this purpose, the development of the Barda and Shirvanli structures located in the Yevlakh-Agjabedi depression along the section was investigated and it was determined that they had an uneven development. The Shirvanli fold, which is located in the southwestern zone of the region, had a height of 50-70 m according to the top of the Late Cretaceous. According to the top of the Paleocene, it reached a height of 150 m, and according to the top of the carbonate layer, which forms the lower part of the section of the Eocene, a fold developed and reached a height of 300 m. The Shirvanli fold, which began to form in the Eocene, developed more intensively in the Maikop age sediments. The reason for this was the high mobility of clay sediments along the section and the activation of compressive stress. The development of the Shirvanli structure in the Cretaceous proves its hereditary origin. The Barda fold, located in the northeast part of the Shirvanli fold, according to the top of the Eocene express itself as a structural terrace. It does not express itself as a structure by the bottom of Paleocene and the washed surface of the Cretaceous sediments complexes, but according to the top of the Maikop sedimentary complex, it is a local fold with a height greater than 300 m. It was determined that the thickness of Maikop sediments in the core of the Barda fold confirms that Maikop clays play a key role in the development of the fold. At the same time, the significant decrease in the thickness of the Sarmatian and Chokrak sediments in the crest part of the mentioned fold is indicative of its syn-depositional development in the same time interval. As it is clear from the morphological and developmental features of both mentioned folds , they are of diapiric origin, but due to the relatively weak development of compressive stresses, the low thickness of the sedimentary layer lying on the Maikop sediments, these folds did not have the necessary energy potential to fully realize diaprism. The latitudinal bending mechanism in the formation of these folds was relatively weak. The effusive massif in the Yevlakh-Agjabedi depression significantly limits the activity of compressional stress in this area. Compressive stresses have had their effect on the structures formed in the Oligocene-Miocene sediments on the northwestern slope of the Yevlakh-Agjabedi depression, but they were weakly expressed in the Neogene sediments due to the regional erosion that began in the second half of the Sarmatian age. It should be noted that the Barda and Shirvanli structures began their development period in the Cretaceous, and were faced with the compressive stresses in Maikop. Within the Godin massif, the morphology of the folds, their disordered three-dimensional position, testify to the absence of the influence of compressive stresses on the fold formation process.&#x0D; &#x0D; &#x0D;

DRX mechanisms of a Ni-Co-W type superalloy with typical columnar grains during hot compression

Columnar evolution and DRX mechanisms of a Ni-Co-W type superalloy with typical columnar grains during hot deformation were investigated processed at the γ′ sub/super-solvus temperatures. Electron backscatter diffraction (EBSD) and transmission electron microscopy (TEM) was employed to characterize the nucleation at columnar boundary. The results show that columnar grains gradually replaced by new dynamic recrystallization (DRX) grains and nucleation was prioritized at original columnar boundary or/and folding position. Meanwhile, DRX mechanisms of the columnar structure associated with γ′ phase were identified deeply. Discontinuous dynamic recrystallization (DDRX) was the main mechanism when deformation processed at γ′ sub/super-solvus temperatures. Bulging columnar grain boundaries are first as the nucleation sites of the new DDRX grains under various conditions. High angle grain boundaries (HAGBs: θ > 15°) bends to the side with γ′ phase, and then the DRX grains formed at the bulging grain boundary. In addition, high dislocation density zone occurred around the large size γ′ phases (more than 1 µm), leading to the misorientation generated rapidly and then the HAGBs formed. The formation of DRX grains by this way is also called particle stimulated nucleation (PSN) mechanism. Continuous dynamic recrystallization (CDRX) occurs when hot deformation processed at γ′ sub-solvus temperature with high strain level, which is accompanied by dislocation accumulation and an obviously increase in the fraction of grain boundaries with 10–15° misorientation angle. The findings help to understand different DRX mechanisms of Ni-based superalloy with columnar structure during microstructure evolution under hot forming, and are also beneficial for optimizing the microstructure to control the required properties of the Ni-based superalloys for manufacturing turbine disc.

A Prospective Cohort Study Re-examining Tissue Oximetry Monitoring in Microsurgical Breast Reconstruction.

The goal of inpatient monitoring after microsurgical breast reconstruction is to detect vascular compromise before flap loss. Near-infrared tissue oximetry (NITO) is commonly used for this purpose, but recent reports challenge its specificity and utility in current practice. Fifteen years after Keller published his initial study using this technology at our institution, we re-evaluate the role and limitations of this popular monitoring device. A 1-year prospective study was performed for patients undergoing microsurgical breast reconstruction and monitored postoperatively using NITO. Alerts were evaluated, and clinical endpoints relating to an unplanned return to the operating room or flap loss were recorded. A total of 118 patients reconstructed with 225 flaps were included within the study. There were no cases of flap loss at the time of discharge. There were 71 alerts relating to a drop in oximetry saturation. Of these, 68 (95.8%) were deemed to be of no significance. In 3 cases (positive predictive value of 4.2%), the alert was significant, and there were concerning clinical signs apparent at that point. A sensor in an inframammary fold position was associated with nearly twice the average number of alerts as compared with areolar or periareolar positions ( P = 0.01). In 4 patients (3.4%), a breast hematoma required operative evacuation, and these cases were detected by nursing clinical examination. The monitoring of free flaps after breast reconstruction through tissue oximetry shows a poor positive predictive value for flap compromise and requires clinical corroboration of alerts but missed no pedicle-related adverse events. With a high sensitivity for pedicle-related issues, NITO may be helpful postoperatively, but the exact timeframe for use must be weighed at the institutional level.

Flat band in hole-doped transition metal dichalcogenide observed by angle-resolved photoemission spectroscopy

Layered transition metal dichalcogenides (TMDCs) gained widespread attention because of their electron-correlation-related physics, such as charge density wave (CDW), superconductivity, etc. In this paper, we report the high-resolution angle-resolved photoemission spectroscopy (ARPES) studies on the electronic structure of Ti-doped 1T-Ti x Ta1–x S2 with different doping levels. We observe a flat band that originates from the formation of the star of David super-cell at the x = 5% sample at the low temperature. With the increasing Ti doping levels, the flat band vanishes in the x = 8% sample due to the extra hole carrier. We also find the band shift and variation of the CDW gap caused by the Ti-doping. Meanwhile, the band folding positions and the CDW vector q CDW are intact. Our ARPES results suggest that the localized flat band and the correlation effect in the 1T-TMDCs could be tuned by changing the filling factor through the doping electron or hole carriers. The Ti-doped 1T-Ti x Ta1–x S2 provides a platform to fine-tune the electronic structure evolution and a new insight into the strongly correlated physics in the TMDC materials.

Optimal Deep Learning-Based Vocal Fold Disorder Detection and Classification Model on High-Speed Video Endoscopy.

The use of high-speed video-endoscopy (HSV) in the study of phonatory processes linked to speech needs the precise identification of vocal fold boundaries at the time of vibration. The HSV is a unique laryngeal imaging technology that captures intracycle vocal fold vibrations at a higher frame rate without the need for auditory inputs. The HSV is also effective in identifying the vibrational characteristics of the vocal folds with an increased temporal resolution during retained phonation and flowing speech. Clinically significant vocal fold vibratory characteristics in running speech can be retrieved by creating automated algorithms for extracting HSV-based vocal fold vibration data. The best deep learning-based diagnosis and categorization of vocal fold abnormalities is due to the usage of HSV (ODL-VFDDC). The suggested ODL-VFDDC technique starts with temporal segmentation and motion correction to identify vocalized regions from the HSV recording and gathers the position of movable vocal folds across frames. The attributes gathered are fed into the deep belief network (DBN) model. Furthermore, the agricultural fertility algorithm (AFA) is used to optimize the hyperparameter tuning of the DBN model, which improves classification results. In terms of vocal fold disorder classification, the testing results demonstrated that the ODL-VFDDC technique beats the other existing methodologies. The farmland fertility algorithm (FFA) is then used to accurately determine the glottal limits of vibrating vocal folds. The suggested method has successfully tracked the speech fold boundaries across frames with minimum processing cost and high resilience to picture noise. This method gives a way to look at how the vocal folds move during a connected speech that is completely done by itself.

A Mechanics Analysis of Carbon Fiber Plain-Woven Thermoset Prepreg during Forming Process Considering Temperature Effect.

The preforming quality of carbon fiber plain-woven thermoset prepreg (CFPWTP) is critical to the performance of composite aerospace parts. The deformation ability of the CFPWTP material during preforming is affected by both the fabric woven structure and the resin viscosity, which is different from the dry textile material. Incorrect temperature parameters can enlarge the resin’s viscosity, and high viscosity can inhibit fiber deformation and cause defects. This study proposes an equivalent continuum mechanics model considering its temperature–force behavior. Picture frame tests and axial tensile tests at 15 °C, 30 °C, and 45 °C are conducted to obtain the temperature–stress–strain constitutional equations. By Taylor’s expansion formula and surface fitting method, the constitutive modulus of the material is obtained. Consequently, a saddle-shaped forming simulation is carried out, which is later validated by experiments. Results show that the accuracy of the predicted model is high, with 0.9% of width error and 5.1% of length error separately. Besides, the predicted wrinkles are consistent with the test in fold position and in deformation trend under different temperatures.

Long-term outcomes of oncoplastic breast resection with local perforator flaps

Background. Oncoplastic breast resections with perforator flaps are relatively common now; however, many studies demonstrate contradictory results, especially in terms of long-term outcomes.Objective: to assess short-term and long-term outcomes of oncoplastic breast resection with defect repair using perforator flaps.Materials and methods. This study included 62 breast cancer patients who underwent oncoplastic breast resection with defect repair using local perforator flaps, including lateral intercostal artery perforator (LICAP) flaps (40.3 %), lateral thoracic artery perforator (LTAP) (19.4 %), anterior intercostal artery perforator (AICAP) (27.4 %), and medial intercostal artery perforator (MICAP) (12.9 %) flaps. The assessment of oncological, functional, and aesthetic outcomes was performed in patients who were followed-up for at least a year (n = 57). Mean follow-up time was 26.5 months (range: 14–38 months).Results. The following complications were registered among the patients studied: seroma in the area of excised primary tumor (8.1 %), insufficient blood supply of the flap that caused focal lipofibrosis/liponecrosis (3.2 %), positive resection margin (3.2 %), low position of the submammary fold (11.3 %), locoregional recurrence (0 %), generalized process (3.5 %). All women evaluated their functional and aesthetic result as good or excellent. According to BCCT.core 3.0, 91.3 % of patients achieved good and excellent results.

Stepwise approach to preserve the external branch of superior laryngeal nerve during thyroidectomy

BackgroundMost of the surgeons tend to avoid exposing and identification the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy. In this study, our aim is to assess sequential steps to ligate superior thyroid vessels safely away from the External branch of superior laryngeal nerve (EBSLN).MethodsThis prospective case series study was conducted on 60 patients going for either total or hemi thyroidectomy in a tertiary teaching hospital between January 2016 and June 2019. During thyroidectomy, firstly we skeletonized the upper pole of the thyroid gland by its capsular dissection followed by anterolateral down retraction of the superior pole. Then, entry and opening of the cricothyroid space and lastly clamping and ligating superior thyroid pedicle close to the upper pole away from EBSLN.ResultsThis study included 60 cases; 19 total thyroidectomy and 41 hemi thyroidectomy with 79 superior thyroid vessels ligation and EBSLN at risk. In all patients, no evidence of superior laryngeal nerve (SLN) palsy or bleeding was detected. Postoperative video laryngoendoscopy showed apparently normal mobility, length, level, and position of the vocal folds with symmetry of the larynx. The patients’ voice showed no changes from preoperative evaluation in all studied patients at 3 months postoperative evaluation. No patients complained of any changes in their voice or voice activities.ConclusionThe described stepwise approach for preservation of the EBSLN serves to completely remove the superior pole of the thyroid gland and ligate superior thyroid vascular pedicle without risk of SLN injury.

A Simple Preoperative Marking of Implant Augmentation Mammoplasty: The Semicircle Method.

The location of the inframammary fold is the most critical step in the preoperative marking of implant augmentation mammoplasty. At present, most of the calculation formulas for new inframammary fold location determination are complicated. Based on the aesthetic standards of the breast, we proposed a simple and effective method, the Semicircle method, to determine the location of the new inframammary fold. In this prospective study, 21 patients were enrolled to record the distance from the nipple to the new inframammary fold calculated by the Semicircle method, Tebbetts method, Randquist method, Mallucci's ICE method and compare the Semicircle method to the other three methods by using the intraclass correlation coefficient. According to the statistical results of the intraclass correlation coefficient, the Semicircle method had poor consistency with the Tebbetts and ICE methods, but good consistency with the Randquist method. The Semicircle method is a simple and aesthetically acceptable design method for breast augmentation mammoplasty, which can quickly and efficiently determine the position of the new inframammary fold. At the same time, this method has good consistency with the Randquist method and can obtain satisfactory breast morphology. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Discovery of Novel GR Ligands toward Druggable GR Antagonist Conformations Identified by MD Simulations and Markov State Model Analysis.

Binding of different ligands to glucocorticoid receptor (GR) may induce different conformational changes and even trigger completely opposite biological functions. To understand the allosteric communication within the GR ligand binding domain, the folding pathway of helix 12 (H12) induced by the binding of the agonist dexamethasone (DEX), antagonist RU486, and modulator AZD9567 are explored by molecular dynamics simulations and Markov state model analysis. The ligands can regulate the volume of the activation function‐2 through the residues Phe737 and Gln738. Without ligand or with agonist binding, H12 swings from inward to outward to visit different folding positions. However, the binding of RU486 or AZD9567 perturbs the structural state, and the passive antagonist state appears more stable. Structure‐based virtual screening and in vitro bioassays are used to discover novel GR ligands that bias the conformation equilibria toward the passive antagonist state. HP‐19 exhibits the best anti‐inflammatory activity (IC50 = 0.041 ± 0.011 µm) in nuclear factor‐kappa B signaling pathway, which is comparable to that of DEX. HP‐19 also does not induce adverse effect‐related transactivation functions of GR. The novel ligands discovered here may serve as promising starting points for the development of GR modulators.

Effects of percutaneous injection laryngoplasty on voice and swallowing problems in cancer-related unilateral vocal cord paralysis.

BackgroundUnilateral vocal cord paralysis may result from nerve compression by tumors or direct nerve injuries during tumor resections, which can cause dysphonia or dysphagia, and reduced quality of life.ObjectivesThis prospective, single‐group study aimed to investigate the effect of percutaneous injection laryngoplasty on voice and swallowing function in patients with cancer‐related unilateral vocal cord paralysis.MethodsPatients underwent percutaneous injection laryngoplasty with hyaluronic acid under local anesthesia. Stroboscopy and videofluoroscopic swallowing study were conducted to evaluate the voice‐ and swallowing‐related outcome measures, respectively. The participants were evaluated before injection laryngoplasty, as well as after two weeks and three months.ResultsInjection laryngoplasty significantly improved the glottal gap, vocal fold position, Maximum Phonation Time, and Voice Handicap Index‐10. Post‐hoc analysis using Bonferroni correction showed that the improvements occurred within two post‐treatment weeks and remained at three post‐treatment months. In the subgroup analysis, the patients who underwent injection laryngoplasty within 8 weeks from onset showed significantly higher improvements in the videofluoroscopic dysphagia scale and swallowing function than the patients who received the procedure after 8 weeks or more.ConclusionPercutaneous injection laryngoplasty improves glottal closure and voice in patients with cancer‐related unilateral vocal cord paralysis. Early injection laryngoplasty may lead to greater benefits on swallowing function.Level of Evidence4.

Quantitative Analysis of Nipple to Inframammary Fold Distance Variation in Tuberous Breast Augmentation: Is there a Progressive Lower Pole Expansion?

In patients with short nipple to inframammary fold (N-IMF) distance, as in tuberous breast, the cohesivity and gel distribution of shaped implants work as a controlled tissue expander, progressively adapting the tissues to the implant's shape. This phenomenon translates into a gradual increase of the N-IMF distance over time, but the true extent to which this occurs has not been quantified to date. This study aims to quantify the postoperative variation of the N-IMF distance in tuberous breast treated with shaped cohesive silicone breast implants. We did a retrospective review of a prospective maintained database of all consecutive patients with bilateral Groulleau I and II tuberous breasts who underwent primary breast augmentation between April 2017 and May 2018 at our institution. To quantify the lower mammary pole's morphological changes, we evaluated the N-IMF distance under maximal stretch as an endpoint. We recorded this value at time 0 (preoperative), immediate post-op (equivalent to the distance planned preoperatively) and at month 1, month 6 and 1-year post-op. Then we calculated the average N-IMF distance variation of our sample of patients with a 99% interval of confidence for each breast obtained. Comparisons were performed using the Sign test and the Mann-Whitney U test. The average implant weight was 353g (range 290-450; SD ±46.147). Of the 54 breasts analyzed, the immediate post-op N-IMF distance was on average 2.43 cm longer than the preop IMF with a 99% confidence interval between 2.01 and 2.86 and SD of ±1.22. The mean difference between the preop N-IMF distance and after 1, 6 and 12 months was respectively 2.78cm (SD,1.56) (99% CI, 2.24-3.34), 3.08 cm (SD, 1.57) (99% CI, 2.53-3.64), and 3.36 (1.55) (99% CI, 2.82-3.91) Comparing immediate postoperative nipple to inframammary fold distance (N-IMF) to the 1, 6 and 12 months N-IMF values, an average of 4.23% (CI 1.3-7.16), 7.74% (CI 4.25-11.23) and 10.84% (CI 7.21-14.49) of skin length, was gained respectively. According to implants' weight, subgroup analysis showed that implants > 400g were associated with significantly higher N-IMF distance increase (p <0.05) compared to implants < 400g. Our findings suggest that a significant progressive postoperative increase in N-IMF distance should be expected in all cases of tuberous breast augmentation with anatomical implants over a 1 year period. This aspect may have an important implication on the IMF incision and the new fold position preoperative planning. LEVEL OF EVIDENCE IV.

Laryngeal framework surgery

Laryngeal framework surgery is an umbrella term for all phonosurgical procedures by which the cartilaginous structure of the larynx and thereby the position and tension of the vocal folds are changed. The aim is to improve the voice. By far the best known and most frequently performed operation is thyroplasty type1 according to Isshiki, also known as medialization thyroplasty, which is indicated for treatment of glottic insufficiency. Although the first medialization thyroplasty was successfully performed by Payr in Germany in 1915, more than 100years later, it is still not widely used in Germany.

The Management in Patients With Bilateral Vocal Fold Immobility: 15 Years' Experience at a Tertiary Centre

In order to correct the varying vocal fold positions to meet the various clinical requirements in patients with bilateral vocal fold immobility, we present pertinent surgical methods to treat them. From 2005 to 2020, 115 patients diagnosed with bilateral vocal fold immobility were addressed for ventilation in 89 patients and for phonation in 26 patients. In the ventilation surgery group, all the neurogenic subjects received mere suture lateralization (SL) procedures and the mechanical ones underwent arytenoid release (AR) plus SL procedures if the cricoarytenoid joint fixation (CAJF) could be confirmed before operation. In the phonation group, neurogenic subjects received nonsurgical treatment and the mechanical ones underwent AR plus arytenoid adduction (AA) procedure. The decannulation rate and respiratory comfort rate for each subgroup will be calculated and the phonatory tests were conducted. In the ventilation group, 55% (49/89) of subjects received related surgeries. Mere SL offered 40 successful decannulation or respiratory comfort in 42 neurogenic subjects (95.2%). The single episode rate was high as 95%. An AR plus SL procedure also obtained 100% of decannulation or respiratory comfort with a single episode of surgical procedure if the CAJF could be confirmed preoperatively. In the phonation group, 15% (4/26) of subjects received appropriate surgeries. Single AR plus AA procedures also led to 100% (4/4) of the appropriate candidates serviceable sound. SL procedure keeping intact laryngeal mucosa usually offered permanent glottis enlarging effect or decannulation with a single episode of procedure. The use of arytenoid release for CAJF has led to remarkable advances in the ultimate surgical outcomes of both the ventilation and phonation in terms of decreasing revision surgeries. level 4.