Glottic Region Research Articles

Transglottic laryngeal melanoma presented as a severe dyspnea

Introduction. While mucosal melanoma of the head and neck remains an uncommon condition, its incidence has been on the rise in recent decades. Within the larynx, the supraglottis represents the most frequently affected subsite, followed by the glottis, with hoarseness being the predominant symptom. Given the tumor's aggressive behavior and its challenging location, it is often overlooked until it progresses to an advanced stage, which significantly worsens the prognosis. Case report. A 45-year-old male patient with stridorous breathing presented to the emergency room. An indirect laryngoscopy revealed a transglottic mass occupying the left piriform recess and almost the entire laryngeal inlet, leading to an exceptionally narrowed airway. Urgent tracheostomy was performed. Contrast-enhanced computed tomography (CT) of the neck identified an ulceroproliferative mass in the larynx, spanning the supraglottic, glottic, and subglottic regions, causing airway narrowing and extending into the left pyriform sinus. Laryngoscopy was performed, and biopsy of the laryngeal lesion confirmed a diagnosis of malignant melanoma. Unfortunately, the patient refused further surgical and oncological treatment, as well as additional diagnostic procedures. Four months after the initial diagnosis, the patient was lost to follow-up. Conclusion. Laryngeal melanoma is an uncommon condition that can necessitate an emergency tracheostomy. Since melanoma can be mistaken for other laryngeal malignancies, immunohistochemical analysis plays a crucial role in making an accurate diagnosis. Early detection of the disease is vital.

Diagnostic Performance of Computed Tomography in Laryngeal Carcinoma and its Extension

Background: Laryngeal carcinoma is a common malignant neoplasm of the head and neck with high incidence of new malignancies worldwide every year. Several imaging techniques including magnetic resonance imaging (MRI) and computed tomography (CT) scans are widely used to detect laryngeal carcinoma. Of them, CT scan is relatively cheaper, easily available and sensitive in the evaluation of laryngeal carcinoma. Objective: To find out the diagnostic performance of CT scan in laryngeal carcinoma and its extensions. Methodology: This cross-sectional study was carried out in the department of Radiology and Imaging, Dhaka Medical CollegeHospital, Dhaka, during the period of July, 2016 to June, 2018 for a period of 2(two) years. A total of 50 samples were included purposively. The enrolled patients were attending outpatient department (OPD) or admitted in indoor and referred to the Radiology and Imaging department for CT scan. All the enrolled cases had laryngectomy and resected tissues were sent for histopathological examination. Data collection was done by the principal investigator and a preformed questionnaire was used during data collection. Following completion of data collection, it was analyzed by SPSS 20.0. Results: Age range of the patients was from 18 to 84 years, with the mean age of 61.2 years + 13.4 years standard deviation and a male-female ratio of about 7.3:1. By multidetector CT scan, majority (32, 64.00%) of the tumours were found confined in a specific area with no extension, followed by 12 (24.00%) involving both supraglottic and glottic region. On the other hand, by histopathology, almost all (47, 94.00%) of the cases were found malignant and majority of the malignant cases (31, 65.96%) were found without nodal metastasis. Validity tests of CT in the diagnosis of laryngeal carcinoma revealed sensitivity, specificity, accuracy and positive predictive values of 97.9%, 66.7%, 96% and 97.9% respectively. In case of nodal metastases, the sensitivity, specificity, accuracy and positive predictive value were 93.8%, 97%, 96% and 93.8% respectively. Conclusion: Contrast enhanced CT scan has good role in detecting nodal metastases, but had complementary role in detecting laryngeal carcinoma. Journal of Monno Medical College December, 2023; 9 (2): 63-67

Role of EBUS in lymphoma presenting as superior vena cava syndrome: bronchoscopic and sonographic findings: a case report

BackgroundThe clinical description of superior vena cava syndrome has been widely studied; however, there is limited information on bronchoscopic findings in clinical practice.Case presentationA 57-year-old man presented with facial and neck swelling and pedal edema of 6 months duration. Computed tomography showed mediastinal lesions in the right paratracheal stations with thrombosis of the right internal jugular vein and superior vena cava (SVC). Without establishing a diagnosis, he was started on oral steroids elsewhere and his symptoms progressed. He did not receive anticoagulation therapy. Bronchoscopy showed edematous supraglottic and glottic regions with hyperemia of the airway mucosa. Endobronchial Ultrasonography revealed a mediastinal mass of heterogeneous echotexture in the lower right paratracheal region, with mediastinal collateral blood vessels. He underwent EBUS-guided aspiration cytology and intranodal forceps biopsy, which confirmed the diagnosis of non-Hodgkin’s.ConclusionIn cases with an unconfirmed diagnosis of lymphoma, it is prudent to refrain from administering glucocorticoids, as these medications can exhibit lympholytic properties and may hinder the diagnostic process. Due to extensive collateral formation in superior vena cava syndrome, utilizing Doppler during endobronchial ultrasound transbronchial needle aspiration (EBUS TBNA) can identify numerous mediastinal collateral vessels, thus minimizing the risk of bleeding.

Laryngeal response to high-intensity exercise in healthy athletes

IntroductionExercise-induced laryngeal obstruction (EILO) is a common cause of exertional breathing problems. The current diagnostic approach rests on evaluation of laryngeal obstruction visualised by laryngoscopy performed continuously throughout a maximal...

An Idiopathic Acquired Supraglottic Web.

Laryngeal webs are abnormal formation of an epithelium-covered fibrous tissue between two structures within the larynx (Pegg et al. in Ear Nose Throat J 90(10):486-488, 2011). Most of the laryngeal webs occurs at the level of glottic region which may extend till anterior 1/3rd of vocal cords, but it can also extend in to posterior glottis and inferiorly till subglottic region (Singh in J Indian Assoc Pediatr Surg 14(3):108-109, 2009). Acquired laryngeal webs are more common than congenital laryngeal web. Idiopathic supraglottic web is a rare entity and only one case have been reported worldwide (Table 1). We report a case of an idiopathic acquired supraglottic web in a 27-year-old man. The web was managed with CO2 laser excision under micro laryngoscopy guidance.

Acantholytic squamous cell carcinoma of larynx: An unusual cause of asphyxial death diagnosed on autopsy

Acantholytic squamous cell carcinoma (ASCC) is an uncommon histopathological variant of squamous cell carcinoma (SCC). This tumor commonly occurs in the sun exposed areas of skin at the head and neck location. The possible occurrence at mucosal sites has seldom been reported. Although, this malignant tumor has an excellent prognosis in the skin, in sharp contrast, mucosal involvement carries a worse prognosis. Here, we explore an intriguing case of an asphyxial death of a 35-year-old man due to a polypoidal mass occluding the airway in the glottic region. Subsequently, based on the histopathological and immunohistochemical findings, the cause of death was diagnosed as ASCC based on histopathological and immunohistochemical findings. Furthermore, this report also highlights the rarity of this variant of SCC at an uncommon location, thus making it the third case ever reported in literature. The other interesting fact about this case is that most of the published reports in the literature have described and diagnosed this rare variant on antemortem examination; contrarily, a postmortem diagnosis of ASCC is exceptional, making it the first report ever in history.

Scale resolving simulations of the effect of glottis motion and the laryngeal jet on flow dynamics during respiration

Background and ObjectiveThe movement of the respiratory walls has a significant impact on airflow through the respiratory tract. The majority of computational fluid dynamics (CFD) studies assume a static geometry which may not provide a realistic flow field. Furthermore, many studies use Reynolds Averaged Navier-Stokes (RANS) turbulence models that do not resolve turbulence structure. Combining the application of advanced scale-resolving turbulence models with moving respiratory walls using CFD will provide detailed insights into respiratory flow structures. MethodsThis study simulated a complete breathing cycle involving inhalation and exhalation in a nasal cavity to trachea geometry that incorporated moving glottis walls. A second breathing cycle was simulated with static glottis walls for comparison. A recently developed hybrid RANS-LES turbulence model, the Stress-Blended Eddy Simulation (SBES), was incorporated to resolve turbulent flow structures in fine detail for both transient simulations. Transient results were compared with steady-state RANS simulations for the same respiratory geometry. ResultsGlottis motion caused substantial effects on flow structure through the complete breathing cycle. Significant flow structure and velocity variations were observed due to glottal motion, primarily in the larynx and trachea. Resolved turbulence structures using SBES showed an intense mixing section in the glottis region during inhalation and in the nasopharynx during expiration, which was not present in the RANS simulations. ConclusionTransient simulations of a realistic breathing cycle uncovered flow structures absent in simulations with a constant flow rate. Furthermore, the incorporation of glottis motion impacted airflow characteristics that suggest rigid respiratory walls do not accurately describe respiratory flow. Future research in respiratory airflow should be conducted using transient scale-resolving models in conjunction with moving respiratory walls to capture flow structures in detail.

Demographic and Clinical Characteristics of Benign Laryngeal Lesions: Insights from a Decade of Experience in a Tertiary Hospital.

Benign laryngeal lesions, characterized by non-cancerous growths in the larynx, significantly impact voice quality and respiratory function. These lesions, which include vocal cord polyps, nodules, papillomas, and cysts, often result from factors such as vocal abuse, viral infections, and chronic inflammation. While studies on benign laryngeal lesions are well-documented globally, data specific to Northern Nigeria remains sparse. This study aims to analyze the demographics, clinical features, treatment modalities, and outcomes of benign laryngeal lesions over a decade in a tertiary otolaryngology center in Northern Nigeria. A retrospective review of 176 cases of benign laryngeal lesions was conducted over 10-years (2011-2020). Data were collected on patient demographics, clinical presentation, risk factors, lesion characteristics, and treatment outcomes. All patients underwent flexible laryngoscopy, with a subset receiving CT scans and histopathological examination. The study excluded malignant lesions. The study population comprised 123 males (69.9%) and 53 females (30.1%), with a male-to-female ratio of 2.3:1. The age range of patients was from 1.5 to 69 years, with a mean age of 34.74 years (±16.64). The most common presenting symptom was hoarseness (94.8%), and most lesions were vocal cord polyps (52.3%), followed by vocal cord nodules (34.7%) and juvenile-onset respiratory papilloma (6.8%). The glottic region was the most frequent site of lesion occurrence (94.9%). Treatment primarily involved voice rest (43.2%), direct laryngoscopy with excision (22.2%), and microlaryngeal surgery (8.0%). Treatment outcomes showed a cure rate of 40.9%, with a recurrence rate of 29.0%. This study provides valuable insights into the demographic and clinical profiles of patients with benign laryngeal lesions in Northern Nigeria. The findings indicate a predominance of vocal cord polyps, significant gender disparity, and the effectiveness of surgical interventions. These results align with regional and international data but highlight the need for more localized studies to better understand the epidemiology and management of these lesions in Northern Nigeria. Further research should explore specific risk factors and the longterm outcomes of different treatment modalities.

The Value of Computed Tomography in Recurrent Laryngeal Cancer Following Organ Preservation Therapy.

This study aims to assess the accuracy of computed tomography (CT) in detecting recurrent laryngeal tumors after failed chemoradiation therapy (CRT). Local recurrence of laryngeal tumors following CRT has been reported in approximately 25%, yet it is often difficult to detect. Ten patients with laryngeal cancer who failed CRT and subsequently underwent salvage total laryngectomy were included. The laryngeal subsites involved in the tumor were identified based on postoperative pathology. The corresponding preoperative CT scans were selected for review by seven experts (head-and-neck surgeons or radiologists) who scored the extent of tumor spread on each scan on a 5-point scale, from no tumor detected to clearly visible tumor. The rates of high tumor detectability (scores 4-5) varied according to laryngeal subsite, from 75% in the glottic region, to 45% in the subglottic region, and to 19% in the supraglottic region (P=0.01). The detectability rates were higher on scans performed 2 years or more after CRT. The CT evaluation of laryngeal cancer after CRT has limited value, particularly in the epiglottis and subglottis.

A case report on attempted suicide by self-slitting resulting in laryngeal fracture

Introduction: Laryngeal fractures cause significant problems with airway patency, vocal production, and swallowing function. The mechanism of injury can be sharp or blunt and can occur in the supraglottic, glottic, or infraglottic regions. Blunt external trauma to the neck caused by motor vehicle accidents, sports-related trauma, assault, and strangulation are the most frequent causes of laryngeal ruptures and fractures. Penetrating trauma is the second leading cause, often due to gunshot or stab wounds to the neck. The immediate goal in patients presenting to the emergency department with laryngeal rupture is to secure the airway. One of the indications for tracheostomy placement includes acute respiratory failure with the need for prolonged mechanical ventilation.

Effects of Short-term Electronic(e)-Cigarette Aerosol Exposure in the Mouse Larynx.

The effects of electronic cigarettes (e-cigarettes) on the larynx are relatively unknown. This study examined the short-term effects of e-cigarette inhalation on cellular and inflammatory responses within the mouse laryngeal glottic and subglottic regions after exposure to pod-based devices (JUUL). Male C57BL6/J mice (8-9 weeks) were assigned to control (n = 9), JUUL flavors Mint (JMi; n = 10) or Mango (JMa; n = 10). JUUL mice were exposed to 2 h/day for 1, 5, and 10 days using the inExpose inhalation system. Control mice were in room air. Vocal fold (VF) epithelial thickness, cell proliferation, subglandular area and composition, inflammatory cell infiltration, and surface topography were evaluated in the harvested larynges. Mouse body weight and urinary nicotine biomarkers were also measured. Chemical analysis of JUUL aerosols was conducted using selective ion flow tube mass spectrometry. JUUL-exposed mice had reduced body weight after day 5. Urinary nicotine biomarker levels indicated successful JUUL exposure and metabolism. Quantitative analysis of JUUL aerosol indicated that chemical constituents differ between JMi and JMa flavors. VF epithelial thickness, cellular proliferation, glandular area, and surface topography remained unchanged after JUUL exposures. Acidic mucus content increased after 1 day of JMi exposure. VF macrophage and T-cell levels slightly increased after 10 days of JMi exposures. Short-term e-cigarette exposures cause minimal flavor- and region-specific cellular and inflammatory changes in the mouse larynx. This work provides a foundation for long-term studies to determine if these responses are altered with multiple e-cigarette components and concentrations. N/A Laryngoscope, 134:1316-1326, 2024.

Assessment of Preoperative Predictors for Difficult Laryngeal Exposure in Endolaryngeal Surgery.

The proper visualisation of the larynx is required for the diagnostic assessment and therapeutic intervention. The most significant challenges for surgeon is to visualise the anterior commissure of the glottis region. The aim of this study is to record the preoperative laryngoscore in patients posted for endolaryngeal surgery and to assess preoperative predictors for intraoperative difficult laryngeal exposure by correlating with preoperative laryngoscore. Prospective, Cross-sectional, Observational study. Department of Otorhinolaryngology in a tertiary care teaching facility. 150 patients were included with an endolaryngeal disease who were planned for surgery with age > 18yrs. In 150 subjects preoperative laryngoscore was calculated, which comprised 11 parameters including thyromental distance, mandibular prognathism, macroglossia, micrognathia, trismus, inter incisor gap, degree of neck flexion-extension, history of prior open-neck surgery or radiotherapy, upper jaw dental status, modified Mallampati score and body mass index in order to produce a total score out of a possible maximum score of 17. According to the anterior commissure visualisation all patients were categorised into five classes, ranging from class 0 to class IV during surgery. The laryngoscore parameters were assessed and compared statistically with five classes of intraoperative anterior commissure visualisation. Out of 150 patients 70 (46.6%) were having 3-4 laryngoscore, followed by 45 (30%) patients with 5-6 laryngoscore. Total 123 (82%) patient had class 0,1 and 2 intraoperative anterior commissure visualisation while 27 (18%) had class 3 and 4 visualisation. If laryngoscore was either less or equal to 5, 90% of the patients had excellent laryngeal exposure whereas only 10% of the patients had challenging laryngeal exposure. At univariate analysis, thyromental distance, degree of neck flexion/extension, and modified Mallampati classification were found statistically significant for difficulty of anterior commissure visualisation independently. A sound, easy and valid preoperative laryngoscore may be significantly helpful in identifying intraoperative difficult laryngeal exposure. This may prevent inadequacy of surgery, abandon of surgery, intra operative complication, and medico-legal cases for laryngologist.

Fabrication of Graphene Optical Devices for Endoscope Calibration

Endoscopic devices used in the clinical examination of pathologies such as glottic tumors can record real-time images of the vocal cords during vibration. Quantitative analysis of the glottic surface requires the metric system to obtain the absolute dimensions of the larynx in a series of acquired images. However, so far, there is no effectively automated and stable calibration method for clinical use. Therefore, most metrics used by professionals are invasive and subjective. Thus, this study reports the microfabrication of a diffractive optical element (DOE) that could potentially quantify cancer cells from the glottic surface of patients. It has been observed that the image of the glottis seen through an endoscope is shaped by its geometric properties and by the shading of color and brightness. Therefore, tumor location and size can be quantified by overlaying the DOE metric with light spots on images that include the glottic region. DOE was developed from processes used in the fabrication of integrated circuits and MEMS, already quite mature. To obtain high-quality images from optical reconstruction of the glottis, the use of graphene monolayers grown by chemical vapor deposition (CVD) on copper (Cu) foil was investigated. This was transferred to a glass substrate by wet method (Fishing method) and the etching steps of the Cu substrate were carried out. In this method, polymethylmethacrylate (PMMA) was used as the supporting polymer through the spinner. Two lithographs were made under the glass substrate with different approaches (using a Karl Suss MJB3 mask aligner system with a maximum resolution of 1 µm). The first, which preceded the thin-film transfer, aimed to delineate the graphene transfer area using an aluminum (Al) deposition technique by sputtering. The second lithography, linked to oxygen Ashing plasma corrosion, made it possible to study the modulation of a microrelief containing parallel and serpentine patterns, of amplitude and phase, spaced from 1 to 10 μm. An optical system containing an EOD and a Fourier lens was attached to the endoscope end to project a laser line parallel to the vocal cords. Image processing methods automatically identify pixels in the image data that belong to the projected laser line. Thus, the detection of the diffractive pattern was based on segmentation of endoscopic images centered on Sobel filtering and on the method with active boundary regions of the watershed. These use successively robust temporal and spatial characteristics of the laser lines projected onto the endoscopic image sequence. In short, the combination of laser projection device and image processing allows calibration of endoscopic images and can provide quantitative metric data for tumors on the surface of the vocal cords. Therefore, the proposed calibration method can be considered a powerful tool to aid in the prognosis of laryngeal pathologies. Figure 1

The subglottic involvement is an independent risk factor for recurrence of laryngeal amyloidosis.

To analyze the risk factors for recurrence of laryngeal amyloidosis (LA). The clinical data of patients with LA admitted in the Otolaryngology Head and Neck Surgery Department of the Second Affiliated Hospital of Xi'an Jiaotong University from August 2009 to June 2022 were analyzed retrospectively; then, the risk factors for recurrence and their impacts on the recurrence time were also analyzed. Of the 44 patients with LA, the majority (38 cases, 86.4%) only involved one anatomical region and the others (6 cases, 13.6%) involved two laryngeal regions concurrently. Overall, the glottic region was the most commonly affected area (28 cases, 63.6%), followed by the supraglottic region (16 cases, 36.4%) and subglottic region (6 cases, 13.6%). In addition, all the lesions were categorized as isolated nodule (31.8%), submucosal localized deposition (52.3%), and submucosal diffuse deposition (15.9%) according to their morphologies under electronic laryngoscope. Finally, six patients (13.6%) had recurrence after operation with a median recurrence time of 24.5months, and subglottic involvement was confirmed to be an independent risk factor for recurrence of LA by univariate and multivariate logistic regression analyses (P < 0.05). Meanwhile, the patients with subglottic involvement presented as submucosal diffuse deposition had a considerable shorter recurrence time (t = 5.759, P = 0.005). The subglottic involvement is an independent risk factor for recurrence of LA.

Multimodality Diagnosis of Laryngeal Cancer in “Dharmais” National Cancer Hospital (DNCH)

Background: Almost 95% of laryngeal cancers are squamous cell carcinoma. Most of them come from the supraglottic and glottic regions. Globally from 1990 to 2017, there was an increase in the incidence of laryngeal cancer by 58.67%. Patients with suggestive grievances of laryngeal cancer symptoms are usually advised to do a further examination. The use of multimodality diagnosis is helpful for the diagnosis of cancer. Diagnostic procedures in diagnosing laryngeal cancer can be made by history and physical examination, clinical (laryngoscopy), and supporting examination (radiology and biopsy). This study aims to determine the distribution of the demographic (gender, age, domicile, marital status, and educational level), clinical distribution (voice changes, respiratory disorders, pain, dizziness, cough, lump on the neck, and others), and modalities of diagnosis (anamnesis, clinical examination, radiology, and biopsy) in laryngeal cancer.Methods: Descriptive study and a routine data-based study was conducted by collecting data on cancer patients who were diagnosed with laryngeal cancer from 2003 to 2007 by the microscopic either in Dharmais National Cancer Hospital (DNCH) or other hospitals. The study sample was 53 out of a total of 68 cases of laryngeal cancer who had been diagnosed with malignancy histopathologically at DNCH or in other hospitals with epithelial or non-epithelial types with completed medical records. Results: The glottic region is the most common subsite, that is, 52.8%, and squamous cell carcinoma (SCC) is the most common histopathological type of laryngeal cancer. In most of the cases, either males or females presented with a change in the voice of 68.8% and 80% respectively. In 6 out of 12 cases have not been examined microscopically before, while 7.5%.of the cases have done the diagnostic procedure completely in DNCH. Conclusions: The most common subsite and histopathological type of laryngeal cancer is glottis and SCC. The most common clinical feature in both sexes is voice changes. Most cases have not been examined according to the standard diagnosis procedure completely.

High frequency jet-ventilation anaesthesia in patients with laryngeal patholog

Airway management in laryngeal surgeries is a challenge for an anesthesiologist due to sharing of airway with a surgeon. The airway is often compromised with potential for perioperative worsening. Introduction of high-frequency jet ventilation (HFJV) in 1970 offered a new modality to secure airway in the laryngology procedures, excluding the disadvantages of classic tracheal intubation. HFJV is characterized by delivery of small tidal volumes (1–2 ml/kg) from a high-pressure jet at supraphysiological frequencies (1–10 Hz) followed by passive expiration. At ENT clinic of “T.Moșneaga” hospital HFJV are used for several years. Applied via supraglottic aproach, HFJV is first choice in patients with severe laryngeal obstruction, lesions of posterior glottic regions, a lot of pacients being suffering of laryngeal papillomatosis. This method can be safely used in microlaryngeal surgery, excluding a lot of serious intraoperative complications, esspecially combustions of conventional endotracheal tubes. Till now, there are not reported complications in our local practice of HFJV.

VASCULAR CAUSE OF VOICE CHANGE/HOARSENESS OF VOICE - A RARE UNLEASHING CASE REPORT

Hemangioma is the most common benign vascular lesion. Laryngeal hemangioma is a rare entity and it is divided into infantile and adult form. Of these two, infantile hemangioma is more common than adult which is most commonly present in the subglottic region which regress spontaneously. Whereas, adult hemangioma requires intervention if large and symptomatic and it is most commonly located in supraglottic and glottic region. This is one such rare presentation in the adult.

Reabilitação vocal em cantoras com queixa vocal: análise da videoquimografia digital

ABSTRACT Purpose: to evaluate the effects of the Comprehensive Vocal Rehabilitation Program associated with the application of transcutaneous electrical nerve stimulation through digital kymography in singers with vocal complaints. Methods: an experimental intrasubject comparative study in 24 singers, who underwent the rehabilitation program associated with transcutaneous electrical nerve stimulation. They were assessed with laryngeal high-speed videoendoscopy before and after vocal rehabilitation. The paired t-test and Wilcoxon test were used to compare the two assessments. The significance level was set at 5%. Results: significant differences were found in the maximum opening, dominant amplitude of the opening variation and dominant frequency of the opening variation of the right vocal fold in the posterior glottic region, and in maximum opening, mean opening, dominant amplitude of the opening variation of the left vocal fold and dominant frequency of the opening variation of both vocal folds in the anterior glottic region. Conclusion: the results showed that the Comprehensive Vocal Rehabilitation Program associated with transcutaneous electrical stimulation decreased the opening amplitude of the vocal fold, increased the vibration frequency, and improved glottal closure in the anterior and posterior glottic regions.

Comparative Preference of Airtraq Laryngoscope Over Macintosh Laryngoscope- A Review

Tracheal intubation using a Macintosh laryngoscope can save lives. However, because intubation is a difficult procedure to master, failures can have disastrous results. A more recent intubation tool than the Macintosh is the Airtraq optical laryngoscope, which offers glottic plane visualization without requiring correct tracheal, pharyngeal and oral axes alignment. Airtraq can improve the incidence of failed first intubations and the time required to manage an airway, especially in patients who have had cervical spine trauma which requires manual stabilization of the cervical spine. With no differences in hemodynamics or intubation duration, the Airtraq laryngoscope offered patients a better laryngeal vision than the Macintosh laryngoscope by providing shorter laryngoscopy and intubation time, and easier intubation. The aim of this literature review was to compare these two laryngoscopes with respect to endotracheal intubation. This review article was put together after a comprehensive study of the literature using the electronic databases PubMed, Medline, Embase and Google. Airtraq laryngoscope was found to be superior to Macintosh laryngoscope as it provides a better view of the glottic region with more ease and less intubation time than the conventional Macintosh laryngoscope.

Adult Laryngeal Hemangioma: Airway Obstruction

AbstractAdult laryngeal hemangiomas (ALH) are clearly defined, with a bluish red color, appearing most often in the glottic and supraglottic region. The principal symptoms are hoarseness, occasional hemoptysis, and in advanced cases, dysphagia and difficulty in breathing. The patient was a 55 year old female suffering from hoarseness for a long time, experiencing shortness of breath for the last 1 year and she was referred to our clinic from the emergency department due to stridor. In the endoscopic examination of the patient, both vocal cords were found to be mobile, and a blue-purple mass lesion was detected, which was filling the subglottic region and allowing air passage only in the posterior part. Emergent tracheotomy was performed for the airway safety. The mass located in the subglottic region was approached with the Laryngofissure technique and was excised. Surgical management is necessary when ALHs became symptomatic for hemorrhagic or infectious complications, or for progressive airway obstruction. In this paper, we present the clinical and radiological features of a large subglottic ALH.