Laryngeal Area Research Articles

Optimizing Radiation Treatment for Head and Neck Cancer with Adapt-to-Shape Planning on a 1.5 MR-Linac

<h3>Purpose/Objective(s)</h3> MR Linac (MRL) has the advantage of using high soft tissue contrast imaging to track the changes in target and critical organs on a daily basis during the entire radiation treatment course. The potential benefits include improved local control and decreased risk of toxicities. We present our experience on using the adapt-to-shape (ATS) technique on a 1.5 MR-Linac for optimized adaptive treatment of our head and neck (HN) patients. <h3>Materials/Methods</h3> Twelve HN patients were treated on a 1.5 MR-Linac in 2021 with one or more adapt-to-shape (ATS) treatment plans. All patients also had backup plans on another Linac unit. We compared the treatment planning software reference plans and backup TPS plans. Adapt-to-position (ATP) plan was routinely used for treatments, while ATS plan was generated based on physician's request, on the observation of daily anatomy change, or on the challenges of ATP plans to meet clinical goals. For patients with ATS plans, CTV volumes and dosimetric criteria of the daily treatments were recorded. ATS plans were compared to ATP plans and the original reference plan. <h3>Results</h3> 12 HN patients were treated in the oropharynx area (n=9), larynx area (n=2), and nasopharynx area (n=1). Median prescription was 69.96Gy (range: 63Gy – 69.96Gy) in 33 fractions (range: 28-33 fractions). MRL reference plans achieved all clinical goals but with lower primary CTV coverage, higher heterogeneity, and higher brainstem and spinal cord maximum dose (p<0.05) when compared to backup plans. 95.5% of the total 351 treatments were performed on the MRL, while 4.5% were performed using the backup plan. A total of 32 ATS plans (15 online, 17 offline) were generated for all 12 patients, and the median number of ATS plans per patient was 2 (range: 1 to 5). Comparing to the original reference plans, the volume change of the primary CTV in ATS plans was -10.2% ± 14.7% (range: -34.1% to 9.1%) in the first half of the treatment course, and -28.1% ± 21.7% (range: -53.1% to -1.6%) in the second half of the treatment course. The daily dose to nearby critical organs was observed to reduce up to 31% after CTV volume shrank. For 8 of the 12 patients, ATP plans struggled to meet the clinical goals of one or more critical organs (brainstem, brachial plexus, optic nerve, parotid) on some treatment days, and ATS plans followed thereafter to verify the contours and adjust optimization objectives to improve the plans. The ATS plans were used as new reference plans for later treatments. With the help of ATS planning, the observed dosimetric values of challenging organs were well below tolerance. <h3>Conclusion</h3> Close monitoring of target and critical organs have the potential to improve local control and reduce toxicities. ATS planning on the MR-Linac system played an important role in optimizing radiation treatment for HN cancer.

Isolated fungal epiglottitis: A rare presentation

Primary fungal epiglotitis is the isolated fungal infection of the epiglottis, without affecting the other body parts such as the larynx, lungs, pharynx, and oral cavity. It is an extremely rare clinical entity. Very few cases could be found in world literature. Pain throat and/or odynophagia are common clinical presentations. It can be secondary to inhaled steroid therapy which is usually mild. : In this article, we introduced a rare case of fungal epiglotitis in a 66 years old immunocompetent male presented with odynophagia without any other symptom or sign. In endoscopic laryngoscopy, using a 70 scope, a white lesion on swollen epiglottis was seen and rest of larynx was normal. No cervical lymphadenopathy was seen. Laryngeal area was tender on deep palpation. Patient was put on antibiotics and anti-inflammatory agents. There was no response even after 24 hers of starting treatment. Patient was put on empirically oral antifungal treatment and he improved in 6-8 hrs. Diagnosis of fungal epiglotitis was clinical, based on patient’s history, signs and sypmtoms. Signs included the inflammatory changes of the epiglotis and candida whitish discoloration of it. There was rapid and obvious improvement in condition of the patient, once started on oral antifungal treatment.

A Rare And Severe Complication Of SLE: Bullous Systemic Lupus Erythematous

Bullous systemic lupus erythematosus (BSLE) is a rare antibody-mediated blistering eruption of subepidermal tissues in patients with underlying SLE. We report a case of a 19 years old Indian unconscious male who presented with acute generalized blistering lesion and widespread tense vesicles and Bullae at the superior trunk, proximal superior limbs, and face(lips) with the symmetrical distribution. Bullae contained haemorrhagic fluid and bleeding was also seen on the ruptured site. The lesions are also seen on mucosal areas such as perioral, pharyngeal, laryngeal, and genital areas. Multiple erosions and crusting lesions are also seen over the body. Multiple scalp plaque erythematous peeling lesions with foul smells. Blood investigation showed leucocytosis and metabolic acidosis with a diagnosis of septic shock secondary to infected BSLE. He was treated with IV hydrocortisone 200mg, analgesic, and IV Ceftriaxone. Unfortunately, he collapsed 24 hours later and passed away. This case report highlights the importance of early detection of BSLE as an acute skin complication in patients with underlying SLE and its management steps.

A Rare And Severe Complication Of SLE: Bullous Systemic Lupus Erythematous

Bullous systemic lupus erythematosus (BSLE) is a rare antibody-mediated blistering eruption of subepidermal tissues in patients with underlying SLE. We report a case of a 19 years old Indian unconscious male who presented with acute generalized blistering lesion and widespread tense vesicles and Bullae at the superior trunk, proximal superior limbs, and face(lips) with the symmetrical distribution. Bullae contained haemorrhagic fluid and bleeding was also seen on the ruptured site. The lesions are also seen on mucosal areas such as perioral, pharyngeal, laryngeal, and genital areas. Multiple erosions and crusting lesions are also seen over the body. Multiple scalp plaque erythematous peeling lesions with foul smells. Blood investigation showed leucocytosis and metabolic acidosis with a diagnosis of septic shock secondary to infected BSLE. He was treated with IV hydrocortisone 200mg, analgesic, and IV Ceftriaxone. Unfortunately, he collapsed 24 hours later and passed away. This case report highlights the importance of early detection of BSLE as an acute skin complication in patients with underlying SLE and its management steps.

Tongue ties do not widen the upper airways in racehorses.

There is contradictory evidence on the potential benefits of tongue ties on upper airway function and their efficacy in inhibiting intermittent dorsal displacement of the soft palate (DDSP) in racehorses. To test the hypothesis that tongue ties increase the pharyngeal diameter and decrease the occurrence of dynamic airway obstruction in racehorses. Prospective, crossover blinded clinical study. Data of 22 Thoroughbred and 8 Standardbred racehorses examined using overground endoscopy under full-intensity exercise on training racetracks with and without fixation of the tongue by use of tongue ties were analysed. Equivalent exercise intensity was ensured by measuring heart rate (bpm), speed (GPS) and venous lactate. Pharyngeal diameter was expressed as pharyngeal-epiglottis (PE) ratios and laryngeal abduction accordingly as laryngeal-median-ratios. Data were analysed using multivariable repeated-measurements ANOVA. The PE ratio increased significantly from 1.11 ± 0.19 to 1.28 ± 0.30 in all horses between rest and full-intensity exercise (p < 0.01). Multi-variable analysis revealed that this effect decreased significantly by the application of tongue ties (1.15 ± 0.27, p< 0.01). Tongue ties did not influence maximum laryngeal width (p=0.09) and area (p=0.2) significantly. DDSP was found in 4 of 30 examinations with tongue tie and in 1 of 30 examinations without tongue tie. The study population was not randomly chosen and was heterogeneous. Few horses had a respiratory noise and the prevalence of upper respiratory tract disorders was too low for statistical comparison of the rate of DDSP with and without tongue ties. A positive effect of tongue ties on pharyngeal or laryngeal diameters was not found in this study. Therefore, the results of this study do not support the use of tongue ties to enhance upper airway function.

Selective local postoperative radiotherapy for T3-T4 N0 laryngeal cancer.

We aimed to investigate the appropriate postoperative radiotherapy dose and selective volume in T3-4 N0 laryngeal cancer patients treated with either total or partial laryngectomy. Patients who received radiotherapy for locally advanced (T3-T4) and pathologic node-negative (N0) squamous cell laryngeal cancer were retrospectively evaluated. Radiotherapy was applied to median 60 Gy (range 54-60 Gy) as selective local radiotherapy (±stoma). The local treatment areas included postoperative bed + laryngeal area for patients with apartial laryngectomy, and the postoperative bed only for patients with total laryngectomy. The median follow-up time was 59months and 52patients were included. The 2‑year, 5‑year, and 8‑year locoregional recurrence controls (LRC) were 95.6%. The 2‑year and 5‑year OS rates were 93.8% and 78.9%, respectively. The 5‑year OS for age &lt; 60years was 95.8%, for above 60years 56.5%. Our data suggest that local selective irradiation to the postoperative bed + stoma is enough in patients with T3-4 N0 laryngeal cancer without applying elective nodal irradiation.

Functional Laryngeal Assessment in Patients with Tracheostomy Following COVID-19 a Prospective Cohort Study

To explore laryngeal function of tracheostomised patients with COVID-19 in the acute phase, to identify ways teams may facilitate and expedite tracheostomy weaning and rehabilitation of upper airway function. Consecutive tracheostomised patients underwent laryngeal examination during mechanical ventilation weaning. Primary outcomes included prevalence of upper aerodigestive oedema and airway protection during swallow, tracheostomy duration, ICU frailty scores, and oral intake type. Analyses included bivariate associations and exploratory multivariable regressions. 48 consecutive patients who underwent tracheostomy insertion as part of their respiratory wean following invasive ventilation in a single UK tertiary hospital were included. 21 (43.8%) had impaired airway protection on swallow (PAS ≥ 3) with 32 (66.7%) having marked airway oedema in at least one laryngeal area. Impaired airway protection was associated with longer total artificial airway duration (p = 0.008), longer tracheostomy tube duration (p = 0.007), multiple intubations (p = 0.006) and was associated with persistent ICU acquired weakness at ICU discharge (p = 0.03). Impaired airway protection was also an independent predictor for longer tracheostomy tube duration (p = 0.02, Beta 0.38, 95% CI 2.36 to 27.16). The majority of our study patients presented with complex laryngeal findings which were associated with impaired airway protection. We suggest a proactive standardized scoring and review protocol to manage this complex group of patients in order to maximize health outcomes and ICU resources. Early laryngeal assessment may facilitate weaning from invasive mechanical ventilation and liberation from tracheostomy, as well as practical and objective risk stratification for patients regarding decannulation and feeding.

Prethyroidectomy voice and swallowing disorders and the possible role of laryngopharyngeal reflux disease

Objectives The aim of the study was to evaluate voice and swallowing function before thyroid surgery and to explore the possible role of thyroid enlargement and laryngopharyngeal reflux (LPR). Methods We conducted a prospective study of patients who underwent hemi- or total thyroidectomy (n = 118) and compared the results with patients of laparoscopic cholecystectomy (n = 110). All subjects underwent videolaryngostroboscopy, filled in subjective evaluations of voice, swallowing and reflux complaints. Acoustic voice analysis (AVA), maximum phonation time (MPT) and perceptual voice evaluation were conducted. Results We found no difference in voice quality between study and control group, neither in subjective complaints nor in AVA or perceptual evaluation. We did find indicative signs of minor laryngeal changes in thyroid group. Swallowing Impairment Score (SIS) revealed worse swallowing function in thyroid patients (p = 0.0006). Comparison of Reflux Symptom Index (RSI) scores revealed that thyroid group patients have higher values compared to control group (p = 0.006). Nevertheless, Reflux Finding Score (RFS) showed identical scores in both groups (p = 0.220). In thyroid group there was a strong positive correlation between RSI and SIS (ρ = 0.641), but no correlation between RFS and SIS (ρ = −0.002). In addition, we found a weak positive correlation between thyroid weight and RFS (ρ = 0.379). Conclusions Changes in laryngeal area caused by thyroid disorders do not lead to subjective but indicate slight objective disturbances in voice quality. We detected a decline in swallowing quality within thyroid patients. Higher RSI scores and a positive correlation between RFS and thyroid weight, indicate a possible role of thyroid gland in LPR.

Case report: Adenocarcinoma of the larynx with later hepatocellular differentiation

Head and neck cancer accounts for 3.5% of annual worldwide cancer diagnoses with the larynx being part of it. The main methods of treatment include laryngectomy, but mainly a combination of radiation with chemotherapy and then combinations of chemotherapy with immunotherapy in more advanced stages of the disease. Histologically it is mostly squamous cell carcinoma, but cases of glandular differentiation have been reported that favor the entry of these patients into clinical trials. In our case we discuss a patient diagnosed with adenocarcinoma to the larynx area treated initially with laryngectomy and radiotherapy. In metastatic setting, he received multiple treatment lines with chemotherapy and immunotherapy and a later biopsy from a paraspinal mass which pathology resulted in an adenocarcinoma from the larynx, with hepatocellular differentiation. We performed upper endoscopy which revealed a high-grade dysplasia and the initiation of irinotecan led to a rapid clinical deterioration.

Correlations between oropharyngeal and laryngeal anatomy and the frequency of singing voice: A population-based study, in Greece

The aim of this study is to explore if there is correlation between the typical voice classification and oropharyngeal anatomy, using cervical posterior-anterior radiography on professional singers in Epirus, Greece. Methods: 70 professional singers, 35 men and 35 women, were recruited for this study. All participants underwent a cervical posterior-anterior radiographic imaging of their oral pharyngeal and laryngeal area. Results: A statistically significant difference of mean distance was observed for the CI-MHP area (p=0,004), the MHP- SCV area (F=2,62, p=0,032), as well as SCV-AI area (F=11,82, p=0,000). For the average length measured in mm of the phonetic area PA, statistically significant differences were computed among all the singers in the group (F [5] = 5.368, p = 0.001), as well as the OPC area (F = 6,48, p = 0,000). Conclusions: The cervical posteroanterior radiography provided new correlations of the voice category of professional singers with their Oropharyngeal and Laryngeal Anatomy.

LITERATURE REVIEW : CHARACTERISTIC ANALYSIS PHYSICAL CHEMISTRY PROPERTIES (ACIDITY, FLOW RATE, CONSISTENCY) SALIVA RADIOTHERAPY HEAD &amp; NECK CANCER PATIENT

Background: Head and Neck Cancer (oral, nose, pharynx, and larynx area) are 890.000 new cases and 450.000 deaths in 2018. One of the treatment’s Radiotherapy affects saliva’s quality in physicochemical properties (flow rate, consistency, and acidity). Physicochemical properties are analyzed because they can influence saliva’s quality. The study is to get updated analysis about physicochemical properties’ saliva in Radiotherapy of Head and Neck Cancer Patient. Method: There are 39.972 articles, searched in Google Scholar, Academia, and Microsoft Academy database. The articles that are connected with keywords topic are 52 articles with abstract and title screening processes. The next process is selecting articles and getting 17 excluding articles and 35 including articles. The total articles are 35 articles. Therefore, they’re ready to be analyzed.Result: Major result of the analysis is radiotherapy affecting patients with Xerostomia. There’s a reducing flow rate, increasing consistency, and pH decrease in the acute phase. In the late phase, physicochemical properties’ saliva quality is decreased because of high ionizing radiation damaging DNA and membrane of the acinar cell. Primary saliva became hypertonic because protein kinase A enzyme and protein kinase C enzyme fail to do phosphorylation to build protein materials in the acinar cell. Conclusion: Radiotherapy making Xerostomia impact decreasing physicochemical properties’ quality in head and neck cancer. Education is the main thing to take Xerostomia’s complications for maintaining OHI like teeth brushing, chlorhexidine, fluoride or salivary stimulant application, and others. Analysis can be developed for the observation of consistency outcomes based on quantity.

Interobserver variability in organ at risk delineation in head and neck cancer

BackgroundIn radiotherapy inaccuracy in organ at risk (OAR) delineation can impact treatment plan optimisation and treatment plan evaluation. Brouwer et al. showed significant interobserver variability (IOV) in OAR delineation in head and neck cancer (HNC) and published international consensus guidelines (ICG) for OAR delineation in 2015. The aim of our study was to evaluate IOV in the presence of these guidelines.MethodsHNC radiation oncologists (RO) from each Belgian radiotherapy centre were invited to complete a survey and submit contours for 5 HNC cases. Reference contours (OARref) were obtained by a clinically validated artificial intelligence-tool trained using ICG. Dice similarity coefficients (DSC), mean surface distance (MSD) and 95% Hausdorff distances (HD95) were used for comparison.ResultsFourteen of twenty-two RO (64%) completed the survey and submitted delineations. Thirteen (93%) confirmed the use of delineation guidelines, of which six (43%) used the ICG. The OARs whose delineations agreed best with the OARref were mandible [median DSC 0.9, range (0.8–0.9); median MSD 1.1 mm, range (0.8–8.3), median HD95 3.4 mm, range (1.5–38.7)], brainstem [median DSC 0.9 (0.6–0.9); median MSD 1.5 mm (1.1–4.0), median HD95 4.0 mm (2.3–15.0)], submandibular glands [median DSC 0.8 (0.5–0.9); median MSD 1.2 mm (0.9–2.5), median HD95 3.1 mm (1.8–12.2)] and parotids [median DSC 0.9 (0.6–0.9); median MSD 1.9 mm (1.2–4.2), median HD95 5.1 mm (3.1–19.2)]. Oral cavity, cochleas, PCMs, supraglottic larynx and glottic area showed more variation. RO who used the consensus guidelines showed significantly less IOV (p = 0.008).ConclusionsAlthough ICG for delineation of OARs in HNC exist, they are only implemented by about half of RO participating in this study, which partly explains the delineation variability. However, this study highlights that guidelines alone do not suffice to eliminate IOV and that more effort needs to be done to accomplish further treatment standardisation, for example with artificial intelligence.

Morphometric Correlations of the Voice Category (VC) in Professional Singers with Oropharyngeal and Laryngeal Anatomy Using Stroboscopy and Cervical Posteroanterior Radiography

Objective(s): The aim of this study is to explore if there is a correlation between the typical voice classification and the oropharyngeal and laryngeal morphology, using video laryngeal stroboscopy and cervical posterior-anterior radiography on professional singers in Greece. Methods: 55 professional singers (28 females: 7 sopranos, 12 mezzo-sopranos, and 9 contraltos; 27 males: 8 tenors, 12 baritones and 7 basses) were recruited for this study. All participants underwent stroboscopic and cervical posterior-anterior radiographic imaging of their oral pharyngeal and laryngeal area. Additionally, the voice classification and features (e.g., height, weight) of individuals were correlated statistically. Results: Statistically significant correlations were observed between the VC of the participants with the Phonetic Area (PA) (r = −0.451, p = 0.001) and the VC with the Oral-pharyngeal Cavity (OPC) area (r = −0.402, p = 0.001) in the total sample. Specifically, in male singers, the PA and VC correlation was r = −0.319, p = 0.047, and the VC and OPC area was r = −0.328, p = 0.044. Likewise, in female singers, the PA area and VC and PA were r = −0.336, p = 0.041 and the OPC area and VC were r = −0.344, p = 0.039. The analysis confirmed no correlations between VC and height and body weight. Conclusions: The cervical posteroanterior radiography in conjunction with laryngeal stroboscopy provided new morphometric correlations of the VC of professional singers with their Oropharyngeal and Laryngeal Anatomy.

Morphological and functional variability in central and subcentral motor cortex of the human brain

There is a long-established link between anatomy and function in the somatomotor system in the mammalian cerebral cortex. The morphology of the central sulcus is predictive of the location of functional activation peaks relating to movement of different effectors in individuals. By contrast, morphological variation in the subcentral region and its relationship to function is, as yet, unknown. Investigating the subcentral region is particularly important in the context of speech, since control of the larynx during human speech production is related to activity in this region. Here, we examined the relationship between morphology in the central and subcentral region and the location of functional activity during movement of the hand, lips, tongue, and larynx at the individual participant level. We provide a systematic description of the sulcal patterns of the subcentral and adjacent opercular cortex, including the inter-individual variability in sulcal morphology. We show that, in the majority of participants, the anterior subcentral sulcus is not continuous, but consists of two distinct segments. A robust relationship between morphology of the central and subcentral sulcal segments and movement of different effectors is demonstrated. Inter-individual variability of underlying anatomy might thus explain previous inconsistent findings, in particular regarding the ventral larynx area in subcentral cortex. A surface registration based on sulcal labels indicated that such anatomical information can improve the alignment of functional data for group studies.

Otolaryngological manifestations of hospitalised patients with confirmed COVID-19 infection.

PurposeThe aim of our study is to evaluate the incidence and characteristics of otolaryngology symptoms in COVID 19 patients.Methods116 patients with positive PCR test results for COVID-19 and followed up by otolaryngologists at a tertiary referral center/COVID-19 pandemic hospital were questioned in terms of otolaryngology symptoms associated with COVID-19 infection. Data including demographics, disease severity, concomitant diseases, previous otolaryngologic diseases,incidence and duration of new onset symptoms were collected and categorically analyzed. In addition, the severity of loss of smell and taste was evaluated by visual analogue score (VAS).ResultsA total of 58 men and 58 women participated. The mean age of the patients was 57.24 ± 14.32 (19–83). The most common otolaryngological findings were hyposmia/anosmia (37.9%) and hypogeusia/ageusia (41.37%), respectively. These complaints were followed by headache (37.1%), and nausea/vomiting (31%). The most common oropharyngeal symptoms were sore throat (32.7%) and dysphagia (20.6%). The rate of otological/vestibular symptoms was dizziness (31.8%), tinnitus (11%), true vertigo (6%), and hearing impairment (5.1%), respectively. The most of symptoms were more frequent in > 60 years and women. There was a significant correlation between nasal itching and smell disturbance in patients with allergic rhinitis. Considering the duration of symptoms, the longest were hyposmia/anosmia and hypogeusia/ageusia. The mean VAS’s in patients with hyposmia/anosmia and hypogeusia/ageusia were 5.52 ± 2.08 and 5.79 ± 2.21, respectively.ConclusionThe most common otolaryngologic symptoms of COVID-19 infection are known as sore throat, smell and/or taste disturbances. However, our study showed that these patients can be seen with different symptoms in otological or laryngeal areas. Therefore, a more careful evaluation should be made in terms of otolaryngologic symptoms when COVID 19 infection is suspected.

Prospective Evaluation of the Safety and Efficacy of THRIVE for Children Undergoing Airway Evaluation.

Background:Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) is a humidified high-flow nasal cannula capable of extending apneic time. Although THRIVE is assumed to stent upper airway soft tissues, this has not been objectively evaluated. Also, there are no prior studies providing safety and efficacy data for those patients undergoing upper airway evaluation using THRIVE.Methods:This report is a prospective study of the safety and efficacy of THRIVE in pediatric patients younger than 18 years old undergoing drug-induced sleep endoscopy. We positioned a flexible laryngoscope to view the larynx, and photographs were taken with no THRIVE flow (control) and with THRIVE flow at 10 and 20 liters per minute (LPM). Upper airway patency was measured using epiglottis to posterior pharynx distance, laryngeal inlet area, and modified Cormack–Lehane score at the trialed parameters. Vomiting and aspiration were our primary safety endpoints.Results:Eleven patients (6 women) with a mean age of 5.3 ± 2.1 years (2–8 years; SD, 2.05) were enrolled. Measurements of upper airway patency showed a significant THRIVE flow–associated increase in epiglottis to posterior pharynx distance (105 ± 54 at 10 L/min and 199 ± 67 at 20 L/min; P = 0.007) and nonsignificant increase of laryngeal inlet area (206 ± 148 at 10 L/min and 361 ± 190 at 20 L/min; P = 0.07). Cormack–Lehane score improved significantly at higher THRIVE volumes (P = 0.006).Conclusions:THRIVE appears to safely improve upper airway patency during sleep endoscopy in the pediatric patient. In this study, we objectively document the flow-dependent increase in laryngeal patency associated with THRIVE.

Evaluation of the effects of helmet continuous positive airway pressure on laryngeal size in dogs anesthetized with propofol and fentanyl using computed tomography.

To evaluate the effect of 5cm H2 O of continuous positive airway pressure (CPAP) on laryngeal size in spontaneously breathing anesthetized dogs via computed tomography (CT). Prospective, randomized, cross-over clinical study. University teaching hospital and referral private practice. Eight healthy client-owned dogs undergoing CT. Dogs were sedated with acepromazine 20 μg/kg IM and induced with fentanyl 2 μg/kg and propofol 3-5mg/kg IV before being maintained on fentanyl (5 μg/kg/h) and propofol (0.3mg/kg/min) constant rate infusion. Dogs received an air/oxygen mixture with (CPAP) and without (NO-CPAP) 5cm H2 O of CPAP in a random order. Each study step lasted 15 minutes. Ten minutes after the beginning of each study period, a CT scan of the laryngeal region was obtained at end-expiration. CT images were analyzed to determine the laryngeal cross-sectional area (CSA; cm2 ), total volume (VTOT ; cm3 ), and laterolateral and dorsoventral diameters (DLL and DDV , respectively; cm). Differences between the 2 treatments were analyzed with t-test for paired data (P< 0.05). Compared to the NO-CPAP, during CPAP the CSA increased by 53.3 ± 23.1% (ie, from 3.3 ± 0.8 to 5.1 ± 1.3 cm2 , P= 0.0004), VTOT increased by 52.4 ± 13.6% (from 6.2 ± 1.7 to 9.4 ± 2.4 cm3 , P< 0.0001), and DLL and DDV were 55.5 ± 13.3% (3.6± 0.8 vs 2.4 ± 0.5cm, P= 0.006) and 20.3 ± 8.8% larger (3.2 ± 0.7 vs 2.7 ± 0.6cm, P=0.0002), respectively. Laryngeal volume and cross sectional area increased during the application of 5cm H2 O of helmet CPAP in spontaneously breathing anesthetized dogs.

Amount of laryngeal upward movement and pharyngeal area as indicators of decreased swallowing muscle function in sarcopenia.

In a recent article in the Journal of Oral Rehabilitation, Miyashita and colleagues suggested the usefulness of measuring the amount of laryngeal upward movement and pharyngeal area by the videofluoroscopic swallowing study to determine decreased swallowing muscle function in sarcopenia (1). Although a small number of patients were included making it hard to perform extensive multivariable analyses and to draw firm conclusions, the study suggests a novel, single procedure to diagnose sarcopenic dysphagia.

Effects of Increase in Laryngeal Cross-sectional Area on Vocal Tract Characteristics in Human Whistling

Effects of Increase in Laryngeal Cross-sectional Area on Vocal Tract Characteristics in Human Whistling

Rhabdomyoma of the Parapharyngeal Space – A Case Report

&lt;b&gt;Introduction: &lt;/b&gt; &lt;i&gt;Rhabdomyomas &lt;/i&gt; (RM) are rare benign mesenchymal tumors. They are a much more uncommon entity than their malignant counterparts, rhabdomyosarcomas. &lt;i&gt;Rhabdomyomas&lt;/i&gt; fall into two general categories: cardiac tumors and extracardiac tumors. Extracardiac myomas are among the rarest tumors in humans and can be classified as fetal and adult, depending on the degree of differentiation of individual tumors by light microscopy. Adult extracardiac myoma is most commonly characterized by the occurrence in the head and neck, and mainly in the laryngeal and pharyngeal area. &lt;b&gt;Case report: &lt;/b&gt;This article presents a case of rhabdomyoma of the parapharyngeal space with a review of world literature.