Laryngeal Fracture Research Articles

Asphyxialdeath due to fracture of thyroid cartilage, cricoid cartilage and arytenoid cartilage as result of blunt trauma of neck in a motorcycle accident:An Autopsy report

Laryngeal fracture is rare but fatal traumatic injury which is mainly caused by severe blunt trauma from interpersonal violence, motor vehicle accident or sports injuries. Laryngeal fracture can lead to severe airway collapse and death.Mortality decreases to less than 5% once the airways made patent and laryngeal injuries are corrected.People must take motorcycle riding safety course to learn how to ride safely. Always follow traffic rules. The motor vehicle accident can be prevented largely through public awareness and education

Machine Learning for Treatment Management Prediction in Laryngeal Fractures

ObjectivesLaryngeal fractures are rare but potentially life-threatening traumas. Complications, such as airway obstruction and disrupted laryngeal anatomy, associate with significant morbidity. Early identification of at-risk patients and optimal management remain crucial for improved outcomes. Recently, machine learning (ML) has attained great attention as a unique and novel technique for evaluating complex non-linear relationships between multiple observations to create a predictive model with greater accuracy. This study aimed to demonstrate the potential of ML in predicting airway and surgical management of laryngeal fracture patients and identify key contributing parameters for the predictive performance of the ML models. MethodsThe ML models were developed using a patient series managed at the Helsinki University Hospital during 2005–2019. The developed models were further evaluated independently using a different cohort collected from the same institution between 1995–2004. ResultsThe ML showed a weighted area under curve (AUC) of 0.93 and accuracy of 0.86 following training for airway management. Likewise, for treatment approach, weighted AUC was 0.85 and accuracy 0.78. Injury type, Schaefer-Fuhrman grade (SF gr), age at incident, cause of injury, and fracture of the cricoid, in decreasing order of significance, were the most prominent features for the model's predictive performance for airway management. Similarly, our model identified SF gr, fracture of the cricoid, injury type, age at incident, and cause of injury as the most significant predictors for surgical treatment approach. ConclusionsThe proposed prediction of management approach by an ML technique can provide accurate predictions and thus aid clinicians in administering early and personalized interventions. The model may serve as a supporting tool in recognizing at-risk patients and in timely decision making. Further independent external validation is warranted for model generalizability.

The prevalence of complicated cervical injuries in near-hanging patients without abnormal levels of consciousness or neck signs

BackgroundCervical injuries are important complications of near-hanging, which is defined as self-injury by hanging if the patient survives at admission. Previous studies have reported that complicated cervical injuries due to near-hanging are uncommon. The primary aim of this study was to evaluate whether cervical imaging can be safely omitted for near-hanging patients who are alert and have no abnormal neck symptoms or signs. MethodsThis was a retrospective observational study to investigate the prevalence of cervical injuries among hospitalized near-hanging patients between April 2014 and June 2023. The primary outcome was the prevalence of any complicated cervical injuries, which included laryngeal fractures, laryngeal deviations, spinal cord injuries, cervical spine fractures, and blunt cerebrovascular injuries. The primary aim of this study was to determine the primary outcome among near-hanging patients with normal levels of consciousness and no abnormal neck symptoms or signs. ResultsDuring the study period, a total of 63 near-hanging patients were hospitalized. Of these, 11 patients (18%) with normal levels of consciousness and no neck symptoms or signs at admission were included. The median age of the patients was 37 years (IQR 27 to 53); 5 (45%) were women, and none had cardiac arrest at the scene. For the primary outcome, no complicated cervical injuries (0%; 95% CI, 0% to 27%) occurred among the small number of near-hanging patients who had normal levels of consciousness and no abnormal neck symptoms or signs at admission. ConclusionsThere were no cases of complicated cervical injuries among near-hanging patients with normal levels of consciousness and no abnormal neck symptoms or signs. Further prospective multicenter studies are warranted to investigate whether cervical imaging can be safely omitted in assessments of these patients.

Changes in occurrence and management of laryngeal fractures at the Helsinki University Hospital during 25 years

PurposeLaryngeal fracture is a rare but potentially life-threatening trauma. Fractures vary from mild to dislocated and extensive with risk of severe complications. This study investigated the occurrence, clinical characteristics and management of laryngeal fractures in the last 15 years.Material and methodsA retrospective population-based cohort study reviewing all laryngeal fractures at the Helsinki University Hospital in 2005–2019. Patient records and imaging studies were systematically reviewed for mode of injury, fracture type, secondary complications, treatment modality, possible airway management, length of stay, and mortality. Results were compared with corresponding data from 1995 to 2004.ResultsOverall 80 fracture patients were recorded (5.3/year); 79% were men and mean age was 42 years (range 18–78). Altogether 91% were closed and 9% open. While unintentional traumas were most common (54%), an increasing proportion were from intentional injury (10%) or Schaefer Gr IV in severity (35%). Altogether 46% had compromised airway and 21% needed airway intervention; airway narrowing was more common with cricoid (p = 0.042) and multiple fractures (p = 0.07) and correlated positively with amount of dislocation (p = 0.001) and number of fracture lines (p = 0.006). Surgery was performed for 33%, of which 46% were Schaefer Gr IV and 62% from intentional trauma. Mortality was 1.4%.ConclusionsDeliberate and violence-related laryngeal fractures have increased. These often result in more extensive injuries predisposing to compromised airway and requiring surgical intervention and longer treatment. Most fractures are still treated conservatively with good long-term outcomes. An observation period of 24 h is recommended to detect any delayed complications. Mortality remains low.

Forensic-medical determination of the severity of closed injuries of the hyoid-laryngeal complex according to the data of a specialized clinic

Victims with closed blunt trauma of the hyoid-laryngeal complex often become the object of forensic examination. The purpose of the work was the forensic determination of the severity of injuries of the hyoid-laryngeal complex based on the materials of a specialized otolaryngological clinic in order to establish ways to improve the effectiveness of forensic diagnostics. 62 medical inpatient and outpatient cards of patients with injuries of the hyoid-laryngeal complex, who were treated in the Kharkiv clinical otolaryngological hospital No. 30 during 2011-2021, were processed. The mechanism of occurrence of injuries of the hyoid-laryngeal complex was as follows: in 51 (82.3% of cases there were blows to the neck with blunt hard objects (blows with fists and other objects), in 11 (17.7%) cases – squeezing of the neck with hands or blunt hard objects. The severity of injuries of the hyoid-laryngeal complex was determined from a forensic-medical point of view based on the observations of patients in a specialized hospital. Injuries of the hyoid-laryngeal complex in 3 (4.8%) patients with the occurrence of life-threatening phenomena, namely acute respiratory failure, were assessed as serious ones. Injuries in 8 (12.9%) patients were assessed as injuries of medium severity, mainly in cases of laryngeal cartilage fractures due to the lack of danger to life. Injuries in 38 (61.3%) patients were assessed as slight physical injuries that caused a short-term health disorder, mainly in cases of damage to the soft tissues of the larynx (hematoma, hemorrhage, swelling). Injuries in 13 (20.9%) patients in cases of acute post-traumatic laryngitis without pronounced morphological changes were assessed as slight ones. It was determined that additional diagnostic criteria for determining the severity of injuries of the hyoid-laryngeal complex, which have to be considered are: the dynamics and terms of restoration of post-traumatic morphological-clinical, and functional changes, the occurrence of life-threatening phenomena. The conducted scientific work made it possible to determine the ways of further improvement of diagnostics in the forensic-medical determination of the severity of the investigated injuries.

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.

CT Findings in Laryngeal Trauma and the Clinical Implications.

Acute traumatic osseous and cartilaginous injuries to the larynx are rare injuries presenting to the emergency department. Despite the low reported incidence, laryngeal trauma carries ahigh morbidity and mortality. The purpose of this study is to identify fracture and soft tissue injury patterns in laryngeal trauma and explore associations with patient demographics, mechanisms of injury, urgent airway and surgical intervention. Aretrospective review of patients with laryngeal injury who underwent multidetector computed tomography (MDCT) imaging was performed. The CT findings of laryngeal and hyoid fracture location, fracture displacement, and soft tissue injuries were recorded. Clinical data including patient demographics, mechanisms of injury, frequency of airway and surgical intervention were also recorded. Correlation of imaging characteristics with patient demographics, mechanism of injury and interventions were assessed for statistical significance using χ2 and Fisher's exact tests. The median patient age was 40years old with astrong male predominance. The most common mechanisms of injury included motor vehicle collisions and penetrating gunshot wounds. Thyroid cartilage fractures were the most common fracture type. Findings of fracture displacement and airway hematoma had ahigher correlation with requiring urgent airway management. Radiologists' early recognition and prompt communication of laryngeal trauma to the clinical service is important to reduce associated morbidity and mortality. Displaced fractures and laryngeal hematomas should be promptly conveyed to the clinical service as they are associated with more complex injuries and higher rates of urgent airway management and surgical intervention.

Larynx and thyroid cartilage fracture after work accident and forensic medical evaluation

Laryngeal injuries are rare but can be fatal. Depending on the type and severity of the trauma, thyroid and laryngeal cartilage fractures, full-thickness mucosal tears, tracheolaryngeal separation, and injuries leading to pneumomediastinum may be observed. Laryngeal traumas can occur either bluntly or penetratingly. Blunt traumas typically result from traffic accidents, falls, and sports injuries, while penetrating injuries are often caused by gunshot wounds or sharp objects. In this particular case study, the case was a 24-year-old male who was brought to the emergency room after being struck by a forklift at In his physical examination, a 10x1 cm wound was observed on his right scapula, along with subcutaneous emphysema in the subclavicular region. As a result of the examinations, the patient was found to have fractures of the larynx, thyroid cartilage, 8th rib and pneumomediastinum. In this study, it was thought that the thyroid and larynx cartilage fractures occurred as a result of hyperflexion/hyperextension of the neck without a direct blow to the neck region. This case is being presented because it is a rare occurrence in the literature, primarily due to its unique mechanism of injury.

A silent laryngeal trauma case: an unexpected late fracture of the superior portion of the thyroid cartilage superior horn.

Attempts to analyze clinical unexpected cases of laryngeal fractures based on mild symptoms and physical findings. Even though a laryngeal fracture is rare in a living patient and when happens it is related to severe airways emergency, this case reported seems important to offer a possible differential diagnosis in patients who present with the same symptoms, if no other causes have been detected, like another one benign laryngeal disease.

Comparison of findings identified at traditional invasive autopsy and postmortem computed tomography in suicidal hangings

Cases of suicidal hanging are a common death referred for medico-legal autopsy throughout the world. Although some advocate using postmortem computed tomography (PMCT) without traditional invasive autopsy (TIA) to investigate such deaths, others reject this approach. There is currently limited evidence to guide practice. In this context, the TIA reports and PMCT images of 50 cases of suspected suicidal hanging during an 11-month period were reviewed. The reviewers were blinded to the findings of the other modality. A Cohen’s Kappa coefficient (K) was calculated to assess agreement between TIA and PMCT across a range of pertinent findings. This analysis demonstrated perfect agreement for identification of a ligature (K = 1.00) and a strong level of agreement for identification of a ligature suspension point (K = 0.832) but only a minimal level of agreement for overall ligature mark (K = 0.223). PMCT demonstrated a weak level of agreement for fractures of hyoid bone (K = 0.555) and thyroid cartilage (K = 0.538). Three probable fractures not identified at TIA were identified on PMCT. TIA was shown to be superior in the identification of intramuscular and laryngeal fracture–related haemorrhage/bruising whereas PMCT was superior to TIA in identifying body gas deposition. There was overall good correlation between the natural disease and trauma identified elsewhere in the body during the TIA and PMCT. The study demonstrates that PMCT can assist the investigation of suspected suicidal hangings. However, the accuracy of many findings is limited, and if it is used as an alternative to the TIA, potentially pertinent findings, such as fractures of the laryngeal cartilages, could be missed.

Laryngeal trauma: a review of current diagnostic and management strategies.

The purpose of this review is to provide the most up to date information on evaluation and management of laryngeal trauma. Timely diagnosis and proper treatment of laryngeal fractures are imperative for preserving a functional larynx. This review will focus on evaluation and management strategies. The larynx provides significant functions including respiration, phonation, and airway protection. Algorithms have been developed in order to standardize the evaluation and management of these injuries to preserve a functional larynx. Physicians must diagnose and treat these laryngeal traumas in a timely fashion in order to prevent morbidity and, rarely, mortality.

Characterization of Laryngotracheal Fractures and Repairs: A TQIP Study

Laryngotracheal trauma is poorly studied and associated with serious morbidity and mortality. This study reports features associated with laryngotracheal fractures, and factors associated with laryngeal fracture repair. Retrospective database study SETTING: American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP®) METHODS: ACS-TQIP® 2014-2015 participant user data files were queried for laryngotracheal fractures using the International Classification of Diseases (ICD) 9th edition encodings. Demographic, diagnostic and procedure characteristics were analyzed with univariate chi-squared analysis and multivariate logistic regression. We extracted 635 cases of laryngotracheal injury, with a median Injury Severity Score of 16 (IQR: 10 - 25). Most were caused unintentionally (65.7%), followed by assault (28.8%). Blunt trauma (79.5%) was more common than penetrating trauma (20.0%). These trends were upheld in the subgroup of repaired fractures, which made up 12.6% (80/635) of cases. The median length of hospital stay was 6 days (IQR: 3 - 13) in all fractures and 10 days (IQR: 6 - 14) in the subgroup of repaired fractures, while the median length of ICU stay was 4 days (IQR: 2 - 9) in all fractures and 4.5 (IQR: 6 - 14.3) in the subgroup of repaired fractures. Cut/pierce injuries (OR: 4.7, P < 0.001) and ISS (OR: 0.97, pP=0.026) significantly affected rate of laryngeal fracture repair. Laryngotracheal fractures are uncommon but serious injuries. Our results show that penetrating causes of injuries have the shortest time to repair, and that a higher ISS score is negatively associated with repair.

Zlomenina kostry hrtanu – kazuistika

Laryngeal injury is a rare condition that may threaten the patient’s life with airway obstruction. Early dia­gnostics is the key management factor. Schaefer’s classification is the most commonly used classification to assess the extent of the injury. Based on this classification, a recommended management of therapy has been developed. There are several opinions on securing the airway by the orotracheal intubation. The authors present a case report of a 40-year-old male with thyroid cartilage fracture caused by a punch to the neck. The patient did not show signs of dyspnoea, had swollen neck and subcutaneous emphysema. Imaging by computed tomography showed a laryngeal fracture. A reconstruction of the thyroid cartilage and a tracheostomy in general anaesthesia were performed. Postoperative course was propitious, and the patient could be decannulated. It is important to consider a laryngeal injury in patients with external neck trauma. The key elements are early dia­gnosis and therapy, in which securing the airway is the crucial step. Further an effort should be made to create conditions for preserving laryngeal functions (respiration, phonation, and swallowing). Key words laryngeal injury – laryngeal fracture – larynx – tracheostomy

Ligature strangulation in 2001–2020 in the materials of the Jagiellonian University Department of Forensic Medicine, Kraków

Aim: The aim of the study was to analyze and compare the most common post-mortem changes which can be found in the body after ligature strangulation and compare it with the most recent literature. Materials and methods: autopsy protocols from years 2001–2020 gathered in the Department of Forensic Medicine in Kraków were investigated. 37 cases of certain and possible strangulation were found and analysed. Prevalence of ligature strangulation, age, sex, information concerning perpetrator and post-mortem changes were considered. Results: we found and analysed 37 cases, however only in 16 cases the certain cause of death was ligature strangulation. in the remaining 18 cases the mechanism of death was not precisely defined. in 3 cases advanced late post-mortem changes disturbed establishment of certain identification. Women constituted 87.5% of all victims, while men 12.5%. among 16 certain ligature strangulations we analysed the most important post-mortem changes. Both subconjunctival hemorrhagic petechiae and facial skin petechiae were observed in 93.8% of the cases, laryngeal or hyoid fracture in 56.3%, and hemorrhages in neck muscles were detected in 87.5% of the cases. Conclusions: The most frequent post-mortem changes after ligature strangulation include subconjunctival petechiae, facial skin petechiae and hemorrhages in the neck muscles which are convergent with the data found in literature. The autopsy may not indicate the circumstance of strangulation.

Systematic Review of Laryngeal Fractures and Trends in Operative Management.

Systematic review of the literature. The goal of this study is to review the current literature on the trends in management of laryngeal fractures following trauma. Independent searches of the PubMed and MEDLINE databases were performed. Articles from the period of 1963 to 2020 were collected. All studies which described laryngeal fractures using the Boolean method and relevant search term combinations, including "Laryngeal", "Fracture", "Operative", and "Management" were collected. A total of 588 relevant unique articles were identified for analysis. Of these, 24 articles were deemed appropriate for inclusion in the literature review. Due to variability in study design and outcome measures, formal synthesis of data in the form of a meta-analysis was not possible. Laryngeal fractures are rare traumatic injuries that require early identification and evaluation with complex management options. This comprehensive review aims to highlight the breadth of the topic with regard to presentation and clinical management. Though there remains no clear best practice for laryngeal fracture management, we review trends in clinical practice throughout the literature.

Clinical, Radiologic, and Endolaryngeal Findings in Laryngeal Fractures: A 15-Year Case Series.

ObjectiveLaryngeal fractures are rare injuries; recent data describing these injuries and associated examination findings are limited. This study aims to describe injury etiology and outcomes associated with laryngeal fractures.Study DesignRetrospective case series.SettingAcademic tertiary center.MethodsPatients with laryngeal fractures from 2005 to 2020 were identified in a retrospective chart review. Patient demographics, injury mechanisms, management, and voice outcomes were examined. Fracture type, radiologic, and endolaryngeal examination findings were analyzed for associations between fracture etiology and examination characteristics.ResultsLaryngeal fractures most commonly occurred at the thyroid cartilage. Fractures were most commonly due to sport-related injuries. Mechanism of injury was not associated with specific radiologic or endolaryngeal findings. Mechanism of injury was additionally not significantly associated with the need for intubation, surgical intervention, or tracheotomy. Fracture location was significantly associated with intubation requirement (P = .015), with 40% of patients with concomitant thyroid and cricoid fractures requiring intubation. Mechanism of injury significantly correlated with dysphonia at follow-up (P = .033). Mechanism of injury, fracture location, and surgical management were not associated with increased vocal fold injury or dysphonia.ConclusionThere are no significant correlations between injury mechanism and fracture location, characteristics, radiologic findings, or endolaryngeal findings. These features emphasize the importance of a thorough and comprehensive laryngeal examination.

FORENSIC MEDICAL ASSESSMENT OF INJURY SEVERITY OF LARYNX AND HYOID BONE BASED ON PRE-JUDICIAL AND JUDICIAL INVESTIGATION

Victims with fatal and non-fatal closed blunt trauma of the larynx and hyoid bone often become the object of forensic medical service during the pre-judicial and judicial investigation. The purpose of this study is to analyze the features of expert qualification of bodily injuries in victims with closed blunt trauma of the larynx and hyoid bone, depending on the nature and severity to determine ways to unify its forensic diagnosis. Materials and methods. The study was based on the conclusions of 35 forensic medical examinations of cases of closed blunt trauma of the larynx and hyoid bone, obtained from the leading expert institution of the Kharkiv region. Results. We determined the peculiarities of estimating the degrees of severity of above bodily injuries. Severe injuries were found in 12 (34.4%) cases of death of the victims from mechanical asphyxia, in one case of reflex cardiac arrest, and in one case of traumatic shock. Injuries of moderate severity were established by experts in 6 (17.1%) cases of lethal and in 6 (17.1%) cases of non-lethal cases with laryngeal cartilage fractures; in 2 (6.2%) cases of non-lethal injuries with acute oedema, hematoma, laryngeal stenosis of the second degree. 7 (20%) cases of non-lethal laryngeal injuries with further development of acute posttraumatic laryngitis were qualified as simple injuries. Conclusion. There are no clear morphoclinical criteria for objective assessment of injuries of the larynx and hyoid bone that can lead to pre-diagnostic expert errors. According to the results of the work, the ways to unify forensic medical assessment and diagnosis of such injury was determined.

Looking deep into the past – virtual autopsy of a Mongolian warrior

• Whole body CT findings of an 800-year-old Mongolian mummy. • Detection of Schmorl´s nodes and osteophytes on CT. • Degenerative changes are possibly related to long-distance horse riding. • CT supported the original hypothesis of the mummy being a mounted warrior. In 2016, a well-preserved mummy was discovered in the cold and dry climate of the Altai Mountains in the western part of Mongolia. The mummy was thought to have been a mounted warrior based on its riding boots and the saddle, bow and arrow found beside the body. A virtual autopsy was approved to obtain additional information on the body's internal structure and to possibly determine the cause of death. A computed tomography (CT) scan was performed on the Mongolian mummy using a 64-slice CT scanner. In addition to multiplanar reconstructions, volume and cinematic rendering techniques were applied for three-dimensional visualization. The shape of the pelvis indicated male sex. The skull demonstrated a flat facial profile, common among ancient Mongolian populations. Signs of periodontitis were detected in one of the six remaining teeth. The intact hyoid and thyroid were visible on the CT images together with the cartilaginous parts of the trachea, which excluded a laryngeal fracture. Signs of degenerative alterations (Schmorl´s nodes and osteophytes) were identified in the lumbar spine, attributed to regular which might be a sign of skeletal changes induced by horse riding. Indications for a violent cause of death were not detected. Through CT examination, some degenerative changes and pathological findings could be detected noninvasively. Although no cause of death could be determined, radiodiagnostic findings, such as degenerative alterations in the lumbar spine, were relevant, for instance, supporting the original hypothesis of a mounted warrior based on the saddle and riding boots found.

A complex fracture of the hyoid bone and the larynx after a bicycle accident - Case report and review of literature.

Introduction and importanceReports about laryngeal trauma and fractures of the hyoid bone are rare in the literature. Most cases are forensic cases and the results of postmortem analysis. Traumatic larynx and hyoid bone fractures represent a rare but important differential diagnosis of the common symptom hoarseness.Case presentationA 60-year-old female patient presented with unclear dysphonia and globus sensation following intubation for a surgical treatment for a lower leg fracture after a bicycle accident two months ago. Endoscopy and the computed tomography (CT) of the neck revealed a fixed and immobile fractured piece of the larynx, a hyoid bone fracture and a pseudarthrosis between the greater horn of the hyoid bone and the upper edge of the thyroid cartilage. The hyoid bone fracture led to a distortion of the supraglottis. After surgical removal of the fractured part of the hyoid bone and the pseudarthrosis separation, the supraglottis appeared symmetrical again. Four weeks after surgery the patient was symptom-free.Clinical discussionThough combined hyoid bone and larynx fractures after traumatic injuries are rare, they represent an important differential diagnosis in trauma patients with dysphagia or dysphonia. The clinical symptoms can vary and occur immediately or within a latent period taking weeks or months until the proper diagnosis. Depending on the symptoms, surgical management can be effective.ConclusionAn isolated partial resection of the hyoid bone with separation of the pseudarthrosis is a reasonable therapeutic option and can lead to completely resolving symptom. Preoperatively, a CT provides further valuable information.

Investigating blunt force trauma to the larynx: The role of inferior-superior vocal fold displacement on phonation

Blunt force trauma to the larynx, which may result from motor vehicle collisions, sports activities, etc., can cause significant damage, often leading to displaced fractures of the laryngeal cartilages, thereby disrupting vocal function. Current surgical interventions primarily focus on airway restoration to stabilize the patient, with restoration of vocal function usually being a secondary consideration. Due to laryngeal fracture, asymmetric vertical misalignment of the left or right vocal fold (VF) in the inferior-superior direction often occurs. This affects VF closure and can lead to a weak, breathy voice requiring increased vocal effort. It is unclear, however, how much vertical VF misalignment can be tolerated before voice quality degrades significantly. To address this need, the influence of inferior-superior VF displacement on phonation is investigated in 1.0mm increments using synthetic, self-oscillating VF models in a physiologically-representative facility. Acoustic (SPL, frequency, H1-H2, jitter, and shimmer), kinematic (amplitude and phase differences), and aerodynamic parameters (flow rate and subglottal pressure) are investigated as a function of inferior-superior vertical displacement. Significant findings include that once the inferior-superior medial length of the VF is surpassed, sustained phonation degrades precipitously, becoming severely pathological. If laryngeal reconstruction approaches can ensure VF contact is maintained during phonation (i.e., vertical displacement doesn’t surpass VF medial length), improved vocal outcomes are expected.