Laryngeal Glands Research Articles

Non-aesthetic uses of botulinum toxin in the head and neck.

The use of botulinum toxin in the specialty of aesthetic surgery in the head and neck is well known. However, it has also been used for other conditions affecting the head and neck, and in recent years its use, as well as the number of relevant applications, has expanded enormously. This article presents a summary of the current range of uses in the laryngeal, pharyngeal, cervical, oromandibular and facial muscles and salivary glands. We highlight particular conditions focusing on dystonia (laryngeal, craniocervical, oromandibular and cervical), multiple system atrophy, migraines, facial nerve palsy, post-laryngectomy, cricopharyngeal dysphagia, Zenker's diverticulum, retrograde cricopharyngeal dysfunction disorder, sialorrhea and gustatory sweating (Frey's syndrome). This article should aid the ear, nose and throat surgeon garner knowledge about the range of uses for botulinum toxin in the head and neck.

Ultrastructural comparison between the tongue of two reptilian species endemic in Egyptian fauna; Bosc's fringe-toed lizard Acanthodactylus boskianus and Sinai fan-fingered gecko Ptyodactylus guttatus.

The current observations focused on the ultrastructure comparison between the tongue of two reptile species endemic the Egyptian fauna; Bosc's fringe-toed lizard Acanthodactylus boskianus and Sinai fan-fingered gecko Ptyodactylus guttatus to exhibit the relationship between the lingual epithelium and its function according to their specific feeding strategy. A. boskianus possessed triangular elongated tongue with bifurcated tapering apex and wide base while; the P. guttatus had a triangular flattened tongue with conical shallow bifurcated apex and broad base. The ventral surface of the lingual apex of A. boskianus had transverse while in P. guttatus had two oval pads and median ventral groove. Both surfaces of the tongue of both examined species are covered by stratified squamous epithelium with great variability of degree of keratinization. The dorsal epithelium formed flattened and conical filiform papillae in A. boskianus, while in P. guttatus formed cylindrical papillae, conical, and tall filiform ones. Few taste buds are observed on the fore-tongue but increase on the mid-tongue of A. boskianus, while in P. guttatus, numerous taste buds are distributed on the fore-tongue and mid-tongue. Both surfaces of the laryngeal mound of both examined species provided with numerous of cilia and orifices of laryngeal gland. The present results confirmed that the tongue of A. boskianus acts as a chemoreceptor organ to follow pheromone trails of prey and mates. While in P. guttatus the tongue may play an important role in the feeding mechanism and act as a chemoreceptor organ.

Sternotomy-sparing surgical dissection technique of a large thyroid substernal goiter with preservation of bilateral recurrent laryngeal nerves and parathyroid glands

Sternotomy-sparing surgical dissection technique of a large thyroid substernal goiter with preservation of bilateral recurrent laryngeal nerves and parathyroid glands

Surgical treatment of patients, suffering goiter with compressive syndrome

Objective. To analyze the operative interventions character, performed in patients, suffering goiter of large size and cervico-retrosternal localization of thyroid gland with signs of compressive syndrome, and to determine preventive measures for prophylaxis of suboperative complications.
 Materials and methods. The data were obtained, concerning operative treatment of 331 patients, suffering various forms of large size goiter, coincided with compressive syndrome and changes in anatomic-topographic interrelationship of the thyroid gland and adjacent organs and structures with their activity disorders, in Department of Surgery of the Second Clinical Hospital of Poltava (clinical base Department of Surgery No 1 of Ukrainian Medical Stomatological Academy) in 2004 - 2018 yrs period.
 Results. There were depicted the operative interventions character, peculiarities of operative technique for patients, suffering large size goiter, as well as the ways for optimal prevention of injury of laryngeal nerves, parathyroid glands and other adjacent organs and structures. Original procedure of suboperative determination of the tracheomalacia presence and creation of external tracheal carcass was depicted.
 Conclusion. The measures and procedures in operations, performed for goiter of large size proposed, have permitted to reduce the operative morbidity risks.

Imaging of Malignant Minor Salivary Gland Tumors of the Head and Neck.

Minor salivary gland carcinomas (MSGCs) are nonminor tumors in the head and neck region and account for about half of all salivary gland carcinomas. Imaging evaluation based on the anatomy of minor salivary and mucous glands in the head and neck region as well as invasion patterns in each site helps in identifying optimal treatment modalities and planning suitable treatment strategies. MSGCs can be divided radiologically into localized and invasive subtypes on the basis of the clinical utility of such categorization. Characteristic invasion patterns of the invasive type include deep submucosal extension, bone marrow infiltration, and perineural spread, which are difficult to assess clinically. MSGCs easily invade adjacent structures because of their submucosal location and may spread along the muscles, nerves, periosteum, and dura mater. Moreover, the tumor may spread into the bone marrow without obvious bone destruction. In addition to imaging classification, examining the anatomy and distribution of the minor salivary glands, including the palatal, lingual, buccal, labial, and retromolar glands, as well as other mucous glands, including the glands of the sinonasal cavity and nasopharynx, lacrimal glands, ceruminous glands, laryngeal glands, and tracheal glands, facilitates MSGC diagnosis and tumor extension assessment. The authors review the precise anatomy of the minor salivary and mucous glands in the head and neck region, discuss the MSGC imaging classifications, and describe how to evaluate the extent of MSGCs in each site on the basis of the imaging classification and invasion patterns. ©RSNA, 2020.

Abstract 4252: 3D label-free, real-time, intelligent-augmented chemistry-sensitive imaging to identify parathyroid adenoma and hyperplasia and to classify parathyroid glands and recurrent laryngeal nerve during surgery

Abstract Background: Accidental excision or damage to a healthy parathyroid gland (PG) during thyroidectomy and the inability to identify diseased PGs during parathyroidectomy can result in postsurgical complications. Meanwhile, hyperparathyroidism includes primary and secondary hyperparathyroidism, which can cause damage in skeleton, kidney, and heart, with bone pain and renal colic. Therefore, it is critical to distinguish healthy parathyroid when the operation is being processed since the extent of the parathyroidectomy depends on the accuracy of the diagnosis. Methods: Human cancerous and healthy thyroid tissues were obtained from Shanghai General Hospital. Porcine thyroid glands, recurrent laryngeal nerves (RLN), adipose tissues, muscle tissues, lymph nodes, and parathyroid glands were harvested in fresh. Each sample was divided into two sections, one for CARS imaging and the other for hematoxylin and eosin staining (H&E). The H&E images were then classified by a senior pathologist. Some imaging analysis methods were performed to quantify some parameters, such as overall normalized intensity, regional normalized intensity, etc., to quantitatively differentiate the six types of tissues. Deep-learning algorithms were developed for auto-diagnosing thyroid cancer and for differentiating parathyroids, thyroids, lymph nodes, fats, RLN, and muscles. Results: Human thyroid cancer tissue can be identified immediately and automatically through CARS imaging combined with deep-learning algorithms. Parathyroid adenoma/hyperplasia presented as enlarged chief cells and clear cells with reduced fat droplets compared with normal parathyroid. The CARS identification results were confirmed by an experienced pathologist. All six different porcine tissues can be identified by the same system, and the correspondence to human equivalents was confirmed by the pathologist. The accuracy of both identification is above 90%. Quantitative analysis was performed to differentiate parathyroid, thyroid, lymph node, and fat, and differentiate RLN from muscle. Significance: The intelligent-augmented label free imaging system combining CARS imaging and deep-learning algorithm can reliably identify thyroid cancer tissue and differentiate it from thyroid gland, lymph node, and adipose tissue morphologically, without staining, accurately, and immediately. Therefore, this system is a potential tool for quantitatively differentiating parathyroid glands and RLN from surrounding tissues and identifying thyroid cancer tissue in real-time for diagnosis and during parathyroid surgery. Ultimately, the imaging technique can be incorporated into handheld probe for use in clinical diagnosis, such as cancer margin detection during surgery for minimal dissection and reducing nerve impairment during prostate cancer surgery. Citation Format: Jiasong Li, Ye Wang, Yunjie He, Mary C. Farach-Carson, Stephen T.C. Wong. 3D label-free, real-time, intelligent-augmented chemistry-sensitive imaging to identify parathyroid adenoma and hyperplasia and to classify parathyroid glands and recurrent laryngeal nerve during surgery [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4252.

SURGICAL TECHNIQUE OPTIONS IN THYROID OPERATIONS

The article highlights the analysis of 552 surgical interventions on different types of goiter performed on at the clinical base of the Department of Surgery No. 1, Ukrainian Medical Stomatological Academy (Poltava). The study included 491 women (88.9%) and 61 men (11.1%). Diffuse toxic goitre was diagnosed in 48 (8.7%) individuals, thyrotoxic adenoma occurred in 8 cases (1.5%), unilateral nodular goitre in 162 (29.3%), multinodular goitre in 334 (60.4%) patients. 20 (3.6%) patients were operated on relapsed goitre. The large size of the goitre, the adhesive process, and the cervical-retrosternal location of the thyroid gland complicate operating situation and often require innovative surgical decisions. Original methods for preventing the damage to the laryngeal nerves and thyroid glands, which are successfully used in non-standard surgical situations, as well as a method of mobilizing the thyroid gland in cervical and thoracic goitre. Complications during surgery were avoided by using extrafascial techniques for manipulating on the thyroid gland, using reliable controlled haemostasis and accuracy during the operation. The main factor to prevent specific intraoperative complications during surgery on the thyroid gland is a reasonable combination of the latest technology and the experience of the surgeon. Postoperative transitory hypoparathyroidism on days 7-8 was observed in 9 (1.6%) patients with normalization of clinical manifestations and calcium levels; 6 (1.1%) complained of hoarseness and weakening of the voice for 3 weeks. Most of these complications occurred in the first half of the period that was analyzed. These variants for performing surgery in difficult situations have enabled to improve the results of surgical treatment.

Safe total thyroidectomy by using intraoperative methylene blue spray

Background Intraoperative localization and preservation of recurrent laryngeal nerve (RLN) and parathyroid glands improve outcomes following thyroid surgery. This can be facilitated by methylene blue. Aim the aim was to evaluate the value of spraying methylene blue dye during thyroidectomy for the help of the identification and dissection of RLN. Patients and methods A total of 34 patients with benign goiter disorders were included in this prospective observational study. During the surgery, after ligation of the superior pole of the thyroid and before ligation of inferior pole, 1 ml (10 mg) of 1% methylene blue solution was sprayed over the thyroid bed and perithyroidal tissue. Identification and safe dissection of the thyroid gland from the RLN and parathyroid glands were done without injuring these structures. Results RLN remained white, whereas thyroid and parathyroid glands were stained blue. The parathyroid glands washed out the stain within 5 min and were visible in its normal yellow color in all cases. Conclusion Spraying of methylene blue dye during thyroidectomy is a safe and effective method for identification and avoiding injury to RLN and parathyroid glands during thyroid surgeries.

Thyroidectomy: Technique, Tips, and Troubleshooting

Historically, thyroidectomy was associated with a high mortality rate, now understood to likely be secondary to postoperative hypocalcemia. In the modern age, perioperative morbidity and mortality rates are extremely low, although some complications, such as recurrent laryngeal nerve injury, can have significant consequences. Understanding the safe approach to total thyroidectomy and thyroid lobectomy is key to minimizing operative morbidity. In particular, the capsular dissection technique facilitates identification and preservation of the recurrent laryngeal nerve and parathyroid glands. The postoperative care of the patient, including diagnosis and management of the more common complications such as hematoma or hypocalcemia, is crucial to optimize patient outcomes. Although novel thyroidectomy techniques have been developed to avoid or minimize the traditional neck incision, these approaches have not become widely used. This review contains 9 figures, 1 table, and 29 references. Key Words: capsular dissection, external branch of the superior laryngeal nerve, intraoperative nerve monitoring, minimally invasive thyroidectomy, postoperative hematoma, postoperative hoarseness, postoperative hypocalcemia, recurrent laryngeal nerve, remote access thyroidectomy

Abstract 3350: Delineating the p63-driven oncogenic network and epigenomic signature in salivary gland tumors

Abstract Head and Neck Squamous Cell Carcinomas (HNSCCs) constitute a diverse group of cancers that share their origin from the epithelium-rich upper aero-digestive tract. These cancers include oro-pharyngeal, laryngeal and salivary gland carcinomas, each endowed with a wide-ranging spectrum of distinct pathological subtypes and defined molecular and genetic determinants. Salivary gland neoplasms in particular, epitomizes this diversity and remain relatively less studied and ill-understood. To address this knowledge void and to get a better understanding of the molecular etiology of salivary gland tumors, we have focused our studies on p63, an oncogenic master transcription factor that is overexpressed in HNSCC, including salivary glands tumors. By utilizing the A253 cells, a representative cell-line isolated from a human submandibular carcinoma, here we have performed a comprehensive transcriptomic and epigenomic characterization of the p63-driven and global transcriptional circuitry. Our ChIP-seq based studies have identified the complete repertoire of the genome-wide enhancer regions in the A253 cells and importantly have unearthed a cohort of H3K27Ac-enriched super enhancers specifically enriched in p63 binding, highlighting the important cell-lineage directing role for p63 in these cells. Furthermore, RNA-seq based examination of the underlying changes in gene expression following the loss of p63 have also unearthed key mediators of the p63-cistrome that are likely to impinge upon cellular and oncogenic functions. In parallel, we have leveraged these newly developed resources with complementary genomic information from TCGA, and specifically HNSCC datasets, to examine the relevancy of our findings in the tumor context. Taken together, our multipronged approach has revealed several novel p63 target-enriched gene regulatory networks that span the breadth of core and emerging hallmarks of cancer. In particular, we have unveiled a p63-dependent network of several E26 transformation-specific (ETS) family of transcription factors which act downstream of p63 and act in concert to generate pro-oncogenic and anti-tumor suppressive forces. Interestingly, our studies also reveal that p63 and its ETS co-partners serve as an upstream molecular switch favoring the repression of TGF-β and concurrent activation of BMP signaling pathways, which may contribute favorably to proliferative and survival circuitry in HNSCC. These observations and other broader genomic insights into cancer cell specific metabolism and transcriptional addiction that has emerged from our studies can be further exploited for the development of diagnostics and/or therapeutics against salivary gland cancers and more broadly HNSCCs. Citation Format: Akinsola Oyelakin, Christian Gluck, Satrajit Sinha, Rose-Anne Romano. Delineating the p63-driven oncogenic network and epigenomic signature in salivary gland tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3350.

ХІРУРГІЧНЕ ЛІКУВАННЯ ЗОБУ

Проаналізовані результати хірургічного лікування 606 хворих з приводу різних форм зобу. Відображені показання до операції, оперативне втручання, новітні хірургічні технології. За вузлового і дифузного токсичного зобу (ДТЗ) перевагу віддають радикальним методам операцій. Застосування екстрафасціальних маніпуляцій на щитоподібній залозі (ЩЗ) та прецизійної техніки дозволяє зменшити вірогідність ушкодження під час операції гортанних нервів і прищитоподібних залоз та частоту післяопераційних ускладнень.
 Ключові слова: щитоподібна залоза; зоб; хірургічне лікування.

Thyroidectomy with Wu Gaosong's Procedure

Abstract Background: Since Dr. Emil Kocher initially modified the conventional open thyroidectomy, it has been the standard surgical technique for almost a century.1 Over the past decade, great development has been achieved in surgical devices, like the electrothermal bipolar vessel sealing systems and the harmonic scalpel (Ethicon Endosurgery), which improve hemostasis as well as reduce heat transfer, but the thick blade makes them awkward to use.1–3 The aim of this video is to describe a new technique: Wu Gaosong's procedure. During the operation, we utilize bipolar forceps, which is characterized by a tiny but precise structure, and thus greatly decreases the possibility of injury to recurrent laryngeal nerve or parathyroid glands during the operation. By dripping the bipolar forceps with 4°C 0.9% saline continuously, we keep it cool and make it produce less thermal damage. Dissecting the thyroid from inferior pole to superior pole would preserve the superior parathyroid glands and cut off the superior...

Tracheolaryngeal Adenoid Cystic Carcinoma: The tumour that almost took her breath away.

Dear Sir, A 40-year-old female patient presented to the Southern Command Hospital, Pune, India, in August 2015 with a six-month history of breathlessness. She was experiencing three to four episodes of dyspnoea per week with each episode lasting a few minutes. The breathlessness was aggravated on exertion and relieved with rest. She had no known comorbidities and had previously been treated symptomatically for asthma with no significant improvement. An indirect laryngoscopy revealed a proliferative growth inferior to the postcricoid area which was partially filling the trachea without affecting the glottic closure [Figure 1A]. Contrast-enhanced computed tomography of the neck revealed a well-defined soft tissue lesion (2.5 × 2.2 × 2.2 cm) in the infraglottic cavity and upper trachea with no significant enhancement [Figure 1B]. Figure 1A–D: A: Fibre-optic bronchoscopy image of a 40-year-old female with a tracheolaryngeal adenoid cystic carcinoma showing a proliferative growth (arrow) inferior to the postcricoid area, partially filling the trachea without hampering the glottic closure. B: ... An emergency tracheostomy was performed and a biopsy revealed tumour cells arranged in cribriform structures, tubules and clusters amidst a fibrous stroma [Figure 1C]; the cells had minimal eosinophilic cytoplasm, indistinct cell borders, oval hyperchromatic nuclei and inconspicuous nucleoli. On subsequent elective excision, all of the surgical margins were positive with the tumour abutting the tracheal cartilage [Figure 1D] and involving the inferior and posterior margins of the left lobe of the thyroid. The tumour showed similar histomorphology with foci of perineural invasion. A diagnosis of an adenoid cystic carcinoma (ADCC) was made at stage T4N0M0, indicating no regional lymph node or distant metastasis. As all of the surgical margins and the thyroid gland were seen to be involved during a frozen section procedure, the surgeons opted for palliative surgery with minimal local resection of the cricoid cartilage and first tracheal ring in addition to a total thyroidectomy. The defect was closed by end-to-end anastomosis with no attempt made at reconstruction. The patient subsequently received palliative radiotherapy (70 Gy) for four weeks. Due to the possibility of mucosal erosion and tracheal restenosis, the tracheostomy was continued for 12 weeks and the incision was closed at the end of the 14th week. The patient was stable with no clinical evidence of recurrence at a four-month follow-up. ADCCs are malignant neoplasms of the laryngeal salivary glands characterised by a protracted and aggressive clinical course.1 These carcinomas form less than 1% of all tracheolaryngeal malignancies and are known to reach large sizes; they usually occur among patients in their fifth and sixth decades of life and no gender predilection has been observed.2 As with the current case, ADCC can present with symptoms of obstruction, such as breathlessness.3 The differential diagnosis for ADCC includes polymorphous low-grade adenocarcinomas, basal cell adenomas, mixed tumours and basaloid squamous cell carcinomas.4 A cribriform pattern of tumour cells is typical of ADCC; however, this pattern is rarely seen in basal cell adenomas, basaloid squamous cell carcinomas and mixed tumours. While distinction between polymorphous low-grade adenocarcinomas and ADCCs can be challenging, the Ki-67 index is 10 times higher for the latter.4 In addition, smooth muscle markers of myoepithelial differentiation are positive in cases of ADCC but negative for polymorphous low-grade adenocarcinomas. Pseudocysts are usually positive with periodic acid-Schiff and Alcian blue stains and contain basement membrane components.4 The epithelial cells are usually positive for carcinoembryonic and epithelial membrane antigens while duct-lining cells are positive for cluster of differentiation 117 and tumour protein 63. Alterations in chromosomes 6q, 9p and 17p12–13 are the most frequent cytogenetic alterations reported.4 Although the histologic appearance of ADCC is well-described with certain features that may predict prognosis, surgical removal is often difficult given the infiltrative nature of these neoplasms with their propensity to invade into the adjacent tissues and extend along nerve segments.5 This is further compounded by the deceptively circumscribed macroscopic appearance of the tumours.3 These factors are challenging for surgeons attempting to remove the tumour with negative margins. Due to inadequate surgical excision, recurrence rates are high, ranging from 75–90%.6 Radical surgery has not been shown to improve survival rates or decrease local recurrence when compared with a conservative surgical approach and postoperative radiation.3 Optimal treatment therefore remains wide local excision with or without postoperative radiation.

Video Presentation Abstracts

ABSTRACT BACKGROUND AND AIMS In recent times, robot thyroid surgery has been performed worldwide in thyroid tumors, and reducing surgical complication is also an important factor in robot surgery besides thyroidectomy. This study presents the surgical technique of preserving the recurrent laryngeal nerve and parathyroid gland in transaxillary robot thyroid surgery. METHODS The drawback of robot thyroid surgery is that it cannot tell how strong the surgeon is holding and retracting the tissues or feels the thermal change when energy device is activated. Dissection or manipulation should be performed by layers and structures. The surgeon should not advance to the next procedure immediately after activating the coagulating energy device when related to tissues for preservation since there could be a thermal injury. After the activation, pause or make contact to a gauze placed in the operative field to check the spread of remaining heat. The shielded side of the device should be placed to the remnant structure side. By doing so, the thermal spread could be minimized. When coagulating vessels, the surgeon should not impatiently manipulate the grasped tissues since they could tear before fully coagulated and encounter bleeding. When preserving the recurrent laryngeal nerve and parathyroid gland, these surgical tips are very important to minimize the injury. RESULTS Applying such surgical techniques, the result of preserving the recurrent laryngeal nerve and parathyroid gland is safe and secure in robot thyroid surgery as presented in our video clip. CONCLUSION Endocrine surgeons perform functionally safe thyroidectomy and reduce the surgical complications in any type of thyroid surgery. The above-mentioned techniques will help preserve the recurrent laryngeal nerve and parathyroid gland in robot thyroid surgery

Impact of Irradiation on laryngeal hydration and lubrication in rat larynx.

The larynx is susceptible to irradiation, which causes significant vocal fold (VF) edema and dehydration shortly after radiotherapy for head and neck cancers. However little is known about radiation-induced damage to VF liquid homeostasis. To evaluate the effects of irradiation on VF hydration and lubrication, we investigated changes in water transporters (aquaporins [AQPs]) and mucin production in vivo and ex vivo, as well as morphometric changes in the laryngeal mucosa and glands of irradiated rat larynges. Animal study. Local irradiation at 18 Gy was delivered to rat larynges. Histologic changes in laryngeal mucosa and glands were observed by light microscopy, and the distributions of AQPs and mucin were investigated by immunofluorescence staining 3 months after irradiation. Early effects on gene regulation of AQPs and mucin were evaluated by quantitative real-time polymerase chain reaction of the extirpated VFs and subglottic laryngeal mucosa at 12, 24, and 72 hours after irradiation. Laryngeal glands exhibited severe atrophic changes and showed decreased density throughout the irradiated larynx. The expression of AQP1, 4, 5, and mucin in VFs, as well as AQP5 and mucin in submucosal laryngeal glands, decreased significantly 3 months after irradiation. An ex vivo study revealed that the gene expression of AQP5 in VF tissues was significantly downregulated at 12 hours postirradiation. Laryngeal irradiation induces damage in laryngeal mucosal barriers and alters laryngeal liquid homeostasis, which may be one reason for vocal dysfunction following irradiation. N/A.

Application of modified endoscopic thyroidectomy via chest and breast areola approach for benign thyroid disease patients

Objective To study the safety and feasibility of modified endoscopic thyroidectomy via chest and breast areola approach for benign thyroid disease patients.MethodsA total of 56 female benign thyroid disease patients,who received endoscopic thyroidectomy in our hospital from March 2011 to March 2012,were included in this study.And 28 of them underwent modified endoscopic thyroidectomy(modified group).Taking the advantage of movable female breast and the long rod-shaped endoscopic instrument,the operation was modified based on endoscopic thyroidectomy via chest and breast areola approach,without subcutaneous dissection of the chest wall.Another 28 patients received conventional approach treatment(conventional group).The two groups were matched in mean age and disease causes.The operation time,blood loss,post-operative pain degree,post-operation hospital stay,and complications were compared between the two groups.ResultsThe operation time,blood loss,post-operation hospital stay,and post-operation drainage volume were not significantly different between the two groups.Compared with patients in the conventional group,patients in modified group suffered significantly less post-operation pain,with mean visual analogue scale scores being 3.0±1.6 vs 4.5±1.8(P =0.042).The modified group also had significantly reduced incidence of skin redness and subcutaneous ecchymosis,edema and chance of effusion on the anterior chest wall(0 vs 21.4%,P =0.01).There were no damages to recurrent laryngeal nerve or parathyroid glands or postoperative hemorrhage in the 56 patients.ConclusionThe modified endoscopic thyroidectomy via chest and breast areola approach is a safe and effective method,and it can greatly reduce the trauma of conventional endoscopic thyroidectomy.

Management of laryngeal nerves and parathyroid glands at thyroidectomy

Management of laryngeal nerves and parathyroid glands at thyroidectomy

Localization and regulation of aquaporins in the murine larynx

Conclusion: Expression of aquaporins (AQPs) in the vocal folds and the parasympathetic regulation of AQPs in the laryngeal glands may be important for controlling laryngeal secretion and vocal fold hydration. These findings are thought to be an initial step towards understanding potential mechanisms of water flow through the vocal fold surface. Objectives: Lubrication of the vocal folds is important for phonation and laryngeal defense. However, the system of water transport in the laryngeal epithelium has not yet been clarified. We investigated the expression of AQP water channnels (AQP1–9) in the murine larynx and examined the neural regulating mechanisms of these subtypes. Methods: The distribution of AQPs (AQP1–9) in the murine larynx was examined by immunohistochemistry. Next, the neural mechanism regulating AQPs in the larynx was investigated using unilaterally vagotomized mice. Results: AQP1, 4, and 5 were expressed in the laryngeal epithelium including the vocal folds. Vocal fold AQP expression was minimal at the vocal process. AQP2, 3, 5, 6, 7, and 8 were localized to the submucosal glands. Expression of AQPs in the vagotomized region was significantly decreased compared with the contralateral intact side. The expression in the laryngeal glands was also decreased in the aged mice.

Pathological characteristics of the epiglottis relevant to acute epiglottitis

The characteristic swelling of acute epiglottitis is thought to be caused by histological factors in the epiglottis. We investigated the relationships between histological findings and the pathology of acute epiglottitis. We examined 23 autopsy cases. For 16 of these, histological assessments were performed. In the remaining 7 subjects, physiological saline was injected at the lingual tonsil. These histological findings revealed abundant laryngeal glands on the laryngeal surface compared with the lingual surface. With regard to the blood vessels and lymphatic vessels, more of these vessels tended to be apparent on the lingual surface compared with the laryngeal surface. In each of the physiological saline injected subjects, almost no swelling of the lingual tonsil occurred, but the lingual surface of the epiglottis was swollen, and morphological changes had occurred that resembled those in acute epiglottitis. Periepiglottic tissues are rich in lymphatic tissues, and it appears easy for inflammation to spread to the epiglottis itself via the gland's own rich networks of blood and lymphatic vessels. In addition, according to the video observation, it appeared that the liquid ingredient that exudes at the inflamed the lingual tonsil may cause swelling the lingual surface of the epiglottis.

Lateral approach to central compartment of neck

Revision surgery in central compartment of neck is often a challenge for the head and neck surgical oncologists/endocrine surgeons. This is often required for completion thyroidectomies, central compartment lymph node dissections, and re-exploration for persistent hyperparathyroidism. Scarring in midline due to prior surgery makes midline access to central compartment difficult and increases the risk of injury to recurrent laryngeal nerve and parathyroid glands. This article describes a simple technique of approaching central compartment between sternocleidomastoid and strap muscles.