Left Arytenoid Research Articles

Laryngo-pharyngeal desensitization following a prosthetic laryngoplasty

A two-year-old Thoroughbred gelding presented eighty-one days after a left-sided prosthetic laryngoplasty (PL). The horse had a continual bilateral foamy ingesta stained nasal discharge as a consequence of dysphagia. An endoscopic examination revealed permanent dorsal displacement of the soft palate (DDSP), which appeared to be associated with a degree of laryngo-pharyngeal mucosal desensitization. The left arytenoid was fixed in a neutral position. It was postulated that the desensitization and thence pharyngeal dysfunction had resulted from surgical trauma to the cranial laryngeal nerve (CLN).

Lipomas of the larynx and hypopharynx: a review of the literature with the addition of three new cases

Lipomas of the larynx and hypopharynx are uncommon mesenchymal neoplasms. This report discusses the clinical and pathological features of three cases of laryngeal and hypopharyngeal lipomas. Two of the cases occurred in females and one in a male. The ages of the patients were 28, 51 and 51 years respectively. Two of the cases involved the supraglottic larynx (left arytenoid and left vestibular fold); the third involved the pyriform sinus. Symptoms included airway obstruction, dysphagia, throat discomfort, a sensation of excessive secretions in the throat and an increase in snoring. The complaints occurred over periods ranging from several months to one year in duration. Clinically, a polypoid lesion described as yellow in appearance was seen. Histologically, the tumours were composed of mature adipocytes without evidence of pleomorphism, lipoblasts or infiltrative growth. Surgery was the treatment of choice and included simple but complete excision in two of the cases. In these two cases, surgery proved curative with follow-up periods of 11 and seven years, respectively. In one case, the initial tumour was removed in pieces. This lesion recurred 15 years after the initial resection and was totally excised at that time. This patient has been free of tumour for more than five years.

Unilateral arytenoid lateralisation and extra‐luminal polypropylene ring prostheses for correction of tracheal collapse in the dog

The surgical repair of tracheal collapse in 25 dogs is described. The initial presenting signs included coughing, dyspnoea, gagging, retching, exercise intolerance, cyanosis and collapse. Diagnosis was based upon the clinical signs, plain radiography and tracheal endoscopy. The collapse was corrected by the application of a number of extraluminal polypropylene prosthetic rings applied to the affected trachea. Additionally, a left arytenoid lateralisation was also performed. The perioperative complication rate was approximately 4 per cent, while the success rate was 75 per cent. The technique reduces the likelihood of catastrophic postoperative complications associated with iatrogenic laryngeal paralysis which is a possible complication of placement of extraluminal tracheal support devices.

下咽頭神経鞘腫例

Neurogenic tumors of the hypopharynx are rare. We report a case of neurilemmoma of the hypopharynx.A 64-year-old female visited our hospital because of dysphagia for two years. Fiberscopic examination revealed a submucosal smooth round mass occupying the left pyriform sinus and left arytenoid. CT showed the mass on the left side of the hypopharynx with an isodensity portion with moderate enhancement and a low density portion in its center. Biopsy under direct laryngoscopy suggested benign neurogenic tumor. The patient underwent lateral pharyngotomy under general anesthesia after tracheostomy, and a submucosal tumor in the left pyriform sinus was extirpated. The histopathological diagnosis was neurilemmoma because almost all the tumor cells were S-100 protein-positive and had a typical Antoni-B type appearance.

Effects of chemical restraint on the endoscopic appearance of laryngeal and pharyngeal anatomy and sensation in adult cattle

Summary Effects of 2 drugs commonly used for chemical restraint of cattle were evaluated for their effect on laryngeal and pharyngeal anatomy, function, and response to stimuli. Eighteen adult Jersey cows, free of respiratory tract disease, were studied. Cows were assigned at random to 1 of 3 treatment groups. Endoscopic evaluations were performed before and at a predetermined time interval after administration of each drug. Responses to stimuli were evaluated by stimulating 7 preselected sites (epiglottis, left and right arytenoid cartilages, left and right vocal folds, and left and right dorsolateral pharyngeal walls) with a closed, transendoscopic biopsy probe. Xylazine HCl (0.05 mg/kg of body weight, IV) was administered to group-1 cows (n = 6), and endoscopy was repeated 5 minutes after administration of the drug. Xylazine (0.07 mg/kg, IV) was administered to group-2 cows (n = 6), and endoscopy was repeated 5 minutes after administration of the drug. Acepromazine maleate (0.035 mg/kg, IV) was administered to group-3 cows (n = 6), and endoscopy was repeated 10 minutes after administration of the drug. Responses to stimuli were scored as brisk (0), moderate (1), slow (2), and absent (3). Scores for responses to stimuli were compared, using the Wilcoxon signed-rank test for data within groups, and a general linear models procedure, using the Kruskal-Wallis test between groups. Interobserver agreement rates were generated for each group. A value of P< 0.05 was considered significant. Xylazine profoundly changed laryngeal sensitivity and function at both dosages. The corniculate processes of the arytenoid cartilages were observed to be in a markedly adducted position after sedation. Response to stimuli was significantly (P = 0.03) slower than normal after sedation, using both dosages. Displacement of the soft palate dorsal to the epiglottis was persistent in 50% of the cows after stimulation tests subsequent to sedation with xylazine. Acepromazine had a mild effect on laryngeal sensitivity and function. The corniculate processes of the arytenoid cartilages were observed in paramedian position after sedation. Acepromazine did not significantly affect responses to stimuli. Effects of sedation on responses to stimuli were not significantly different for groups 1 and 2. However, effects for group 3 were significantly different from those for groups 1 and 2 (P = 0.006 and 0.004, respectively). Endoscopic evaluation of the proximal portion of the respiratory tract of cattle should be performed without sedation, when possible. If sedation is required to facilitate restraint for endoscopy, acepromazine maleate is recommended over xylazine on the basis of results of this study.

巨大喉頭血管腫例

A large laryngeal hemangioma was found in a 45-year-old male complaining of abnormal sensation in the larynx. The tumor had a wide pedicle from the left arytenoid and the aryepiglottic fold, and was about 30mm in diameter. From laryngoscopic findings and CT scan, hypervascularity of the tumor was suggested. The tumor was resected by YAG laser under laryngomicroscope. Histological examination revealed cavernous hemangioma. The hemangioma has not reccurred for 6 months following surgery.

Laryngeal Liposarcoma

I read with interest the article entitled "Head and Neck Liposarcoma: A Histopathologic Reevaluation of reported cases" written by McCulloch and colleagues.¹Unfortunately, another case reported by us in 1988 was not mentioned.²Our patient, a 37-year-old man, who had a liposarcoma on the posterior part of the left arytenoid underwent a total laryngectomy and a postoperative course of 70-Gy telecobalt irradiation. In spite of the fact that only a small focus of liposarcoma was found in the left arytenoid and in the lamina propria of the left vocal cord, and in spite of the adjuvant radiotherapy in the fifth year of follow-up, lung and bone metastases occurred and the patient died. Although liposarcoma of the larynx is rare, the course of the disease is aggressive and in spite of a complete tumor excision and radiation therapy the ultimate prognosis is poor.

Laryngeal Liposarcoma-Reply

We regret having missed the case report on liposarcoma of the larynx, published by Gertner et al in 1988. The article reviews the case of liposarcoma of the posterior left arytenoid in a 37-year-old man. The tumor pathology is well described and depicted in the original article. The pathologic subclassification of this lesion is somewhat difficult. Overall, it appears to be a well-differentiated lesion; however, the noted presence of pathologic mitoses identified at a not infrequent basis would tend to push this lesion toward the pleomorphic subcategory or perhaps a well-differentiated lesion showing dedifferentiation. With this histologic finding, the patient received an appropriately aggressive approach. The patient apparently died in his fifth year of follow-up of both lung and bony metastases. This certainly would be consistent with the clinical course expected of a pleomorphic liposarcoma. Since our article was published, I have also treated an additional case of

喉頭の腺様嚢胞癌例

Adenoid cystic carcinoma of the larynx is very rare. Less than 0.25 per cent of all laryngeal carcinomas are adenoid cystic tumors, and only seventeen cases have been reported in the Japanese literature. In this paper, a case of adenoid cystic carcinoma originating in the supraglottic area of the larynx is reported.A 56-year-old woman complained of cough and hoarseness of two months duration. Indirect laryngoscopic examination revealed a smooth mass involving the left false cord and arytenoid area. The pathology report was compatible with adenoid cystic carcinoma. The patient underwent total laryngectomy and left neck dissection. She has remained well for the last two years with no evidence of recurrence or metastases.We examined the resected specimens histologically by whole organ serial sectioning and discuss the evaluation, treatment, clinical course and prognosis of adenoid cystic carcinoma of the larynx.

A comparison of techniques to enhance the evaluation of equine laryngeal function

This study was designed to define a simple, unequivocal test for the evaluation of laryngeal function and the diagnosis of idiopathic laryngeal hemiplegia (ILH). ILH is a disorder that results from left recurrent laryngeal neuropathy and in which there is no movement of the left arytenoid cartilage and vocal fold. Laryngeal function was evaluated in seven horses using four techniques designed to stimulate laryngeal movements:-nasal occlusion, exercise, swallowing and administration of a respiratory stimulant. In addition, the effects of sedation and twitching on the endoscopic examination were also examined. The cross-sectional area of the rima glottidis was measured in each horse at rest and after each technique was performed. There was no statistically significant difference in the increase in area seen after nasal occlusion or exercise. Doxapram hydrochloride increased the cross-sectional area of the rima glottidis, whereas xylazine caused a decrease. Neither of these pharmacological agents exaggerated or decreased the amount of asynchronous movement or tremoring of the arytenoid cartilages. Manual occlusion of the external nares during endoscopy is a simple, yet effective method of stimulating arytenoid function and hence diagnosing ILH.

Carcinoid Tumor of the Larynx

Carcinoid tumor of the larynx is a rare neoplasm. Two cases of laryngeal carcinoid tumor are reported and the relevant literature is reviewed. One patient was an 82-year-old male who complained of odynophagia. The tumor was located on the left arytenoid and neck metastasis were present when he died 3 years after surgery. The other patient was an 82-year-old male who complained of hoarseness. His tumor was located in the left ventricle. Bone metastasis was detected one month after surgery and he died of distant metastasis two months following surgery. A review of the literature showed that carcinoid tumors of the larynx are aggressive and malignant, with distant metastasis being the most common cause of death. This tumor is unresponsive to radiotherapy and chemotherapy, so adequate surgical excision remains the only effective treatment.

Upper Airway Function during Maximal Exercise in Horses with Obstructive Upper Airway Lesions Effect of Surgical Treatment

Upper airway pressure was measured during maximal exercise in 10 Thoroughbred racehorses with naturally occurring upper airway obstruction. Left laryngeal hemiplegia and arytenoid chondropathy resulted in substantial increases (30-40 cm H2O) in inspiratory upper airway pressure (Pl), whereas complicated aryepiglottic entrapment and subepiglottic cysts produced only modest increases (15 cm H2O) in Pl. Uncomplicated aryepiglottic entrapment and grade IV pharyngeal lymphoid hyperplasia produced only slight increases (3-5 cm H2O). In general, surgical procedures restored airway pressures to within normal limits. Subtotal arytenoidectomy improved but did not normalize airway pressures in horses with arytenoid chondropathy. Pharyngeal lymphoid hyperplasia appeared to have little effect on upper airway function.

巨大な喉頭血管腫の１症例

A case of large laryngeal hemangioma which almost occluded the laryngeal inlet is reported. A 39-year-old male visited our clinic with complaints of snoring and apnea while sleeping. Neither dyspnea nor hoarseness was noted on physical examination. The tumor had a wide pedicle attached to the left arytenoid and the left aryepiglottic fold, and was removed by lateral pharyngotomy. The excised tumor was balloon-shaped and had a diameter of 3 cm. Histological examination revealed that the tumor was cavernous hemangioma.

Roaring in Clydesdales

An endoscopic survey was performed to assess arytenoid cartilage movement during quiet respiration in 48 Clydesdale horses. Physical characteristics which could influence the length of the recurrent laryngeal nerves were also recorded from these horses and the relationship of these characteristics to the presence of abnormal left arytenoid cartilage movements was assessed statistically. Some degree of abnormal arytenoid movement was observed in 50% of the animals over one year of age. No significant correlation between sex, age, estimated weight, height, or neck length could be found although affected animals were, on average, slightly taller, lighter and longer necked.

Pulmonary haemorrhage in standardbred horses after racing.

Endoscopic examinations of the upper respiratory tract were done on 92 of 314 Standardbred horses that raced one or more times at 4 consecutive, weekly race meetings. Although participation was voluntary, the characteristics of the population of horses examined were not statistically different from those of all horses that raced. No horse showed epistaxis, but 34 (32.4%) examinations of the trachea revealed blood that ranged from a trace in the tracheal mucus to large amounts scattered over the tracheal walls. Forty-four horses exhibited minor degrees of pharyngeal lymphoid hyperplasia, 2 had asynchronous movement of the left arytenoid cartilage and 15 had grains of sand in the respiratory tract. There was no association between bleeding and age, sex, distance of race, place in race or date of race. Mucus and mucopurulent material occurred less often after longer races and more often on the last 3 race nights.

Laryngeal Edema Associated With Sickle β-Thalassemia Disease

SICKLE β-thalassemia, a hemoglobinopathy closely related to sickle cell disease, demonstrates vaso-occlusive phenomena similar to homozygous sickle cell anemia. We describe a patient who experienced severe laryngeal edema secondary to sludging of sickled RBCs (drepanocytes) in the capillaries and lymphatic channels in the laryngeal microvasculature. To our knowledge, this finding has not been previously reported in the literature. <h3>Report of a Case</h3> A 29-year-old man with known sickle β-thalassemia disease came to the emergency room with acute dyspnea on June 26, 1980, and was admitted to the hospital. Indirect laryngoscopy showed marked edema of the left arytenoid mucosa and false vocal cord. The true vocal cord was obscured by a ventricular band. The glottic opening was diminished on deep inspiration. The right side of the larynx, however, appeared normal. A regimen of 100 mg of hydrocortisone every six hours produced some abatement of the patient's symptoms. Two days after admission,

Equine laryngeal hemiplegia part II: some clinical observations

Some clinical features of laryngeal hemiplegia in 127 horses are described. Possible aetiologic factors were found in only 11% of affected animals. The onset of clinical signs was either sudden or insidious. The majority of cases were presented because of an abnormal respiratory noise made at exercise. Other clinical signs, particularly those usually attributed to laryngopalatal dislocation, were observed in a substantial proportion of affected animals. In all cases surveyed the left arytenoid was affected, although in 3 animals a bilateral laryngeal dysfunction was noted. Thirty of 65 animals examined with a fibreoptic endoscope had other upper respiratory tract abnormalities in addition to abnormal arytenoid movements. Electrocardiographic examination of 45 affected horses did not reveal a significantly higher incidence of abnormalities than that observed in the racing population. The majority of haemograms taken from affected animals were also within normal limits.

喉頭披裂部カルチノイドの一生検例

A 74-year-old housewife consulted with dyspnea of almost 1 year duration. She had neither dyspnea, hemoptoe, nor hoarsness. Her physical examinations including X ray shadows revealed no abnormality. A nodular tumor was detected to be extending from the left arytenoid in laryngoscopy. There were no palpable lymph nodes in the cervical regions, and neither tumor nor ulcer in the esophageal mucosa. A biopsy specimen revealed carcinoid tumor in the arytenoid. The patient did not show so-called carcinoid syndromes. The excised tumor,0.6 x 0.6 X 0.3 cm, was gray white and somewhat nodular. Microscopically, the tumor cells were located within the submucosa beneath the histologically normal, surface-covering squamous epithelium. They were fairly small, uniform-sized cells with scanty cytoplasm, and arranged in nodular and/or acinar structures. Few mitotic figures could be seen. In the cytoplasms of tumor cells, argentaffin reaction was negative and argyrophilic stain was positive. Ultrastructurally, the nuclei exhibited irregular shapes with prominent nucleoli but no obvious chromatin condensation at their margins. Many of the uniform-sized (200-300 nm in diameter), electron-opaque granules with clear halo and limiting membrane, which were similar to the neurosecretory granules in the carcinoid tumor or the oat cell carcinoma of the lung, were found in the cytoplasms. Carcinoid of the arytenoid has never been described in the literatures. Only 1 case of laryngeal carcinoid,14 cases of tracheal carcinoid and 2 cases of esopahgeal carcinoid have been reported. Oat call carcinoma has been described in 6 tracheas and 7 esophagi.

Ein Fall Von Einer Laryngocele Beim Neugeborenen

A case of anew-born infant, aged 35 days old, with laryngocele was succesfully treated by laryngomicroscopic operation under general anaesthesia.He was suffered from congenital inspiratory dyspnea due to cystic swelling of the left arytenoid region.Although therapeutic efforts had been made by repeated punctions for the laryngeal cystic swelling, inspiratory dyspnea did not improve. Total removal of laryngocele by laryngomicro-surgery seems to be appropriate for this lesions.

Involvement of the larynx in a congenital ?myopathy?, unilateral aplasia of the arytenoid, micrognathia, and malformation of the brain ? A new syndrome?

Neuromyopathic changes were found in various limb muscles and in intrinsic laryngeal muscles of a two month old girl. She had been noted to have micrognathia, arthrogryposis and congenital stridor and died as a result of respiratory insufficiency and aspiration. Autopsy revealed an absent left arytenoid cartilage and severe histogenic abnormalities of the brain. Although the muscles involved showed a mainly myopathic pattern, marked signs of peripheral neurogenic involvement were present. These differed from motor neuron disease or aplasia of anterior horn cells. These findings cast a new light on the discussion of unclassified congenital myopathy resembling the picture of congenital muscular "dystrophy". This is the first case of congenital neuromyopathy in which involvement of intrinsic laryngeal muscles has been demonstrated morphologically.