Thyroid Cartilage Calcification Research Articles

Virtual Reality Helps Describe the Progression of Thyroid Cartilage Calcification

ObjectivesThyroid cartilage (TC) calcifications may impact surgical planning and clinical management. However, few studies to date have implemented virtual reality (VR) to evaluate these calicifications. This study assessed the feasibility of evaluating TC calcifications in various regions and measuring their volumes through VR models generated from computed tomography (CT) scans. We also investigated age and gender-related differences in calcification patterns. MethodsNinety-two participants were categorized into younger, middle-aged, and older age groups. Calcification patterns (degree in Hounsfield units and volume of calcification in cm3) in different TC regions were identified by VR analysis, which enabled comparisons between age groups and genders. ResultsSignificant differences in calcification patterns were observed between males and females, particularly in the middle right, middle left, bottom left, and vertex regions. Age-related differences in the vertex region showed increased calcification in the older age group. ConclusionThis study points to the contribution of VR in the evaluation of complex anatomical structures. The findings revealed significant gender and age patterns in thyroid cartilage calcification. These insights can inform surgical planning and highlight the potential of using VR to gain a better understanding of thyroid cartilage calcification clinically.

Evaluation of the Incidental Prevalence of Soft Tissue Calcifications in the Neck Region with Cone Beam Computed Tomography

Objective: The aim of this study was to retrospectively evaluate the incidental prevalence of heterotopic soft tissue calcifications in the neck region, on Cone Beam Computed Tomography (CBCT) images, and their relationship with age and sex.
 Methods: A total of 6620 CBCT images were examined. CBCT images of 503 patients aged between 20 and 86 years were included in the study. Patients were grouped into five age groups: 20-30 (N = 132), 31-40 (N = 68), 41-50 (N = 92), 51-60 (N = 104), and 61 and above (N = 107). The images were assessed according to the presence of lymph node calcification, carotid artery calcification, thyroid cartilage, and triticeous cartilage calcification in the neck region. Descriptive statistics, crosstabs, and chi-square tests were used for data analysis. The significance level was set to 0.05
 Results: At least one calcification was detected in 372 (73.9%) patients. The difference between the prevalence of each calcification according to age groups was statistically significant. A significant relationship was found between the presence of carotid artery calcification and the sex variable (p< .05). The presence of other calcifications did not show statistically significant differences associated with sex (p> .05).
 Conclusion: The results of this study showed a significant amount of soft tissue calcification in the neck region. The most common calcifications were thyroid cartilage calcifications, and the least common calcification was lymph node calcification.

Is there a relationship between sella turcica calcification and thyroid cartilage calcification? A random study using lateral cephalometric radiography

Thyroid cartilage changes begin in the second decade of life with the horn of the thyroid cartilage, and spread throughout the individual’s lifetime to other cartilage plates. However, the objective of the present study is to assess if there is an association between thyroid calcification (TC) and sella turcica bridging (STB). Forty patients, 11 men and 29 women, aged between 40 and 62 years with a mean age of 48.6 years were studied. The sample inclusion criteria of this study were age in the fourth decade, no craniofacial deformities, no history of craniofacial surgical intervention, good-quality lateral cephalometric radiographs, and good visualization of the sella turcica (ST). A total of 40 registered patients were included in the assessment of calcification of the thyroid cartilage. Of these, 75% presented with thyroid calcifications, and 25% did not. Data on sex was available for all 40 registered patients. A total of 72.5% were female, and 27.5% were male. While in a comparison between calcification of the thyroid and calcification of the sella turcica, no statistical relationship was observed between the two variables. Thyroid cartilage calcification could be considered a normal part of the ageing process, while STB could appear on lateral radiographs due to superimposition of the anatomical structures. In this study, we found no relationship between thyroid cartilage calcification and STB, and a larger patient sample is required for evaluating calcification of the thyroid and STB.

Role of Laryngeal Ultrasonography in screening for laryngeal diseases in symptomatic patients

Abstract Background Laryngoscopy is widely considered the most appropriate tool for evaluating the larynx, however, it is invasive and not all patients can tolerate it. Although laryngeal ultrasound has been proposed as a promising noninvasive technique that can play an important role in laryngeal imaging, there is lack of consensus regarding its role. Objective The aim of this study is to assess laryngeal ultrasound sensitivity compared to indirect laryngoscopy in screening for laryngeal diseases in symptomatic patients. Patients and methods 30 undiagnosed symptomatic patients underwent laryngeal ultrasound and indirect laryngoscopy. Their results were compared. Results Technical success rate of laryngeal ultrasound was (83%). It showed overall sensitivity of (78.9%) in detecting organic laryngeal diseases with high sensitivity in detecting laryngeal masses, reinke’s edema, vocal cord cysts and polyps (100%), vocal cord palsy (83.3%), intermediate sensitivity for vocal cord nodules (66.7%), and poor sensitivity for laryngitis and non organic voice disorders (0%). Conclusion Laryngeal ultrasound is a useful non invasive imaging tool that can be used with acceptable sensitivity in detecting organic laryngeal diseases excluding laryngitis, hindered mainly by complete thyroid cartilage calcification in older males. Consequently we recommend its use as complementary to clinical examination and mirror laryngoscopy, or as an alternative to indirect laryngoscopy when required and in routine neck ultrasound exams when appropriate.

Brightness and contrast adjustments influence the radiographic detection of soft tissue calcification.

To assess the influence of subjective enhancement of brightness and contrast of digital panoramic radiographs on the detection of soft tissue calcifications. In this observational study, 500 digital panoramic radiographs were evaluated by two examiners in consensus, who scored the images for the presence of calcifications for each right and left side of the image. After 30days, all images were revaluated under subjective manipulation of digital brightness and contrast. Calcifications were classified based on the diagnostic hypothesis: sialolith, tonsillolith, calcified atheroma, phlebolith, rhinolith, maxillary sinus antrolith, synovial chondromatosis, lymph node calcification, stylohyoid ligament, triticeous cartilage, or/and upper horn of thyroid cartilage calcification. For intra-examiner agreement, 20% of the sample was reevaluated. The Kappa test and McNemar test were used (α=0.05). In original images, calcifications were observed in 44.2% of the patients, and in enhanced images, this number was 70.8%. Many calcifications were detected only in enhanced images, mainly in the diagnostic hypotheses of calcified atheroma and stylohyoid ligament. Intra-examiner agreement was excellent for the detection of soft tissue calcifications (0.82) and for the classification (0.81). Subjective enhancement of brightness and contrast alters the detection of soft tissue calcifications in digital panoramic radiograph.

USEFULNESS OF TRANSCUTANEOUS ULTRASOUNOGRAPY VERSUS COMPUTED TOMOGRAPHY IN THE ASSESSMENT OF CANCER LARYNX

Background: The use of ultrasonography as a complementary diagnostic tool to CT in the assessment of cancer larynx has always been underestimated due to the anatomical obstacles in the form of thyroid cartilage calcification yet specific anatomic sites with proper technique implementation raised the sensitivity and specificity of the sonographic results and presented it as a trustable screening tool taking advantage of its additional dynamic criteria. Aim of work: To evaluate the usefulness of ultrasonography versus Computed Tomography in assessing cancer larynx. Patients and Methods: 46 patients with histopathologically proven laryngeal carcinoma were enrolled after exclusion of 5 patients from surgery. A comparative assessment was made between the detection rate of localization and sensitivity, specificity, PPV, NPV and accuracy of pre-therapeutic ultrasonography compared to CT with post operative pathology as a standard reference.Results: Most of the patents were males [47(92.2%)/51] and aged > 60 years [25(49%)/51]. The detection rate was highest in glottic lesions being the same in both ultrasonography and CT [32 (96.9%)/33] with a sensitivity and specificity of 90.9% and 84.6% versus 93.9% and 92.3% in each modality respectively. (p=0.000). The specificity, sensitivity, PPV, NPV and accuracy results of invasion of the intra-laryngeal structures were comparable for both modalities: U/S and CT in detection of thyroid cartilage invasion being 88.8%, 89.3%, 84.2%, 92.5% and 89.1% for U/S versus 88.8%, 96.4%,94.1%, 93.1 and 93.4% for CT, paraglottic fat infiltration being 90.3%, 86.7%, 93.3%, 81.2% and 89.1% for U/S versus 93.5%, 93.3%, 96.7%, 87.5% and 94.4% for CT and anterior commissure infiltration being 88.5%, 90%, 92%, 85.7% and 89.1% for U/S versus 96.2%, 100%, 100%, 95.2% and 97.8% for CT. Conclusion: Ultrasonography could be used as a valuable supplementary imaging method to CT and laryngoscopy in the assessment of laryngeal carcinoma, even in male adults with some calcifications of the thyroid cartilage.

Transcutaneous laryngeal ultrasonography (TLUS) as an alternative to direct flexible laryngoscopy (DFL) in the perioperative evaluation of the vocal cord mobility in thyroid surgery.

Direct flexible laryngoscopy (DFL) is the golden standard to evaluate the vocal cord (VC) function in thyroid and parathyroid surgery pre- and postoperatively. Transcutaneous laryngeal ultrasonography (TLUS) could represent an alternative to the DFL and has been evaluated in the present study comparing the results of both methods performed at two referral centers for endocrine pathologies. In the setting of a retrospective study, 668 patients (560 female, 118 male; mean age 50.3 ± 14.2) were included from two tertiary referral centers of endocrine surgery. In all patients, TLUS was performed pre- and postoperatively prior to transnasal DFL, which served as a golden standard. TLUS was performed by B-scan (probe 5-13MHz, aperture 40mm). Preoperative visualization of the vocal cords by TLUS was possible in 526 patients (78.7%). Due to the frequent thyroid cartilage calcification (TCC) in male patients, a significant difference in the visualization rate was found between female and male (88.7% vs. 26.8%) [p < 0.0001]. Additionally, the visualization rate was inversely related to the patient's age [p < 0.001]. The sensitivity of preoperative TLUS was found to be 66.7%, the specificity 100%. DFL confirmed a postoperative palsy in 34 out of 40 patients with supposed abnormal vocal cord mobility at TLUS and demonstrated a palsy in four more cases with supposed regular mobility at TLUS. Therefore, the sensitivity of postoperative TLUS was 86%, the specificity of 99.1%, positive predictive value 89.4%, negative predictive value 98.7%. TLUS could represent an alternative for the evaluation of vocal cords mobility. This method has the potential to replace the DFL in the majority of cases, especially in female patients. Nevertheless, DFL is still necessary in about 20% of the patients with failed visualization at TLUS.

A Novel Gel Pad Laryngeal Ultrasound for Vocal Cord Evaluation.

Laryngeal ultrasound (LUS) is a new method for vocal cord evaluation in patients with risk of vocal cord palsy (VCP). However, the previously described LUS reportedly had a high failure rate of vocal cord visualization in male patients. A novel gel pad LUS was devised to overcome the limitations of the previous method. A total of 482 (100 male) consecutive LUS and direct laryngoscopy examinations were performed in thyroidectomy and other neck surgery patients. The conventional LUS and gel pad LUS were used for all patients. Findings were independently cross-validated with direct laryngoscopy. The conventional LUS and gel pad LUS methods had a 93.4% and 99.0% visualization rate, respectively, with a sensitivity of 98.0% for both methods, and a specificity of 99.7% and 99.8%, respectively. Among the 482 patients, 51 patients had VCP and 91 patients had diffuse thyroid cartilage calcification interrupting LUS. The new gel pad LUS method significantly enhances the visualization of vocal cords in patients who have diffuse thyroid cartilage calcification interrupting LUS and, therefore, the overall efficacy of LUS as a perioperative diagnostic tool for VCP.

Comparison of ultrasound frequency in laryngeal ultrasound for vocal cord evaluation

Laryngeal ultrasound is a new method of vocal cord evaluation in patients at risk for vocal cord palsy. However, the previously described laryngeal ultrasound reportedly has a high failure rate of vocal cord visualization in male patients. We compared 2 ultrasound frequencies in laryngeal ultrasound to improve on the limitations of this method. A total of 301 (55 male, 246 female) consecutive laryngeal ultrasound and direct laryngoscopy exams were performed for patients with thyroidectomy and other neck operations. High-frequency transducer (12-5MHz broad band spectrum) and low-frequency transducer (9-3MHz broad band spectrum) were used for all laryngeal ultrasound. Findings were independently cross-validated with direct laryngoscopy. High-frequency and low-frequency laryngeal ultrasound had 88.4% and 97.7% visualization rates, respectively. In addition, low-frequency laryngeal ultrasound showed improved sensitivity of 97.6% and specificity of 96.5%, compared with a sensitivity of 92.9% and specificity of 86.5% for high-frequency laryngeal ultrasound in vocal cord evaluation. The low-frequency laryngeal ultrasound method significantly enhances the visualization of vocal cords, especially in patients who have diffuse thyroid cartilage calcification interrupting laryngeal ultrasound, and therefore enhances the overall efficacy of laryngeal ultrasound as a perioperative diagnostic tool for vocal cord palsy. Hence, we recommend using a low-frequency transducer (about 9-3MHz) for laryngeal ultrasound if it is available.

Impact of vocal cord ultrasonography on endocrine surgery practices

It is common practice to perform flexible laryngoscopy (FL) to ensure true vocal cord (TVC) mobility in patients with previous neck operations or patients with suspected VC dysfunction. Vocal cord ultrasonography (VCUS) is accurate in identifying TVC paralysis. The goal of this study is to evaluate the impact of VCUS as the initial study to confirm TVC mobility in patients requiring preoperative FL. A total of 194 consecutive patients with indications for preoperative FL underwent VCUS. In group 1, 52 patients had FL regardless of the results of VCUS, whereas in group 2, 142 patients had VCUS followed by FL only when VCUS was unsatisfactory. VCUS visualized TVC/arytenoids in 164 of 194 (85%) patients. TVC visualization was more common in women (95%) and in patients without thyroid cartilage calcification (92%) (P < .0005). VCUS predicted all paralyzed TVC. In group 2, 76% of patients had adequate VCUS and avoided preoperative FL. Among 24% of patients in whom VCUS was inadequate, 16 had preoperative FL attributable to a lack of TVC visualization, 6 had abnormal TVC mobility, 11 needed additional confirmations, and 2 had previous FL for another reason. VCUS changed surgeon practices by avoiding the need for preoperative FL in the majority of patients. This noninvasive and sensitive method demonstrates TVC mobility and safely precludes preoperative FL in most patients.

The progression of thyroid cartilage calcification as it relates to the utilization of laryngeal ultrasound.

The purpose of this study is to review the computed tomography (CT) scans of infants, children, and adults to assess the degree of calcification of the thyroid cartilage at various ages in order to understand in which age group laryngeal ultrasound can be utilized. Retrospective. Two hundred patients from newborn to 50 years who received a CT scan of the neck were identified. The Hounsfield units (HU) of the thyroid cartilage were calculated at one o'clock, four o'clock, eight o'clock, and eleven o'clock at the level of the true and false vocal fold. The Spearman correlation coefficient was calculated to evaluate the correlation between each measure and age, then a linear regression with a logarithmic transformation was applied to further study how the measures were related to age. The Spearman correlation coefficients ranged from 0.58 to 0.75. The P values of these coefficients were all < 0.0001, showing a significant relationship to age. The age increase by 1 year resulted in increased calcification by 1.5% to 4%. The Wilcoxon signed rank test compared the rate of calcification at each site measured. This showed that the two posterolateral sites calcify faster than the two anteromedial sites. The thyroid cartilage calcifies at a rate that is significantly related to increasing age and calcifies in a posterolateral to anteromedial direction. Based on the HU, the thyroid cartilage is not consistently denser than soft tissue until greater than 40 years of age, which would make laryngeal ultrasound feasible for this population. 4.

Feasibility of surgeon-performed transcutaneous vocal cord ultrasonography in identifying vocal cord mobility: A multi-institutional experience

Transcutaneous vocal cord ultrasonography (TVCUS) is a noninvasive study used to identify true vocal cord (TVC) mobility. Its sensitivity in predicting TVC paralysis when compared with indirect flexible laryngoscopy (IFL) ranges from 62 to 93%. This study aimed to evaluate the feasibility of surgeon-performed TVCUS in assessing TVC mobility in the outpatient setting. At 5 institutions, 510 consecutive patients underwent 887 TVCUS performed by 8 surgeons during initial surgical evaluation. IFL was obtained in selected patients. TVCUS was repeated during the first postoperative visit, and IFL was obtained only when judged necessary. Clinical parameters were collected and later correlated with TVC visualization. TVC visualization was possible in 688 of 887 TVCUS (77%); visibility ranged from 41 to 86% among performing surgeons. IFL was done in 81 patients (16%) and TVCUS predicted TVC paralysis in all cases when TVC were seen. TVC visualization was possible more often in females than males (83% vs 17%; P < .0005) and in patients without thyroid cartilage calcification than those with calcification (83% vs 42%; P < .0005). Experienced surgeon-ultrasonographers can use TVCUS to visualize TVC in most female patients and less so in males. TVCUS is highly sensitive, but operator dependent. This study demonstrates the feasibility of TVCUS and directs further attention to defining its optimal role in assessment of TVC mobility.

A case of familial tumoral calcinosis/hyperostosis–hyperphosphatemia syndrome due to a compound heterozygous mutation in GALNT3 demonstrating new phenotypic features

A new case of familial tumoral calcinosis (FTC)/hyperostosis-hyperphosphatemia syndrome (HHS) due to a novel compound heterozygous mutation in N-acetylgalactosaminyltransferase 3 (GALNT3) and with new phenotypic findings is presented. The response in serum phosphate and fibroblast growth factor 23 (FGF23) to medical treatment is detailed. This case expands the genotype and phenotype of FTC/HHS and gives insight into its treatment and pathophysiology. FTC and HHS are caused by mutations in FGF23, GALNT3, or KLOTHO. They are characterized by hyperphosphatemia, increased phosphate reabsorption, and elevated or inappropriately normal serum 1,25-dihydroxyvitamin D(3) (1,25-D(3)); FTC is associated with calcific masses, and HHS with diaphyseal hyperostosis. A 36-year-old woman presented with abnormal dental X-rays at age 12 and was hyperphosphatemic at 22. She underwent radiographic, biochemical and genetic testing, and medical treatment. Serum phosphorus was 7.3 mg/dL (2.5-4.8), TmP/GFR 6.99 mg/100 mL (2.97-4.45), 1,25-D(3) 35 pg/mL (22-67). Radiographs revealed tooth anomalies, thyroid cartilage calcification, calcific masses in vertebral spaces, calcification of the interstitial septa of the soft tissue in the lower extremities, and cortical thickening of the long bones. Her total hip Z score was 1.9. C-terminus serum FGF23 was 1,210 RU/mL (20-108), but intact FGF23 was 7.4 pg/mL (10-50). DNA sequencing determined she was a compound heterozygote for mutations in GALNT3. Treatment with niacinamide and acetazolamide decreased TmP/GFR and serum phosphate, which was paralleled by a decrease in serum C-terminus FGF23. This case broadens the spectrum of phenotypic and genotypic features of FTC/HHS and suggests treatments to decrease renal phosphate reabsorption in the setting of a low intact FGF23.

Partial calcification of thyroid cartilage

Partial calcification of thyroid cartilage

CONTRIBUTION OF THE LARYNGOGRAM TO THE MANAGEMENT OF MALIGNANT LARYNGEAL TUMORS.

The larynx has been the subject of x-ray investigation almost since the inception of radiography. Thyroid cartilage calcification in cadavers was studied as early as 1896 (1). The first major contribution to roentgen examination of the larynx was by Coutard (2), who reported on the value of the lateral soft-tissue film of the neck in tumor diagnosis and in following tumor response to radiotherapy. He described the normal radiographic anatomy and the principles of tumor interpretation, based on the static findings of a mass projecting into the air passages, distortion of laryngeal structures, and cartilage destruction. Frontal tomography of the larynx, described by Leborgne (3), was the next step of importance. In tomograms the laryngeal structures can be demonstrated free from the overshadowing cervical vertebrae, permitting more accurate localization of tumors and evaluation of the subglottic space. The value of these two radiographic methods has been emphasized repeatedly in the world literature (4–7). The use of multiple maneuvers and contrast material described by Powers et al. (8) is the most recent advance in larynx radiography or laryngography. This examination has proved highly accurate in determining the presence and extent of tumor (9). Since 1948, a larynx tumor survey consisting of a lateral soft-tissue film of the neck and frontal tomograms has been used in this institution (M. D. Anderson Hospital and Tumor Institute, Houston) in all cases of tumors of the larynx. The usefulness of this survey in over 500 cases has recently been reviewed (10). Since July 1961 laryngograms have also been obtained. It is the purpose of this paper to evaluate the respective usefulness of laryngography and the classical tumor survey in the diagnosis of laryngopharyngeal disease. The value of the laryngographic findings in the management and follow-up of patients will be emphasized. Approximately 130 cases which were studied by both methods form the basis of this report. Methodology The natural history of squamous-cell carcinomas of the larynx depends on the anatomic site of origin, and for this reason it is on this site that their classification in this institution is based. Even when the tumor has extended to involve several sites, an attempt to determine the original is made. The anatomic divisions of the classification are illustrated in Figure 1. The laryngogram and larynx tumor survey were reviewed separately without benefit of clinical information. In each case the presence or absence of tumor, its site of origin, clinical type, and extent were recorded. Accuracy and clinical significance of this information were then assessed from a review of hospital charts and pathologic specimens. Technic of Examinations The Larynx Tumor Survey: The lateral soft-tissue film is obtained during phona-tion, with the patient erect at 6 feet target-film distance.