Video demonstrating representative accessory thymic superior horn arising below the innominate vein during routine thymectomy in another patient

To evaluate the efficacy of ultrasound-guided thyroid cartilage plane block (TCPB) on postoperative sore throat (POST) in patients undergoing suspension laryngoscopy vocal cord polypectomy (SLVCP). Ninety patients scheduled for elective SLVCP were randomized to either the TCPB group (general anesthesia + ultrasound-guided TCPB) or the C group (conventional GA), with 45 patients in each. The primary outcome was the incidence of POST at 2h after extubation. Secondary outcomes included the incidence and severity of POST at 0.5, 2, 6, 12, and 24h after extubation; the incidence and severity of hoarseness at 0.5, 2, 6, 12, and 24h after extubation; and cough response during emergence. The incidence of POST was significantly higher in the C group compared to the TCPB group at 0.5h (93% vs. 67%, RR = 0.20, 95% CI [0.06-0.64]; P = 0.003), 2h (78% vs. 47%, RR = 0.42, 95% CI [0.23-0.77]; P = 0.004), and 6h (64% vs. 27%, RR = 0.49, 95% CI [0.32-0.77]; P = 0.001) after extubation. No significant difference in the incidence and severity of hoarseness between the groups at any time point. During extubation, the incidence of cough response in the C group was 60%, significantly higher than the 20% in the TCPB group (RR = 0.50, 95% CI [0.34-0.74]; P = 0.001). Ultrasound-guided TCPB significantly reduces the incidence and severity of POST and cough response in SLVCP patients. This trial was registered in the Chinese Clinical Trial Registry (ChiCTR2500100227) on April 7, 2025 (https://www.chictr.org.cn/).

Laryngeal fracture is a rare but potentially life-threatening injury requiring prompt recognition and management due to the risk of airway compromise. We present the case of a 42-year-old man who presented to a tertiary center with symptoms of dysphonia and neck pain following blunt trauma sustained when a barbell fell on him while bench pressing without assistance. Computed tomography (CT) imaging confirmed a displaced fracture of the thyroid cartilage. He was managed conservatively with corticosteroids and high dependency unit airway monitoring. He recovered well and later resumed weightlifting with appropriate supervision. This case outlines the stages of assessment and management of laryngeal fractures, including airway evaluation, CT imaging and ear nose and throat (ENT) involvement. We discuss the benefit of conservative management in selected cases even when there are significant clinical findings and the importance of public health messaging to prevent such injuries. A high index of suspicion is essential for emergency physicians and ENT specialists when evaluating patients with neck trauma and voice changes.

Laryngeal cancer imaging research lacks standardised public datasets to enable reproducible deep learning (DL) model development. We present LaryngealCT, a curated benchmark of 1,029 computed tomography (CT) scans aggregated from six collections from The Cancer Imaging Archive (TCIA). Uniform 1mm isotropic volumes of interest encompassing the larynx were extracted using a weakly supervised parameter search framework validated by clinical experts. Six 3D DL architectures (custom 3D CNN, ResNet18/50/101, DenseNet121 and MedicalNet-pretrained ResNet50) were benchmarked on (i) early (Tis-T2) vs. advanced (T3-T4) and (ii) T4 vs. non-T4 classification tasks. On the independent test set, the 3D CNN achieved the strongest overall performance across global and per-class metrics (Accuracy = 0.854, F1-macro = 0.841) in early vs. advanced classification. In the T4 task, AU-ROC values exceeded 0.82 for most models, but sensitivity for T4 disease remained limited (≤ 0.412), with ResNet101 showing the most promising calibrated T4 recall (0.706). Model explainability assessed using GradCAM ++ with thyroid cartilage overlays for the T4 classification task revealed anatomically plausible peri-cartilage activations although spatial overlap remained modest. Through open-source data, pretrained models, and integrated explainability tools, LaryngealCT offers a reproducible foundation for AI-driven research to support future clinical decision-making in laryngeal oncology.

Photobiomodulation in Muscle Tension Dysphonia: A Pilot Study.

Facial feminization surgery (FFS) reduces gender dysphoria and improves psychosocial well-being in transfeminine patients, but its multiprocedural nature leads to long operative times, increasing anesthetic risk, and limiting daily surgical output. This study analyzes operative times across FFS procedures and describes a comprehensive approach that maximizes efficiency during multiprocedural FFS. 55 patients who underwent FFS from August 2024 through October 2025 were included. A four-person operating team was utilized in all cases. Fourteen patients (25.5%) underwent full FFS, 22 (40.0%) underwent near-full FFS, and 19 (34.5%) underwent partial FFS, totaling 267 procedures (mean: 4.9 procedures per patient). The mean operative time for full FFS was 196.4±39.4 minutes. Frontal sinus setback averaged 50.0±19.1 minutes, compared with 24.4±7.8 minutes for frontal sinus contouring with egg burr alone. Thyroid cartilage reduction averaged 31.6±8.9 minutes, genioplasty averaged 25.7±9.9 minutes, mandibular angle reduction averaged 25.1±9.6 minutes, lip augmentation averaged 8.2±2.2 minutes, fat grafting to the cheeks averaged 5.0±2.3 minutes, and open septorhinoplasty averaged 75.5±22.6 minutes. No intraoperative complications occurred. Two patients (3.6%) developed minor intraoral infections one month postoperatively, both resolving with oral antibiotics. Through deliberate procedural sequencing, concurrent task execution, and a well-trained team, full FFS can be completed efficiently without compromising patient outcomes or trainee education. This approach reduces anesthetic exposure and enables multiple FFS cases within a single day, expanding access in a field where surgical demand exceeds available capacity.

Masculinization of the thyroid cartilage ("Adam's apple") is an important yet underreported component of gender-affirming surgery. Traditional augmentation techniques using autologous rib cartilage provide durable projection but introduce additional donor site morbidity. We describe a novel single-incision technique utilizing autologous thyroid alar cartilage grafts for thyroid cartilage augmentation. A 29-year-old transmale underwent augmentation via a high cervical incision. Bilateral thyroid alar cartilage grafts were harvested, fashioned into a neothryoid notch construct, and secured to the native cartilage to enhance anterior projection. The patient was discharged without complication and reported high satisfaction with both aesthetic and tactile outcomes at 15 days and 9.5 months postoperatively. This approach leverages the favorable properties of thyroid alar cartilage while avoiding the morbidity associated with distant donor sites. The technique allows for effective augmentation through a single, less-invasive operative field. Thyroid alar cartilage grafting represents a promising, less invasive alternative for masculinization of the thyroid cartilage in appropriately selected patients.

Anterior commissure exposure is the primary challenge in Wendler glottoplasty, often hindering successful suturing in narrow or prominent larynges. We describe a "scarless" hybrid technique for difficult cases. Following fiber-laser de-epithelialization, two 18-gauge trocars are inserted percutaneously through the thyroid cartilage. A suture is passed through the trocars, retrieved endoscopically, and tied externally over a Silastic sheet, bypassing endolaryngeal space constraints. Hyaluronic acid is injected to reduce suture tension. This combined approach salvages the procedure when endoscopic exposure is inadequate, ensuring a tight synechia without visible cervical scarring, optimizing outcomes for transgender patients.

Aim: The aim of this study was to analyze anterior and posterior thickness measurements of the thyroid cartilage lamina and to assess their association with age and sex, with a focus on interindividual anatomical variability relevant to personalized medialization thyroplasty. Methods: A retrospective observational study was conducted on 47 patients with unilateral vocal cord paralysis who were candidates for medialization thyroplasty. The thickness of the thyroid cartilage was measured at its anterior and posterior aspects on an axial CT scan at the level of the glottic plane. The Wilcoxon signed-rank test was used to compare anterior and posterior thickness measurements, and a generalized linear mixed model (was fitted to assess the influence of anatomical region, age, and sex on cartilage thickness, with patient as a random effect. Results: The posterior thickness was significantly greater than the anterior thickness (median difference = 1 mm; p < 0.001). No significant differences were found in the magnitude of this difference by gender (p = 0.37) or a significant correlation with age (r = 0.16; p = 0.28). The mixed model confirmed that anatomical region was the only statistically significant fixed effect: the posterior region showed a Risk Ratio of 1.71 (95% CI: 1.26-2.32; p < 0.001) relative to the anterior region, indicating that the posterior thickness was approximately 71% greater than that of the anterior region. The interaction between cartilage thickness, age and gender was not statistically relevant. Discussion: In our sample, the thyroid cartilage had a thicker posterior width in both sexes. These findings underscore the importance of individualized radiological assessment in laryngeal framework surgery and support a personalized approach to implant selection and surgical planning in medialization thyroplasty.

Arterial variations in branching patterns off the external carotid artery are of clinical significance, especially in surgical operations and procedures of the head and neck. Variations of the eight typical branches off the carotid artery and their branching patterns have been documented in the literature and several classification systems have been proposed. The common carotid artery typically bifurcates at the upper border of the thyroid cartilage into the external carotid and internal carotid arteries. This case report details the rare occurrence of a bilateral common carotid artery pentafurcation, with the external and internal carotid artery and three additional branches that typically branch off of the external carotid artery. Limited documentation of pentafurcation of the carotid artery exists, and bilateral pentafurcation has not been previously documented in the literature. A bilateral pentafurcation of the common carotid artery was found during routine cadaveric anatomy dissection by first year medical students at Kansas City University College of Osteopathic Medicine. Detailed dissection of the carotid system branches was then performed to verify findings and identify the atypical branching patterns. Measurements were taken and characteristics of all branches were documented. In addition to the typical internal and external carotid branches, the right and left common carotid artery produced the superior thyroid, ascending pharyngeal, and occipital arteries, resulting in bilateral carotid artery pentafurcation. This case presents a rare finding of bilateral carotid artery pentafurcation. Documentation and reporting of the variability in carotid vasculature benefits both radiologic and surgical specialties and assists in predicting the impact of carotid artery anomalies on the pathophysiology of carotid atherosclerosis.

Acrometastasis is an uncommon presentation of lung cancer with poor prognosis. We describe bone scintigraphy and FDG PET/CT findings in a case of pulmonary nuclear protein in testis (NUT) carcinoma with only initial presentation of bony metastasis to the distal phalanx of the right little finger after traumatic injury. FDG PET/CT showed intense activity of the primary lung tumor with multiple FDG-avid lymph node, adrenal, bone, and cartilage metastases including unusual and unexpected metastases at the finger, mandibular condyle, and thyroid cartilage. Bone scintigraphy significantly underestimated the extent of osseous involvement because the osseous metastases appeared as non-osteoblastic lesions.

To develop a subject-specific, three-dimensional finite element (FE) model of the human upper airway and evaluate how ansa cervicalis stimulation (ACS), a novel neurostimulation for obstructive sleep apnea (OSA), alters upper airway anatomy under physiologic loading. Upper airway anatomy was reconstructed from a head-and-neck CT of an adult female using a semi-automated pipeline, including segmentation, smoothing, tetrahedral meshing, and registration. Linear elastic material properties were assigned from the literature. ACS was simulated as a caudal load on the anterior thyroid cartilage, and inspiratory collapse tendency was mimicked with a -70 Pa luminal negative pressure. Structural displacement and cross-sectional area (CSA) changes were quantified at the soft palate, lateral pharyngeal wall, tongue base, and epiglottis. ACS produced caudal displacement of the thyroid cartilage by approximately 10 mm with coordinated motion of the hyolaryngeal complex and longitudinal pharyngeal wall strain. It also tilted the epiglottis antero-inferiorly and increased its curvature, reducing posterior-inferior motion under negative pressure by more than 50% (5.0 to 2.2 mm). Retro-epiglottic CSA increased by 68.8% without negative pressure (42.43 to 71.63 mm2) and by 2980.3% with negative pressure (0.79 to 24.19 mm2). Retropalatal CSA improved by 34.4% without negative pressure (65.04 to 87.42 mm2) and by 20.3% with negative pressure (16.98 to 20.43 mm2). This proof-of-concept, subject-specific FE model shows that ACS imparts caudal traction through the hyolaryngeal complex, producing multilevel anatomic stabilization under physiologic loading. The findings establish a quantitative, hypothesis-generating framework for interrogating ACS-mediated airway stabilization mechanisms and support further investigation across broader OSA populations and collapse phenotypes. N/A.

Background: Metabolic syndrome (MetS) is a constellation of cardiometabolic risk factors like abdominal obesity, hypertension, hyperglycemia, and dyslipidemia associated with substantially increased risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Conventional screening methods involving waist circumference (WC) measurements can be challenging in resource-limited settings. Neck circumference (NC) has emerged as a simpler, non-invasive anthropometric marker of upper-body adiposity with potential utility for MetS screening.Objective: To determine the prevalence of MetS and its sociodemographic correlates in an urban community, to examine the association and correlation of NC with MetS and other anthropometric indices, and to establish optimal NC cut-off values for predicting MetS in adult males and females.Methods: A community-based cross-sectional study was conducted from April to July 2023 in the field practice area of the Urban Health Training Centre (UHTC) attached to Sawai Man Singh (SMS) Medical College, Jaipur. A total of 400 adults aged 18-60 years were enrolled using systematic random sampling. MetS was diagnosed using the National Heart, Lung, and Blood Institute (NHLBI) criteria (presence of ≥3 of five components). NC was measured at the level of the thyroid cartilage with an inelastic tape. Associations were analyzed using the chi-square test; correlations using Pearson's coefficient; and optimal NC cut-off values using receiver operating characteristic (ROC) curve analysis.Results: The mean age of participants was 39.11 ± 12.7 years, with a slight female predominance (M: F = 0.93). MetS was present in 43.5% of subjects. Abnormal NC was observed in 33.5% of participants (mean NC: 35.0 ± 3.1 cm). NC was significantly associated with MetS (chi-square = 218.71, p < 0.001); 95.5% of those with abnormal NC had MetS versus 17.3% with normal NC. NC showed strong positive correlations with WC (r = 0.705, p < 0.001) and BMI (r = 0.581, p < 0.001). ROC analysis identified optimal NC cut-off values of 37 cm in males (sensitivity 87.0%, specificity 96.0%, diagnostic accuracy 92.7%) and 34 cm in females (sensitivity 71.4%, specificity 92.2%, diagnostic accuracy 81.6%). Age, sex, education, occupation, socioeconomic status, personal habits, and marital status were significantly associated with MetS.Conclusions: NC is a reliable, inexpensive, and clinically practical screening tool for MetS in urban Indian adults. Cut-off values of 37 cm for males and 34 cm for females demonstrate excellent and clinically meaningful diagnostic performance, respectively, facilitating population-level MetS screening in primary care settings in Rajasthan and comparable populations.

Hyoid suspension is a method used to address hypopharyngeal obstruction in multilevel surgery for obstructive sleep apnea (OSA). The procedure involves suspending the hyoid bone to either the mandible or thyroid cartilage, determined by surgeon preference. This meta-analysis aims to compare the effectiveness of these two approaches in multi-level sleep surgery. PubMed, Embase, Scopus, and The Cochrane Library. All studies underwent a 2-stage blinded screening, extraction, and evaluation process. Primary outcomes of the study included pre- and postoperative apnea hypopnea index (AHI), Sher surgical success rate (≥50% reduction in AHI and postoperative AHI < 20), and changes to Epworth Sleepiness Scale (ESS) Score. Database searches yielded 1502 studies with 74 full-text articles screened, and 21 studies ultimately included. In patients who underwent hyothyroidpexy and palatal surgery (n = 582), the average AHI was reduced 20.98 (confidence interval 16.87, 25.08), ESS score improved by 5.99 [4.35, 7.63], and 57.5% met Sher criteria for surgical success. Patients who received hyomandibular suspension (n = 141) achieved an average AHI reduction of 29.21 [20.87, 37.55], improvement in ESS by 4.4 [1.33, 7.51], and Sher success rate of 73.8%. Although improvement in AHI and ESS scores were not statistically significant between groups, the proportion of patients meeting Sher Criteria success was greater for hyomandibular suspension (P = .006) CONCLUSION: The results of this study show that both methods of hyoid suspension are effective in treating OSA when used as a component of multilevel sleep surgery but suggests that hyomandibular suspension may provide greater improvement than hyothyroidpexy.

Evaluation of hanging deaths in childhood: An autopsy study.

Preservation of thyroid cartilage mobility via lateral cervical approach mitigates anterior neck dysfunction following hemithyroidectomy.

A Novel Low-Cost, Open-Source, Three-Dimensionally Printed Thyroplasty Simulator

The superior thyroid artery (STA) and its branch, the superior laryngeal artery (SLA), are key vascular structures within the carotid triangle, and variations in their origins, branching patterns, and courses are of significant clinical importance during cervical surgical procedures. A 72-year-old male cadaver of Greek origin demonstrated a rare combination of vascular variations. On the left side, a linguofacial trunk arose from the external carotid artery, while the STA originated from the common carotid artery; notably, the SLA was absent, with no identifiable compensatory arterial supply. On the right side, the STA arose from the external carotid artery in its typical position; however, the SLA followed an aberrant course, penetrating the thyroid cartilage before entering the larynx. This case highlights an exceptional coexistence of arterial variations within the carotid triangle. Awareness of such complex vascular configurations is essential for safe surgical dissection and for minimizing the risk of iatrogenic neurovascular injury during head and neck procedures.

L-shaped reduction malarplasty is a popular surgery in Oriental population. None of the previews studies investigated the relationship between bone moving and the orientation of the osteotomy lines. This study aimed to illustrate the relationship between zygomatic complex bone moving and the orientation of the osteotomy lines, and to propose a geometric model for surgical planning. Osteotomy lines of L-shaped reduction malarplasty were projected to the coronal plane. Four geometric models were made to analyze the relationship between zygomatic complex bone moving and the orientation of the osteotomy lines. A retrospective study of bone move in L-shaped reduction malarplasty was made. Differences of the data gained by measurement on CT images and the results calculated by the geometric equations were analyzed with a paired t test. Differences were considered statistically significant at a P value less than 0.05. Results consistency was assessed with the Bland-Altman plot. Equations analyzing the relationship between zygomatic complex bone moving and the orientation of the osteotomy lines were proposed. The oblique osteomy line affects the downward bone moving, and the direction of the vertical osteotomy lines affects the inward bone moving along with the width of bone removed. A retrospective clinical study included 20 sides of zygoma on ten consecutive patients who underwent L-shaped reduction malarplasty from 2023 to 2024 was made. Statistical analysis shown no statistical significance (P = 0.891) between the data gained by measurement and calculated by the equations. A great accordance was shown by the Bland-Altman plot analyses. Orientation of the osteotomy lines affects the zygomatic complex bone moving. Less slant of the oblique osteotomy line is recommended to minimize the downward moving. The two parallel osteotomy lines on the anterior part of the zygomatic bone are recommended to be vertical to achieve precisely operation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cervical chondrocutaneous branchial remnants (CCBRs) are rare developmental anomalies that arise during early embryogenesis. Because of their rarity, most published reports consist of small case series, and no standardized classification system has been established. The purpose of this study was to define the standardized clinical characteristics of CCBRs and to propose a comprehensive classification system based on the largest cohort reported to date. We retrospectively reviewed 55 CCBRs in 53 patients who underwent surgical excision between 2014 and 2023. Data collected included sex, age at diagnosis, age at surgery, associated anomalies, pathological findings, laterality, anatomical location, morphological shape, and intraoperative characteristics. All CCBRs were bounded superiorly by the inferior border of the thyroid cartilage, inferiorly by the upper border of the sternoclavicular junction, and laterally by the posterior border of the sternocleidomastoid muscle (SCM). Location was divided into three zones: "central" above the trachea, "medial" between the trachea and SCM, and "lateral" over the SCM. Morphology was classified by protrusion pattern-pedunculated or sessile-and further categorized as spherical, ovoid, lobed, or nodular according to cross-sectional geometry. A total of 55 CCBRs were identified. No significant differences were observed in sex distribution (male 53%, female 47%) or laterality (right 50.9%, left 49.1%). Histopathological examination revealed elastic cartilage in all evaluated specimens. Associated congenital anomalies were minimal (7.5%), and no serious systemic anomalies were identified. Medial lesions were most common (47%), followed by lateral (38%). Sessile lesions (60%) were more frequent than pedunculated lesions (40%). Ovoid configuration was most common (36%), followed by nodular (25%) and spherical (23%). This study presents a standardized, globally applicable classification system for CCBRs, facilitating comparative research and promoting unified nomenclature for international academic communication.