Thyroid Cartilage Research Articles

The Unilateral Excessive Length of Superior Cornu of Thyroid Cartilage: A Case Report.

The excessive length of the superior cornu of the thyroid cartilage is extremely rare, and the etiology is unknown. Few reports of this condition exist in the literature. The objective of the present study was to present a rare case of unilateral excessive length of the superior cornu of the thyroid cartilage.

3D printed sodium alginate/gelatin/tannic acid/calcium chloride scaffolds laden bone marrow mesenchymal stem cells to repair defective thyroid cartilage plate.

Due to the absence of blood vessels, cartilage exhibits extremely limited self-repair capacity. Currently, repairing laryngeal cartilage defects, resulting from conditions such as laryngeal tumors, injury, and congenital structural abnormalities, remains a significant challenge in the Department of Otolaryngology, Head and Neck Surgery. Previous research has often focused on enhancing the mechanical properties of synthetic materials. However, their low biological activity and weak cell adhesion necessitate compensatory measures. This study aims to capitalize on the advantages of natural materials in cartilage tissue engineering. Sodium alginate, gelatin, tannic acid, and calcium chloride were utilized to prepare bioinks through cross-linking for application in 3D printing cartilage scaffolds. Bone marrow mesenchymal stem cells with multidirectional differentiation potential were chosen as seed cells, with appropriate growth factors incorporated to promote their differentiation into cartilage during in vitro culture. The scaffold laden cells was subsequently implanted into rabbit thyroid cartilage plate defects at the appropriate time. HE staining, toluidine blue staining, Masson staining, and collagen type II staining were employed to assess cartilage defect repair at 4, 8, and 12 weeks, respectively. Results demonstrated that scaffolds made from natural materials could emulate the mechanical properties of fresh cartilage with commendable biocompatibility. Stained sections further confirmed the efficacy of the composite hydrogel scaffolds identified in this study in promoting rabbit thyroid cartilage plate restoration. In summary, this study successfully fabricated a natural material scaffold for rabbit laryngeal cartilage tissue engineering, thereby furnishing a new idea and experience for the clinical application of laryngeal cartilage defect reconstruction.

Experimental research on nonlinear vibration characteristics of double-layer mining string for deep-sea hydrate extraction under internal and external flow excitation

The vibration mechanism of the deep-sea hydrate mining string is extremely complex due to the combined effects of internal gas–liquid solid multiphase flow, structural contact collision, soil creep effect, and external ocean random load. Based on this, using the principle of similarity, a simulation experimental platform for the vibration of double-layer mining riser in deep-sea hydrate wells under internal and external flow excitation is developed, considering the vortex-induced effect of external flow field on the mining riser in the ocean section (which can simulate a maximum ocean flow velocity of 0.5 m/s), the three-phase flow-induced effect of gas–liquid–solid inside (which can simulate a maximum flow velocity of 2.0 m/s), and the coupling effect of mining string–conductor anchor node (CAN)–seabed. The influence of particle size, phase ratio, three-phase flow, and external flow velocity on the vibration response characteristics and nonlinear behavior of mining string are investigated. It is found that the vibration of vertical string is significantly affected by external ocean currents and internal three-phase currents. The vibration displacement amplitude of the horizontal section (average 0.08 mm) is significantly smaller than those of the vertical section (average 70 mm). The strong vibration positions of the vertical and horizontal sections of the mining string are different, in that the vertical section is mostly located below the middle section (just at 1800–2400 mm), while the horizontal section is mostly located at the three-phase inlet (just at 500 mm). The vertical section of the mining string presents a motion trajectory of oblique straight line, wide oblique straight line, or approximately wide oblique straight line, while the horizontal section is mostly a chaotic trajectory or an “8”-shaped chaotic trajectory. The decrease in particle mesh size and the increase in solid-phase proportion are reflected in the difficulty and accumulation of particle transport, leading to an increase in vibration displacement, as well as a decrease in vibration displacement amplitude and vibration energy. When the particle size set as 50 mesh, the displacement of mining string is largest, just for 110 mm of vertical section and 0.08 mm of horizontal section. The increase in the proportion of gas phase will lead to changes in the flow state of multiphase flow, which will affect the vibration displacement amplitude of the mining string to varying degrees. The increase in three-phase flow velocity further induces vibration of the mining string, and when the flow velocity is between 1.5 and 1.75 m/s, it will resonate with the string system, resulting in a sudden increase in the amplitude of vibration displacement. The research results can effectively guide operations and improve the service life of deep-sea hydrate mining riser.

Real-time deep learning-assisted mechano-acoustic system for respiratory diagnosis and multifunctional classification

Epidermally mounted sensors using triaxial accelerometers have been previously used to monitor physiological processes with the implementation of machine learning (ML) algorithm interfaces. The findings from these previous studies have established a strong foundation for the analysis of high-resolution, intricate signals, typically through frequency domain conversion. In this study we integrate a wireless mechano-acoustic sensor with a multi-modal deep learning system for the real-time analysis of signals emitted by the laryngeal prominence area of the thyroid cartilage at frequency ranges up to 1 kHz. This interface provides real-time data visualization and communication with the ML server, creating a system that assesses severity of chronic obstructive pulmonary disease and analyzes the user’s speech patterns.

Age estimation from endochondral ossification pattern of thyroid cartilage in the population of Punjab

Objective: The present study aims at studying the ossification of thyroid cartilage and to compare it with age of the individual. Methods: The study was conducted in 300 samples of thyroid cartilage collected during autopsy in the department of Forensic medicine in a tertiary care hospital. Each thyroid cartilage is divided in to thirteen anatomical area and ossification in each defined area was studied through gross and cut section features and classified as ossified and not ossified areas. The samples were grouped in to seven groups of age and ossification features were compared between the age groups. Results: On analysing the ossification pattern of thyroid cartilage in thirteen defined anatomical areas and comparing it with the age, a peculiar sequence of ossification was noted, and it was also observed that frequency of ossification increases significantly with increasing age groups. Conclusion: Ossification of thyroid cartilage helps in establishing the age of individual and it can be categorised to an age group of ten years.

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

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

Anatomical Variations of the Bifurcation Levels of the Common Carotid Artery and Superior Thyroid Artery.

Variations in the carotid arterial system significantly impact atherosclerosis's clinical and surgical management, which predominantly occurs at arterial bifurcations. This study aimed at evaluating anatomical variations in the bifurcation levels of the common carotid artery (CCA) and the superior thyroidartery (STA), emphasizing clinical relevance. This was an observational cross-sectional study conducted in June 2021 using 32 embalmed cadavers of adult age from medical schools in Khartoum, Sudan. Sixty-four carotids were examined, noting the levels of CCA bifurcation and STA origin, and their symmetry across both sides of the body. Results: Among the cadavers studied, CCA bifurcation most commonly occurred at the superior border of the thyroid cartilage (46.9%), followed by the body of the hyoid bone (40.1%). The STA predominantly originated from the external carotid artery (ECA) (65.6%). Conclusion: No significant correlation was found between the bifurcation levels of the CCA and the origins of the STA. Bilateral symmetry in the bifurcation of the CCA and the origin of the STA was observed in most cases. The study highlights notable variations in the anatomy of the carotid arteries. These findings suggest that pre-surgical imaging and careful planning are crucial to accommodate anatomical diversities.

Primary Site Influences the Ability of Magnetic Resonance Imaging to Assess Cartilage Invasion in Advanced Laryngeal Cancer.

Accurate staging of advanced laryngeal cancer is important, as treatment can vary significantly between larynx preservation and total laryngectomy. The purpose of this study was to evaluate the accuracy of magnetic resonance imaging (MRI) in assessing features of T4a disease in locally advanced laryngeal cancer and determine if primary site played a role in the accuracy of MRI in this setting. A retrospective cohort study of patients undergoing a total laryngectomy in a tertiary referral center for head and neck cancer over a 10-year time period was carried out. Patients met inclusion criteria if they underwent a primary total laryngectomy for squamous cell carcinoma (SCC) of the larynx during the study period. Data collected included basic demographic data, primary tumor subsite, and clinical and pathological staging. The predictive ability of MRI on outer thyroid cortex invasion, extralaryngeal extension, and overall T4a stage was analyzed with receiver operating characteristics analysis. Analysis was compared to histological data on outer thyroid cortex invasion, extralaryngeal extension, and histological T4a stage. A total of 112 patients met inclusion criteria. The mean age of the cohort was 65.1. Glottic primary subsite was associated with a statistically significant elevated risk for histological outer cortex erosion (p = 0.006), but MRI demonstrated worse sensitivity in detecting this outer cortex invasion in glottic primaries(p = 0.002). Glottic primaries tumors display an increased likelihood of thyroid cartilage invasion, however, MRI demonstrates a poorer sensitivity for detecting these features. Level 3 Laryngoscope, 2024.

Recurrent Ischemic Strokes Due to Anatomic Variation of the Hyoid Bone and Thyroid Cartilage.

Recurrent Ischemic Strokes Due to Anatomic Variation of the Hyoid Bone and Thyroid Cartilage.

Chronic Cough Related to Thyroid Cartilage Superior Cornu Abnormality.

Chronic cough is a common troublesome symptom in otolaryngology head and neck surgery practice. In rare cases, chronic cough may be related to anatomical abnormalities. In this article, we report the history of a 64-year-old female with a chronic course due to a curved superior cornu of the thyroid cartilage and related irritation of the laryngeal superior nerve. The cough was atypical and resolved after the surgical resection of the abnormal cornu. There was no recurrence at 9 months post-surgery. The findings of the present case report highlight the need to explore the laryngeal anatomy in patients with chronic cough to identify potential abnormalities, which may be treated surgically.

Instrumentation Considerations for Calcified Thyroid Cartilage during Chondrolaryngoplasty

ObjectiveChondrolaryngoplasty, also known as thyroid cartilage reduction, alleviates gender dysphoria by reducing the thyroid cartilage to conform to a patient's gender identity. Reduction of the thyroid cartilage prominence (“Adam's apple”) is often performed with a scalpel, but in cases of cartilage calcification, rongeurs or drills are utilized. This study aims to characterize the success rate with scalpel‐only excision and relate this to patient age and operative time.MethodsBilling records were screened for chondrolaryngoplasties performed between 2020 and 2023 by a single surgeon. Patient demographics, operative notes, and operation duration were recorded. Type of instrumentation was categorized as scalpel only, rongeur, or drill. All cases began with attempted scalpel excision of cartilage and were transitioned to rongeur or drill if there was calcification that prevented sharp excision. Descriptive statistics were used to describe patient and surgical factors.Results52 individuals underwent chondrolaryngoplasty: 30 cases (57.7%) had soft cartilage requiring only a blade, 22 (42.3%) required use of either drill or rongeur. The average age of these groups was 25.7 (SE 1.8) and 41.3 years (SE 2.2), respectively; this difference was statistically significant (p < 0.0001). Cases requiring a drill or rongeur lasted on average 78.5 min (SE 2.3), whereas those using only a blade were shorter at 66.8 min (SE 2.7); this difference was significant (p = 0.0017).ConclusionCartilage calcification should be expected in a significant number of chondrolaryngoplasties, and surgeons should be prepared for this scenario. The need for alternative instrumentation is higher in older individuals and may extend procedural time.Level of Evidence4 Laryngoscope, 2024

Transmission Coefficient Measurements Using a 2.48-4.7 GHz Lateral Multiband Microstrip Patch Antenna (MB-MPA)

We designed a standard triple-wavelength multiband microstrip patch antenna (MB-MPA) by electromagnetic simulation and fabricated it using an FR-4 substrate. The fundamental resonant frequency f1 was 2.48 GHz, the second-order resonant frequency f2 was 3.7 GHz, and the third-order resonant frequency f3 was 4.7 GHz. The f2 signal resonated at 1/2 the length of the patch width W, and the electrical field intensities of Eφ and Eθ showed π/2 rotation polarization relative to the f1 signal. The polarization angle of the f3 signal was about 34 degrees as the f3 signal resonated at a length of 1/2 of the oblique line of the right triangle consisting of the shortened length L and 1/2 of the width W of the patch. The 0.1 - 6 GHz frequency band reflection and transmission coefficients of S-parameters S11 and S21 measured at a spatial propagation distance of 0.1 - 0.3 m with MB-MPAs as the transmitting and receiving antenna were consistent with the transmission system simulation results. The simulated transmission coefficient S21 at three wavelengths with a spatial propagation distance of 10 - 50 m with two-stage LNAs showed practical values. The lateral resonant MB-MPA can be practically designed by using 3D electromagnetic current density distribution, electric field intensity radiation, and evaluating the transmission coefficient S21.

A Novel Technique for Repairing Alveolar Clefts: Computer-Assisted Design With Posterior of Mandible Block Bone Grafts

Objective: Iliac cancellous bone graft is the gold standard for the treatment of alveolar clefts. However, the resorption rate of iliac cancellous bone is generally high. In this study, the authors propose a new method for repairing alveolar clefts using block bone grafts in the posterior region of the mandibular molar and the anterior margin of the ascending branch. Methods: Ten patients with a diagnosis of unilateral or bilateral alveolar cleft were collected. Block bone grafting between the posterior mandibular molar region and the inner and outer oblique lines of the anterior margin of the ascending branch was used to treat the alveolar synostosis. Preoperative, 1-week postoperative, and 6-month postoperative multislice spiral computed tomography scans of the patients were collected and analyzed for preoperative design and postoperative graft bone morphology using computer-assisted software tools, which were also required to measure the changes in the bone tissue density in the posterior mandibular bone extraction area. Results: At 6 months postoperatively, the mean bone resorption rate of the posterior mandibular bone grafts for cleft alveolar processes was 33.96% ± 11.23%. Bone tissue density in the posterior mandibular bone grafting area recovered to near preoperative levels at 6 months postoperatively. Conclusion: The novel method of bone grafting for the cleft alveolar process used in this paper is really effective. Postoperative posterior mandibular bone extraction did not cause sequelae such as mandibular bone defects or poor morphology in the patients. Computer-assisted design and three-dimensional printing technology helped to improve intraoperative bone grafting accuracy and postoperative assessment.

A finite element analysis on the indication for extracting partially impacted mandibular third molars considering mandibular trauma

BackgroundPatients presenting with partially impacted lower third molars (M3) have a higher likelihood of experiencing angle fractures while simultaneously decreasing the risk of condylar fractures. However, the specific biomechanical mechanism responsible for this occurrence remains unclear. Moreover, there is an ongoing debate regarding whether the removal of M3s might actually increase the risk of condylar fractures. This study aimed to evaluate how the presence of M3s influences mandibular fractures resulting from blows to the symphysis and lateral mandibular body, and to determine the indication for extracting M3s in such cases.MethodsModels of the mandible with a partially M3-impacted model (M3I), M3-extracted model (M3E), and M3-absent model (M3A) were generated using a computer. A traumatic blown force of 2000 N was applied to the symphysis and the right body of the mandible. Von Mises and principal stresses were analyzed, and failure indexes were determined. Two cases of mandibular linear fractures were chosen for model verification and interpretation.ResultsWhen force was applied to the symphysis, the condylar region exhibited the highest stress levels, while stress in the mandibular angle region was much less regardless of the M3 state. On applying the force to the right mandibular body, stress in the condylar region decreased while stress in the mandibular body increased, especially in the blown regions. Impacted tooth or cavity formation post-M3 extraction led to uneven stress distribution on the blown side of the mandible, increasing the risk of mandibular angle fractures. In cases where M3 was absent or the extraction socket had healed, stress from lateral traumatic blown force was evenly distributed along both the inner and outer oblique lines of the mandible, thereby reducing the risk of mandibular fractures.ConclusionsThe reduced risk of condylar fractures in patients with partially impacted lower M3s and mandibular angle fractures is mainly due to lateral blows on the mandible, which generate less stress in the condylar region than blows on the mandibular symphysis, rather than being caused by the M3 itself. Extraction of the lower M3 can decrease the risk of mandibular fractures, with a minor influence on condylar fractures.

The Use of Male Implants in Thyroplasty Reinterventions for Female Patients: A Case Series Study

Montgomery’s medialization thyroplasty is a laryngeal frame surgery to treat patients with unilateral vocal cord paralysis. This procedure uses a silicone implant in six sizes each for male and female patients. The results of this technique are generally good; however, the results can be suboptimal in some female patients because of differences in female and male laryngeal anatomy. The angle formed by the thyroid cartilage is greater in women than in men, meaning that the posterior portion of this cartilage is further away from the midline in women. We describe our results using male prostheses to improve suboptimal results in some of our female patients. This study is a retrospective case series study. We included female patients who underwent thyroplasty reintervention from 2014 to 2021 using male Montgomery thyroplasty prostheses. Functional results were studied using maximum phonation time (MPT), the GRBAS scales, and two questionnaires: Voice-Handicap Index 30 and Eating Assessment Tool 10. The functional results for all of these women improved after secondary thyroplasty. In one case, the MPT parameter did not change but patient satisfaction improved. The use of male Montgomery implants in women can be a useful tool to achieve improvement in female thyroplasty failure.

Outcome of isolated and combined direct feminization laryngochondroplasty: Our first 20 cases

This retrospective study describes the surgical outcomes of our first 20 transgender women to undergo feminization thyroid laryngochondroplasty (FLC) by a direct transvestibular FLC (DTV-FLC) approach from December 2019 to October 2023. The medical records of all patients were retrieved and reviewed. Data on the operative, postoperative, and follow-up courses, complications, and functional and cosmetic outcomes were retrieved. The cosmetic results were evaluated by four independent facial plastic surgeons. Thirteen patients underwent DTV-FLC combined with genioplasty or genioplasty with mandibular angle reduction and seven underwent isolated DTV-FLC. DTV-FLC was feasible in all planned cases. Complications (skin flap perforation, thyroid cartilage fracture, mental hypoesthesia, hematoma, dehiscence of the vestibular incision, vestibular scar adhesions, and anemia) were minor and resolved spontaneously. The preoperative grade of thyroid cartilage protrusion was 1.9 ± 0.9 on a scale from 1 to 3. The postoperative cosmetic results of 18 patients were judged as having improved (a score of 2.1 ± 0.8 on a scale from −1 to 3). Eighteen patients were satisfied with the cosmetic result, one was dissatisfied (the revision surgery patient), and one was lost to follow-up. In conclusion, DTV-FTLC is a valid surgical approach for FLC, yielding high patient satisfaction and good cosmetic results.

Mechanical compression of the carotid artery by the pharynx in the retropharyngeal space during swallowing and the induction of stenosis and embolic stroke: illustrative case.

Compression of the carotid artery (CA) by hyoid bony structures, such as the hyoid bone and thyroid cartilage, during swallowing or neck rotation can induce stroke. However, no reports have described ischemic stroke caused by mechanical compression of the CA by the pharynx during swallowing. A man with left CA stenosis developed recurrent ischemic stroke in his left hemisphere. Computed tomography angiography of the neck showed that the left common carotid artery was trapped by the hyoid bone and thyroid cartilage and that the internal carotid artery (ICA) ran in the retropharyngeal space. Angiography during swallowing of a contrast agent showed dynamic compression of the left CA posterolaterally by the pharynx during swallowing, despite the fact that the CA on the healthy right side moved anteromedially. The retropharyngeal ICA was then transposed to its normal location and endarterectomy was performed. No ischemic events occurred postoperatively, and angiography showed that the left CA now moved anteromedially during swallowing. Movement of the pharynx during swallowing can be a risk factor for CA stenosis. It is important to evaluate the anatomical interaction between the CA and surrounding structures, as well as their dynamics, to ensure appropriate diagnosis and treatment. https://thejns.org/doi/10.3171/CASE2483.

Treatment of hyoid bone syndrome with surgical excision: our monocentric experience in the past five years

PurposeIn 1968, Steinmann described the hyoid bone syndrome as a degenerative and inflammatory insertion tendinosis. It causes unilateral pain in the neck, increased by swallowing and palpation. The treatment is conservative, but when this fails, surgery is an option. Our aim is to assess the post-operative outcome of patients for whom a surgical hyoid bone resection procedure was performed in the University Hospital of Antwerp (UZA). MethodsA retrospective study was performed. Patients were seen at the laryngology clinic in the UZA from 2018 until 2023. They were diagnosed with the hyoid bone syndrome based on anamnesis and clinical examination. Pre-operative imaging was performed to evaluate for anatomical changes and fiberoptic laryngoscopy performed to exclude other causes. Pre- and postoperative VAS pain scores were questioned. ResultsSeventeen patients were operated, two of them bilaterally. All patients had pain located to the affected side, and almost half of patients (n = 7) had dysphagia. On imaging, 10 patients had an elongated styloid process and 7 had calcification of the stylohyoid ligament. All patients underwent resection of the greater horn of the hyoid bone, 13 patients underwent resection of the stylohyoid ligament and in 9 patients the superior horn of the thyroid cartilage was removed. Mean pre-operative VAS pain score was 9 (/10) and mean postoperative score was 1.3 (/10). ConclusionOur preliminary results show a good clinical effect of the surgical excision procedure and offer insight in the hyoid bone syndrome. Follow-up is necessary to assess the long-term results and potential recurrence of symptoms.

Evaluation of neck ultrasound measurements as a difficult airway predictor: A prospective observational study.

This study aimed to investigate the relationship between cervical measurements and difficult airways using ultrasonographic measurements. American Society of Anesthesiologists grade I to III, male or female, 120 adult patients, undergoing elective surgery were enrolled in the study. The study involved measuring the distance of the trachea, cricoid cartilage, thyroid cartilage, vocal cord anterior commissure, and hyoid bone to the skin using a 10 to 13 MHz linear ultrasound probe in the transverse plane. Additionally, the length of the cricothyroid and thyrohyoid membranes, along with their distance from the skin, were measured using the probe in the sagittal plane. Subsequently, another experienced anesthesiologist conducted mask ventilation and intubation after the patient's induction of general anesthesia. Throughout this process, the patient was assessed for difficulties in mask ventilation, laryngoscopy, and intubation. 28 (23.3%) patients had a difficult airway. Analyzing the measurements associated with difficult airways, the most reliable predictor was the epiglottis midline-skin distance [AUC (area under the curve): 0.847, P < .001, cutoff: >19.9, sensitivity: 78.6%, specificity: 79.4%]. Additionally, other factors such as hyoid bone to skin distance, thyroid cartilage to skin distance, thyrohyoid membrane to skin distance, and vocal cord anterior commissure-skin distance were also identified as predictors for a difficult airway. The increase in the distance of the epiglottis midline, vocal cord anterior commissure, hyoid bone, thyrohyoid membrane, and thyroid cartilage to the skin at the level of the isthmus measured by ultrasonography is predictive of difficult airways. Based on our study outcomes, we assert that ultrasonographic evaluation can be used in the prediction of difficult airways.

Diagnostic accuracy of post-mortem computed tomography for fractures of the hyoid-larynx complex.

Post-mortem computed tomography (PMCT) is routinely used at many forensic institutions to guide the following autopsy and is especially useful for diagnosing fractures. This systematic review aims to investigate the sensitivity and specificity of a PMCT scan in fracture diagnosis of the hyoid-larynx complex (HLC) compared to traditional autopsy in cases involving traumatic neck injuries. We searched PubMed, SCOPUS and Web of Science and included papers with cases n ≥ 3 published between January 2000 and April 2023 reporting on PMCT and autopsy findings of fractures of the HLC. The search provided 259 results of which 10 were included. Overall sensitivity and specificity were 0.70 [0.59; 0.79] and 0.92 [0.80; 0.97] for hyoid bone fractures and 0.80 [0.62; 0.91] and 0.76 [0.63; 0.85] for the thyroid cartilage. The results show great variation, and a large range between studies. These results indicate that PMCT cannot replace autopsy in cases with HLC fractures. Future larger prospective studies are needed, examining fracture details, scan protocols and different slice thicknesses using uniform reporting.