The purpose of this study is to use optical coherence tomography (OCT) to characterize the effect of dehydration on the optical attenuation coefficient of porcine vocal fold (VF) tissue. Assessing laryngeal hydration is clinically relevant for evaluating vocal function; however, no reliable noninvasive methods currently exist to quantify it. Six porcine larynges were bisected into 12 halves, yielding 12 VFs. Each specimen underwent serial dehydration using a vacuum oven to approximately 5%, 10%, and 15% mass loss, with OCT scans obtained at each interval using a 1300 nm wavelength system. Attenuation coefficients were extracted from OCT B-scans through custom MATLAB processing, and the relationship between tissue dehydration and attenuation was modeled using a linear mixed-effects model. Across VFs, attenuation decreased by approximately 0.08 mm-1 for each 1% increase in tissue mass loss (b = -0.079, 95% CI [-0.105, -0.054]). Attenuation decreased linearly with increasing tissue dehydration. The true VF exhibited consistently higher attenuation values than the false folds by an average of 1.47 mm-1 (p < 0.001). Interfold variability was low (ICC = 0.041), indicating strong reproducibility across specimens. OCT-derived attenuation provides a quantitative, reproducible indicator of VF dehydration. The linear relationship between attenuation and tissue mass loss supports the feasibility of OCT as a noninvasive optical biomarker of VF hydration. Future multi-wavelength and invivo studies will be critical to translate this approach into clinical monitoring of VF hydration, edema, and lesion formation. NA.

Background/Objectives: The human larynx exhibits marked sexual dimorphism and undergoes age-related structural remodeling, both of which influence voice characteristics and have important implications for diagnostic assessment. While sex-related differences in laryngeal size are well recognized, the extent to which aging contributes to dimensional versus qualitative structural changes remains incompletely defined. This study aimed to analyze sex- and age-related morphometric and histological characteristics of the human larynx, with a focus on features relevant to voice evaluation and diagnostic interpretation. Methods: A cross-sectional anatomical study was conducted on 80 cadaveric human larynges preserved in 10% buffered formalin. Specimens were stratified by sex and age (<30, 30-60, and ≥60 years). Direct morphometric measurements included anteroposterior laryngeal length, thyroid cartilage height, thyroid angle, and relative glottic area. Epiglottic morphology and the presence of laryngeal cartilage calcification/ossification (binary classification: present vs. absent) were recorded. Histological analysis of vocal fold tissue was performed on a stratified subset of specimens. Statistical analysis included t-tests, chi-square tests, two-way ANOVA, effect size estimation, and logistic regression. Results: Male specimens showed significantly greater anteroposterior length, thyroid cartilage height, and relative glottic area, along with a narrower thyroid angle, compared with females (all p < 0.001), with large effect sizes. Age did not significantly influence overall laryngeal dimensions. In contrast, cartilage calcification/ossification increased markedly after the age of 60. Logistic regression identified age ≥ 60 years as the only independent predictor of calcification (OR = 4.37, p = 0.039), while sex was not significant. Epiglottic morphology demonstrated a sex-dependent distribution. Histology revealed age-related muscle atrophy and reduced collagen and elastin density. Conclusions: Sex defines the baseline morphometric framework of the adult larynx, whereas aging, particularly beyond 60 years, drives qualitative structural degeneration. These findings provide a reproducible anatomical reference for distinguishing sex-related variation from age-related changes in diagnostic assessment.

Autoimmune associated vocal fold lesions (AaVFL) are a result of underlying autoimmune conditions that include laryngeal rheumatoid nodules, bamboo nodules, and other nonspecific disease lesions. Women being more prone to autoimmune disease are therefore more likely to develop these vocal fold lesions. This relationship showed a greater association in women in their 4th and 5th decades when treating these lesions. This greater association is theorized to be due to introduction of hormone replacement therapy (HRT) containing estrogen in their 4th and 5th decades of life. The proinflammatory nature of estrogen in women with autoimmune disease and the presence of estrogen receptors on cells within vocal fold tissue presents a potential pathway for development of these lesions. In this retrospective cohort study, we used TriNetX a deidentified global patient database to perform a comparative risk analysis of two cohorts: women with underlying autoimmune conditions who have or have not been exposed to HRT containing estrogen. The underlying autoimmune conditions queried for were rheumatoid arthritis, systemic lupus erythematous, sjögren syndrome, autoimmune thyroiditis, sarcoidosis, amyloidosis, scleroderma, and relapsing polychondritis. Risk analysis showed a statistically significant 1.65 times higher risk of developing a vocal fold lesion when exposed to HRT containing estrogen. This comparative risk analysis supports a relationship between the development of a AaVFL after the exposure to HRT containing estrogen in women. Evidence of this relationship supports further research into the estrogen-estrogen receptor complex pathway within the larynx and altering clinical procedures for treating patients with AaVFL on HRT containing estrogen.

The high fundamental frequency in horse whinnies is generated by an aerodynamic whistle.

IntroductionModeling the mechanics of human vocal folds during phonation is a challenging task. This is partly due to the mechanics of their soft and highly anisotropic fibrous tissues, which undergoes finite strains with both elasticity and strain-rate sensitivity.MethodsWe propose a visco-hyperelastic micro-mechanical model capable of predicting the complex cyclic response of the vocal-fold fibrous tissues based on their histo-mechanical properties. For that purpose, we start from the hyperelastic micro-mechanical model proposed by Terzolo et al., J. Mech. Behav. Biomed. Mater. 128:105118 (2022). We include in the model non-linear viscoelastic contributions at the fibril scale to account for the dissipative and time-dependent response of vocal-fold tissues.Results and DiscussionThe relevance of the model is demonstrated and discussed through comparison with a comprehensive set of reference experimental data, within a wide range of loading modes, strains, and strain rates: cyclic and multi-axial loadings at finite strains (tension, compression and shear), along with small-amplitude oscillatory shear (SAOS) and large-amplitude oscillatory shear (LAOS) from low to high frequencies. This study elucidates how the viscoelasticity of vocal-fold tissues can result from combined time-dependent micro-mechanisms, such as the kinematics and the deformation of their fibril bundles, along with the mechanical interactions likely to develop among fibrils and the surrounding amorphous matrix.

Edema of the vocal folds (VFs) is the result of an inflammatory response to injury (phonotrauma), or other deleterious stimuli, causing fluid build-up in the VF tissue. Although a mild level of edema has been postulated to be prophylactic, excessive edema has been identified as a pathway in the development of vocal hyperfunction. Herein we present a multi-time scale finite element model to examine the progression of VF edema in response to phonotrauma. Phonotraumatic damage was assessed by two measures: viscous dissipation and positive strain energy rate. Time-averaged phonotrauma over short time scales was assumed to drive swelling over longer time scales in proportion to the damage measure via a damage sensitivity gain. Healing was assumed to continuously act to reduce swelling. Growth rate analysis indicated that edema depends on a balance between healing, compensatory adjustments to maintain desired voice output measures, and altered VF vibration due to edema. For high damage sensitivity relative to healing, peak edema resulted in roughly 25% local peak swelling at 0.15 h, whereas low damage sensitivity led to swelling trending toward a steady condition requiring little compensation to maintain voice outputs. In general, fluid accumulation was distributed non-uniformly across the VFs with concentrations near the VF medial surface and the superior end of the body. Results from this first-ever model connecting phonotrauma at the short time scale and swelling at the longer time scale exhibited rapid edema progression under certain conditions, aligned with the "vicious cycle" hypothesis of hyperfunction, wherein localized edema initiated a positive feedback loop that led to even greater localized swelling.

Blunt force trauma to the larynx can cause significant damage, resulting in displaced laryngeal cartilage fractures. Vertical misalignment of the left or right vocal fold (VF) in the inferior-superior direction and scarring of the VF tissue are common outcomes. The influence of inferior-superior VF displacement and VF scarring on phonation was investigated using synthetic, self-oscillating VF models in a physiologically-representative facility. Acoustic, kinematic, and aerodynamic parameters were assessed as a function of inferior-superior vertical displacement and asymmetric VF stiffness. The combination of vertical misalignment and asymmetric VF tissue stiffness became most prominent when the inferior-superior misalignment of the VFs exceeded the thickness of the medial surface. Only a small degree of stiffness asymmetry was tolerated before VF kinematics and acoustics were significantly degraded. The position of the scarred VF relative to the healthy one also influenced outcomes. If the stiffer VF was positioned inferior to the normal VF, phonatory outcomes were poorer than when it was positioned superior to the normal VF. Measures of shimmer and jitter were more than twice as high, while cepstral peak prominence was 3-5 dB lower.

Increased extracellular matrix deposition and stiffness promotes solid tumour progression. Yet, the precise mechanotransduction pathways, especially in less-studied mechanically responsive cancers, remain poorly understood. Here we address this gap using patient-derived tumour cells from early (mobile, T1) and advanced (immobile, T3) stages of vocal fold cancer, the most common squamous cell carcinoma severely impacting the voice box. We reveal that vocal fold cancer progression is linked to cell surface receptor heterogeneity, a loss of laminin-binding integrins in cell–cell junctions and a flocking mode of collective cell motility. Mimicking the physiological movement of healthy vocal fold tissue with stretching or vibrations decreases oncogenic β-catenin and Yes-associated protein (YAP) nuclear levels in vocal fold cancer. Multiplex immunohistochemistry of vocal fold cancer tumours shows a correlation between the extracellular matrix composition, nuclear YAP and patient survival, concordant with vocal fold cancer sensitivity to oncogenic YAP-TEAD Hippo pathway inhibitors both in vitro and in vivo. Overall, our findings suggest that vocal fold cancer is a mechanically sensitive malignancy, and that the restoration of tumour mechanophenotype or YAP/TAZ targeting represents a tractable anti-oncogenic therapeutic avenue for vocal fold cancer.

This study examines the impact of vocal fold (VF) lesions located on the superior surface on glottal airflow dynamics and tissue oscillatory behaviors using biomechanical simulations of a two-layered realistic VF model. It is hypothesized that morphological changes in the VFs due to the presence of a lesion cause changes in tissue elasticity and rheological properties, contributing to dysphonia. Previous research has lacked the integration of lesions in computational simulations of anatomically accurate larynx-VF models to explore their effects on phonation and contribution to voice disorders. Addressing the current gap in literature, this paper considers a computational model of a two-layered VF structure incorporating a lesion that represents a hemorrhagic polyp. A three-dimensional, subject-specific, multilayered geometry of VFs is constructed based on STL files derived from a human larynx CT scan, and a fluid-structure interaction (FSI) methodology is employed to simulate the coupling of glottal airflow and VF tissue dynamics. To evaluate the effects of the lesion's presence, two FSI models, one with a lesion embedded in the cover layer and one without, are simulated and compared. Analysis of airflow dynamics and tissue vibrational patterns between these two models is used to determine the impact of the lesion on the biomechanical characteristics of phonation. The polyp is found to slightly increase airflow resistance through the glottis and disrupt vibratory symmetry by decreasing the vibration frequency of the affected fold, leading to weaker and less rhythmic oscillations. The results also indicate that the lesion increases tissue stress in the affected fold, which agrees with clinical observations. While quantitative ranges depend on lesion size and tissue properties, these consistent and physically meaningful trends highlight the biomechanical mechanisms by which lesions influence phonation.

Identifying progenitor cells in laryngeal and vocal fold (VF) mucosa is essential for advancing stem cell-based therapies for VF diseases. In this study, we used Lrig1 (leucine-rich repeats and immunoglobulin-like domains 1) gene to label tissue-resident stem cells within laryngeal and VF mucosa, aiming to investigate cellular networks underlying VF homeostasis and regeneration. Lrig1+ cells exhibited hallmark features of quiescent stem cells-including slow cycling, long-term persistence, and differentiation potential-and contributed to sustained VF regeneration and repair after naphthalene injury. By one week post injury Lrig1+ progeny restored the damaged VF epithelium. Transcriptionally, these cells suppressed cell type specific genes and proliferation while activating programs related to RNA metabolism, epigenetic regulation, and protein ubiquitination, consistent with quiescence and readiness for activation. Lrig1+ cells were enriched in basal, parabasal, and immature secretory populations within surface epithelium and submucosal glands, residing in niches characterized by transcriptional flexibility and spatial shielding from direct stress-features that likely prevent premature or chronic mobilization. Notably, analogous LRIG1 expressing cells were identified in human laryngeal and VF tissues, highlighting the translational relevance of our findings. To explore regulation of Lrig1+ cell quiescence, we conditionally deleted Notch1, which led to epithelial hyperplasia, expansion of secretory populations, and mucus hyperproduction. In summary, Lrig1 marks a conserved, quiescent stem cell population in the larynx and VFs that supports long-term tissue homeostasis and repair, with quiescence maintained via Notch1 signaling.

Ethyl Cinnamate-Based Tissue Clearing Technique on Vocal Fold Mucosa with Vasculature Model.

Precise and timely intraoperative classification of vocal cord leukoplakia is vital for early staging and detection of laryngeal cancer. Current endoscopic imaging, such as narrow-band imaging (NBI) and white-light laryngoscopy (WLI), has the capability to evaluate the malignancy, but has low sensitivity (<70%) for grading the low-risk dysplasia. For the vocal fold lesions, optical coherence tomography (OCT), a non-invasive imaging technology, has been widely used to show the texture and pixel change of lesions caused by squamous epithelial cell hyperplasia and atypical hyperplasia. Here, a handheld OCT probe (OD = 3 mm, length = 25 cm) was designed and fabricated, and a swept-source OCT system was built for vocal lesion monitoring during the surgery. Home-built OCT probe has both a small OD and a long length for penetration depth imaging with good quality, which may enable the accurate and timely intraoperative localization detection of vocal cord tissues. The probe system has a 2D imaging speed of 100 frames per second, 7.96 µm lateral resolution, 16.24 µm axial resolution, and an imaging depth of 2.12 ± 0.43 mm in vocal fold tissues. We collected 378 OCT b-scan images (114 low risk, 175 high risk, 89 malignant) from 12 patients (4 low risk, five high risk, three malignant). A total of eight features of single B-scan images were extracted, including the mean pixel intensity (PI), median PI, minimum PI, and maximum PI; meanwhile, the mean attenuation coefficient (AC), median AC, minimum AC, and maximum AC of A-lines. The random forest (RF) model achieved the best overall accuracy (92.59%) and recall (93.25%) for low risk, high risk, and malignant classification, using 5-fold validation, with each patient's assessment completed within 10 minutes. Our OCT system was demonstrated to provide rapid and accurate pathological diagnosis of vocal cord leukoplakia intraoperatively. Our handheld OCT system facilitates identification of low-risk dysplasia with a sensitivity of up to 84.21% during the surgery, offering critical guidance on whether to opt for conservative or surgical treatment based on the lesion's severity.

ABSTRACTObjectiveLaryngeal dysplasia and Reinke's edema (RE) are common vocal fold lesions associated with smoking. While the former is cancer prone, most cases of the latter do not undergo malignant transformation. Therefore, we proposed identifying biomarkers of smoking‐induced benign‐malignant transformation of vocal fold lesions.MethodsIntraoperative vocal fold tissue specimens were collected from 12 smoking patients, including 4 cases of RE, 4 cases of high‐risk dysplasia (HD), and 4 cases of laryngeal carcinoma (CA), and from 4 nonsmoking vocal fold polyps (VFP) patients. RE and HD were set as experimental groups, and CA and VFP were set as positive and negative control groups, respectively (for subsequent expression analysis of hub genes screened). RNA sequencing and DIA‐MS were employed to screen for differentially expressed genes (DEGs) and differentially expressed proteins (DEPs) in RE\\HD. Venn analysis was used to identify co‐expressed DEGs\\DEPs. Functional enrichment analysis was performed to explore DEG\\DEP‐related pathways. LASSO regression and SVM‐RFE algorithm were applied to screen for hub genes. The expression levels and prognosis of the hub genes were analyzed based on the TCGA database. The expression levels of the hub genes were further verified using RT‐qPCR.ResultsA total of 45 co‐expressed DEGs\\DEPs were identified in RE\\HD, with significant enrichment observed in the HIF‐1 signaling pathway. Three hub genes were identified: TMPRSS11B, SASH1, and TPRG1, which exhibited reduced expression and were associated with poor prognosis in head and neck squamous carcinomas. RT‐qPCR analysis confirmed that the mRNA levels of TMPRSS11B were highly expressed in RE and low in HD compared to VFP.ConclusionThis study reveals that TMPRSS11B may be a potential biomarker of smoking‐induced benign‐malignant transformation of the vocal fold lesions, providing a predictive and therapeutic target for early diagnosis and treatment of laryngeal carcinoma.

Laryngeal high-speed video (HSV)-endoscopy allows for fast, non-invasive diagnosis of voice disorders and forms the basis for a comprehensive quantitative analysis of the vocal folds’ (VFs’) spatiotemporal vibrational behavior. Previous approaches, such as the Phonovibrogram (PVG), describe the vibrational behavior of vocal folds (VFs) based exclusively on the time-varying glottal opening. However, focusing solely on the glottal area overlooks the full extent and dynamic behavior of the VF tissue, factors that are crucial for the voice production process. This complicates clinical interpretation and, thus, the comparability of vibrational dynamics in both cross-sectional and longitudinal interventional studies. To address these limitations, this work aims to extend the PVG to provide a more comprehensive representation of the vibrational behavior across the entire VF tissue. Here, we present the Laryngovibrogram (LVG), which is obtained by segmenting not only the glottal area but also the VFs’ tissue, providing a compact quantitative representation of the VFs’ vibrational behavior. The potential of the proposed LVG representation was investigated on 73 HSV recordings from healthy (38 HSVs) and pathological subjects (35 HSVs) in stationary as well as non-stationary phonations. It is demonstrated that the LVG reliably maps the vibrational behavior along the entire length of the VFs tissue for both physiological and pathological phonations. Compared to PVG-based measures, LVG-based measures exhibited greater stability in healthy subjects, allowing for a narrower normative range, and showed stronger effect sizes in differentiating clinical groups, suggesting a more robust assessment of vibratory impairments. By scaling the vibration amplitude relative to the length of the segmented VF tissue, the VF vibrations are normalized, enabling meaningful quantitative intra- and inter-individual comparisons. Additionally, calculating the angle enclosed by the two VFs makes it possible to analyze transient effects that occur during non-stationary phonation maneuvers, such as voice onset. By integrating information about the VF tissue, the LVG introduced here represents a paradigm shift in the analysis of laryngeal dynamics from focusing solely on the glottal area to a holistic analysis of the entire VF kinematics, which might improve pathology detection accuracy, reduce subjective assessment errors, and optimize treatment follow-ups, ultimately enhancing both clinical diagnostics and therapeutic outcomes.

Human Vocal Fold Tissue Modifications Related to Laryngopharyngeal Reflux Disease: A Systematic Review.

Systemic hydration is known to promote optimal functioning of bodily systems-including the vocal folds. The impact of systemic dehydration on the biology of the vocal folds and the downstream effects of dehydration on voice output are not well understood. An in vivo rat model of systemic dehydration was employedto investigate vocal fold gene expression, histological changes, and acoustic changes in vocalization. Ultrasonic vocalizations (USVs) were recorded every day for 5 days (baseline), in male and female Long-Evans rats (N = 36, ages: 3-4 months) using an anticipatory reward paradigm. Next, rats were dehydrated (N = 18) using a published water-restriction model for 5 days or euhydrated (N = 18) and provided ad libitum access to water for 5 days. USVs were recorded daily during the dehydration/euhydration period. The USV variables were averaged at baseline and following dehydration/euhydration for individual animals, and the difference between these time periods was used for statistical analysis. USV analysis included total USV count, complexity ratio, duration (s), frequency range (kHz), and maximum intensity (dB). At the end of dehydration/euhydration, animals were euthanized, and kidney and vocal fold tissue samples were dissected and processed for histology and gene expression analysis. Compared to euhydrated rats, dehydrated male and female rats had significantly up-regulated gene expression of kidney renin (male p = 0.047; female p = 0.018), indicating physiologic dehydration. There were no statistically significant differences in the USV acoustic profile or histopathology between the two groups. Differential expression (p < 0.05) of several genes related to extracellular matrix remodeling, inflammatory responses, and water ion transport in the vocal folds was present. Our results indicate that mild systemic dehydration impacts gene expression in the vocal fold mucosa; however, these gene expression changes are not evident in the acoustic profile of vocalizations.

Voice onset is the sequence of events between the first detectable movement of the vocal folds (VFs) and the stable vibration of the vocal folds. It is considered a critical phase of phonation, and the different modalities of voice onset and their distinctive characteristics are analysed. Oscillation of the VFs can start from either a closed glottis with no airflow or an open glottis with airflow. The objective of this article is to provide a comprehensive survey of this transient phenomenon, from a biomechanical point of view, in normal modal (i.e., nonpathological) conditions of vocal emission. This synthetic overview mainly relies upon a number of recent experimental studies, all based on in vivo physiological measurements, and using a common, original and consistent methodology which combines high-speed imaging, sound analysis, electro-, photo-, flow- and ultrasound glottography. In this way, the two basic parameters-the instantaneous glottal area and the airflow-can be measured, and the instantaneous intraglottal pressure can be automatically calculated from the combined records, which gives a detailed insight, both qualitative and quantitative, into the onset phenomenon. The similarity of the methodology enables a link to be made with the biomechanics of sustained phonation. Essential is the temporal relationship between the glottal area and intraglottal pressure. The three key findings are (1) From the initial onset cycles onwards, the intraglottal pressure signal leads that of the opening signal, as in sustained voicing, which is the basic condition for an energy transfer from the lung pressure to the VF tissue. (2) This phase lead is primarily due to the skewing of the airflow curve to the right with respect to the glottal area curve, a consequence of the compressibility of air and the inertance of the vocal tract. (3) In case of a soft, physiological onset, the glottis shows a spindle-shaped configuration just before the oscillation begins. Using the same parameters (airflow, glottal area, intraglottal pressure), the mechanism of triggering the oscillation can be explained by the intraglottal aerodynamic condition. From the first cycles on, the VFs oscillate on either side of a paramedian axis. The amplitude of these free oscillations increases progressively before the first contact on the midline. Whether the first movement is lateral or medial cannot be defined. Moreover, this comprehensive synthesis of onset biomechanics and the links it creates sheds new light on comparable phenomena at the level of sound attack in wind instruments, as well as phenomena such as the production of intervals in the sung voice.

MAGEA9 Expression in Vocal Fold Leukoplakia and Its Enhancement of Vocal Fold Leukoplakia Epithelial Cell Proliferation, Migration, and Invasion Through the NF-kB-MMP-2/9 Pathway.

Mechanotransduction is a crucial property in all organisms, modulating cellular behaviors in response to external mechanical stimuli. Given the high mobility of vocal folds, it is hypothesized that mechanotransduction significantly contributes to their tissue homeostasis. Recent studies have identified mechanosensitive proteins in vocal fold epithelia, supporting this hypothesis. Voice therapy, which, involves the mobilization of vocal folds, aims to rehabilitate vocal function and restore homeostasis. However, establishing a direct causal link between specific mechanical stimuli and therapeutic benefits is challenging due to the variability in voice therapy techniques. This challenge is further compounded when investigating biological benefits in humans. Vocal fold tissue cannot be biopsied without significant impairment of the vibratory characteristics of the vocal folds. Conversely, studies using vocal fold mimetic bioreactors have demonstrated that mechanical stimulation of vocal fold fibroblasts can lead to highly heterogeneous responses, depending on the nature and parameters of the induced vibration. These responses can either aid or impede vocal fold vibration at the physiological level. Future research is needed to determine the specific mechanical parameters that are biologically beneficial for vocal fold function.

We read with great interest the recently published case report by Lim et al. [1]. The authors provided an excellent overview of the airway challenges in patients undergoing Wendler glottoplasty as part of gender-affirming laryngeal surgery, highlighting the use of jet ventilation and supraglottic airway devices. While there is no universal standard in the United States, many institutions including ours, prefer the use of smaller diameter tracheal tubes (internal diameter ≤ 6.0 mm) in Wendler glottoplasty. Although supraglottic airway devices may improve glottic visualisation, their use during glottoplasty requires caution due to the risk of laryngospasm during or immediately after this surgery which occurs in 1.4% of cases [2]. A pilot study by the American Broncho-Esophagological Association found that immediate airway compromise occurred in 5.3% of patients undergoing Wendler glottoplasty and that 15.8% of otolaryngologists favour smaller diameter tracheal tubes over supraglottic airway devices for this reason [3]. The use of supraglottic airway devices for surgery carried out after the gender-affirming laryngeal surgery may result in increased airway resistance due to reduced glottic opening. This can lead to the need for higher airway pressures for ventilation and may also interfere with vocal cord healing, causing persistent granulation tissue, suture dehiscence and scarring of the membranous vocal folds. These are recognised risks for this patient population and may be worsened by using supraglottic airway devices [4]. Optimal airway device selection for gender-affirming laryngeal surgery is crucial, and factors including surgical access, postoperative outcomes and minimising complications, such as atelectases, must be balanced. With limited data in this population, targeted research is needed to evaluate airway outcomes and compare devices to guide practice.