Surgical closure of the larynx for intractable aspiration, using double hinged flaps of the vocal folds and false vocal folds

We report a new surgical procedure to treat intractable aspiration: closure of the larynx, using double hinged flaps of the vocal folds and false vocal folds.The anterosuperior portion of the thyroid cartilage is ablated. A small horizontal incision is made just above the anterior commissure and is continued posteriorly along the laryngeal ventricle; these incisions are continued across the posterior wall of the glottis. Incisions are made into the bilateral vocal folds and false vocal folds in order to create the hinged flaps. The glottis and the supraglottis are closed by approximating the bilateral vocal folds and false vocal folds hinged flaps. Superiorly or inferiorly based sternohyoid muscle pedicles are then inserted into the dead space between the approximated bilateral vocal folds and false vocal folds hinged flaps. The removed lamina of the thyroid cartilage is obliterated between both sternohyoid muscle flaps to enforce the closure of the larynx.

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Method and Clinical Results of a New Transthyrotomy Closure of the Supraglottic Larynx for the Treatment of Intractable Aspiration

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949710600602 ◽

1997 ◽

Vol 106 (6) ◽

pp. 451-460 ◽

Cited By ~ 8

Author(s):

Paul F. Castellanos

Keyword(s):

Decision Making ◽

Surgical Procedure ◽

Vocal Folds ◽

Clinical Results ◽

Decision Making Process ◽

Surgical Decision ◽

Intractable Aspiration ◽

False Vocal ◽

Surgical Decision Making ◽

Supraglottic Larynx

A new procedure has been developed to surgically separate the pharynx from the trachea that employs the best features of the Montgomery technique, but restricts the closure to only the epiglottis and the aryepiglottic folds. The petiole of the epiglottis is plicated to the false vocal folds and the interarytenoid mucosa. It is performed entirely through a midline thyrotomy approach and avoids injury to any of the structures within the rima glottidis. It has been successfully performed on seven very ill patients to date. The surgical decision-making process involved, a complete description of the surgical procedure, and a summary of the patients' preoperative condition, workup, and outcomes are presented and discussed.

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Osteochondroma Arising from the Thyroid Cartilage: A Case Report and Literature Review

Case Reports in Otolaryngology ◽

10.1155/2021/8286012 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Jessa E. Miller ◽

Shaghauyegh S. Azar ◽

Dinesh K. Chhetri

Keyword(s):

Literature Review ◽

Bone Tumors ◽

English Language ◽

Correct Diagnosis ◽

Thyroid Cartilage ◽

Neck Region ◽

Vocal Folds ◽

Radiographic Findings ◽

Histopathologic Analysis ◽

False Vocal

Introduction. Osteochondromas are relatively common benign bone tumors often located at the metaphyseal ends of long bones; however, they are rare in the head and neck region. The objective of this study is to present a case of an osteochondroma arising from the thyroid cartilage causing insidious dysphonia and to present a literature review. Methods. The medical record of a patient treated for osteochondroma of the thyroid cartilage was reviewed. A literature search on osteochondromas was conducted using PubMed and Google Scholar. The epidemiology, presentation, diagnosis, treatment, and outcomes of osteochondromas were reviewed. Results. A 50-year-old female presented with nine months of dysphonia and aphonic voice breaks. Laryngovideostroboscopy revealed a left false vocal fold fullness, glottal gap, and vibratory phase asymmetry. A CT neck demonstrated a well-circumscribed 5 × 8 × 9 mm mass arising from the left thyroid cartilage lamina with a thin calcified rim and a heterogeneous decreased attenuation center. The tumor was excised surgically. Histopathologic analysis demonstrated hyaline cartilage overlying lamellar bone with fatty bone marrow, consistent with osteochondroma. English language literature review revealed no cases of osteochondroma of the thyroid cartilage. The presenting features of osteochondroma may depend on the size and location of the lesion. It is critical to differentiate between benign and malignant bone tumors, and physicians must rely on their clinical examination, radiographic findings, and histopathologic analysis to make the correct diagnosis. Conclusions. Osteochondromas of the laryngeal framework are extremely rare, and to our knowledge, there have been no reports in the literature of this tumor arising from the thyroid cartilage. Dysphonia may be the presenting symptom in a patient with a thyroid cartilage mass causing restricted mobility of the true vocal folds.

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Pseudomonas laryngeal perichondritis: unexpected diagnosis

BMJ Case Reports ◽

10.1136/bcr-2020-237129 ◽

2020 ◽

Vol 13 (12) ◽

pp. e237129

Author(s):

Siti Salwa Zainal Abidin ◽

Thean Yean Kew ◽

Mawaddah Azman ◽

Marina Mat Baki

Keyword(s):

Diabetes Mellitus ◽

Pseudomonas Aeruginosa ◽

Vocal Fold ◽

Histopathological Examination ◽

Thyroid Cartilage ◽

Tracheal Aspirate ◽

Good Recovery ◽

Antituberculous Drug ◽

False Vocal ◽

Oral Ciprofloxacin

A 57-year-old male chronic smoker with underlying diabetes mellitus presented with dysphonia associated with cough, dysphagia and reduced effort tolerance of 3 months’ duration. Videoendoscope finding revealed bilateral polypoidal and erythematous true and false vocal fold with small glottic airway. The patient was initially treated as having tuberculous laryngitis and started on antituberculous drug. However, no improvement was observed. CT of the neck showed erosion of thyroid cartilage, which points to laryngeal carcinoma as a differential diagnosis. However, the erosion was more diffuse and appeared systemic in origin. The diagnosis of laryngeal perichondritis was made when the histopathological examination revealed features of inflammation, and the tracheal aspirate isolated Pseudomonas aeruginosa. The patient made a good recovery following treatment with oral ciprofloxacin.

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Monitoring Vocal Fold Abduction through Vocal Fold Contact Area

Journal of Speech Language and Hearing Research ◽

10.1044/jshr.3103.338 ◽

1988 ◽

Vol 31 (3) ◽

pp. 338-351 ◽

Cited By ~ 106

Author(s):

Martin Rothenberg ◽

James J. Mahshie

Keyword(s):

Contact Area ◽

Time Variation ◽

Vocal Fold ◽

Thyroid Cartilage ◽

Electrical Conductance ◽

Vocal Folds ◽

Linear Phase ◽

Voice Production ◽

Voiced Speech ◽

High Pass

A number of commercial devices for measuring the transverse electrical conductance of the thyroid cartilage produce waveforms that can be useful for monitoring movements within the larynx during voice production, especially movements that are closely related to the time-variation of the contact between the vocal folds as they vibrate. This paper compares the various approaches that can be used to apply such a device, usually referred to as an electroglottograph, to the problem of monitoring the time-variation of vocal fold abduction and adduction during voiced speech. One method, in which a measure of relative vocal fold abduction is derived from the duty cycle of the linear-phase high pass filtered electroglottograph waveform, is developed in detail.

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Spontaneous perforation of cervical oesophagus: a rare variant of Boerhaave's syndrome

The Journal of Laryngology & Otology ◽

10.1017/s0022215109004952 ◽

2009 ◽

Vol 123 (12) ◽

pp. 1378-1380 ◽

Cited By ~ 2

Author(s):

S Mittal ◽

A Rohatgi ◽

R P Sutcliffe ◽

A Botha

Keyword(s):

Vocal Folds ◽

Sudden Onset ◽

Water Soluble ◽

Uneventful Recovery ◽

Oesophageal Perforation ◽

Nasogastric Feeding ◽

Computed Tomography Scanning ◽

Difficulty Breathing ◽

The Right ◽

False Vocal

AbstractBackground:A 29-year-old man presented with sudden onset of severe pain in his throat, difficulty breathing and a hoarse voice, following an episode of vomiting.Investigations:Initial laboratory tests were normal. The patient underwent fibre-optic nasendoscopy, which demonstrated a haematoma in the piriform fossa. Lateral neck radiography and subsequent computed tomography scanning confirmed a 2 cm, loculated, gas-containing collection at the level of the vallecula in the right posterolateral wall, extending to the false vocal folds and communicating between the right parapharyngeal space and the right carotid sheath. Water-soluble contrast swallow confirmed the diagnosis.Diagnosis:Contained oesophageal perforation.Management:Conservative treatment was adopted involving nil orally, intravenous antibiotics and nasogastric feeding. The patient made an uneventful recovery.

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An Anatomic Study of the External Laryngeal Framework with Surgical Implications

Otolaryngology ◽

10.1177/019459989210600305 ◽

1992 ◽

Vol 106 (3) ◽

pp. 235-240 ◽

Cited By ~ 27

Author(s):

Lawrence Z. Meiteles ◽

Pi-Tang Lin ◽

Eugene J. Wenk

Keyword(s):

Vocal Fold ◽

Anterior Commissure ◽

Thyroid Cartilage ◽

Oblique Line ◽

Type I ◽

Anatomic Study ◽

True Vocal Cord ◽

Precise Knowledge ◽

Human Cadavers ◽

Superior Border

Precise knowledge of the level of the vocal fold as projected on the external thyroid cartilage is of critical importance for the performance of thyroplasty type I and supraglottic laryngectomy. Measurements of the external laryngeal framework were made on the larynges of 18 human cadavers in order to identify landmarks that will aid the surgeon in determining endolaryngeal anatomy. On the basis of our results, the following guidelines are recommended: (1) Thyroid cartilage incision for supra-glottic laryngectomy should be made on a line joining the juncture of the upper one third and lower two thirds of the midline length and the juncture of the upper one third and lower two thirds of the oblique line. This will ensure a position above the level of the anterior commissure and the true vocal cord; (2) In thyroplasty type I, the superior border of the thyroid cartilage window should be made at a line joining the midpoint of the midline length and the juncture of the upper two thirds and lower one third of the oblique line. Formation of the cartilage window according to this guideline will ensure its placement lateral to the vocalis muscle.

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