Initial Anatomic Geographic Presentation of Glottal Dysplasia

2009 ◽  
Vol 118 (5) ◽  
pp. 321-325 ◽  
Author(s):  
Yonatan Lahav ◽  
James A. Burns ◽  
Steven Feinberg ◽  
James T. Heaton ◽  
Steven M. Zeitels
Keyword(s):  
Anterior Commissure ◽  
Vocal Folds ◽  
Malignant Degeneration ◽  
Vocal Function ◽  
Vocal Fold Vibration ◽  
Laryngeal Disease ◽  
Superior Surface ◽  
Disease Site ◽  
Dominant Disease ◽  
Superficial Lamina

Glottal dysplasia is likely the most common laryngeal disease with a discernible lesion; however, investigations describing its initial anatomic geographic presentation are rare. To examine this, we identified 52 patients who did not have significant prior treatment or glottal cancer. Thirty-one patients had bilateral disease, so there were 83 vocal folds with precancerous dysplasia. The phonatory mucosa was the dominant disease site in all; the epicenter was on the superior surface in 65 of the 83 folds and on the medial surface in 18 of the 83 folds. The arytenoid mucosa was involved in 8 of the 83 folds. Nineteen of the 52 patients had direct anterior-commissure involvement, and none had interarytenoid mucosal disease. The investigation established the commonly held principle that glottal dysplasia occurs primarily on phonatory mucosa. Given the frequent occurrence and recurrence of glottal dysplasia, treatment goals should focus on disease control to prevent malignant degeneration while preserving the subepithelial superficial lamina propria, necessary for phonatory mucosal pliability, vocal fold vibration, and optimal vocal function.

Reinke's Edema: Phonatory Mechanisms and Management Strategies

1997 ◽  
Vol 106 (7) ◽  
pp. 533-543 ◽  
Author(s):  
Steven M. Zeitels ◽  
Glenn W. Bunting ◽  
Robert E. Hillman ◽  
Traci Vaughn
Keyword(s):  
Lamina Propria ◽  
Fundamental Frequency ◽  
Vocal Fold ◽  
Management Strategies ◽  
Vocal Folds ◽  
Vocal Fold Vibration ◽  
Reinke’S Edema ◽  
Subglottal Pressure ◽  
Almost All ◽  
Superficial Lamina

Reinke's edema (RE) has been associated typically with smoking and sometimes with vocal abuse, but aspects of the pathophysiology of RE remain unclear. To gain new insights into phonatory mechanisms associated with RE pathophysiology, weused an integrated battery of objective vocal function tests to analyze 20 patients (19 women) who underwent phonomicrosurgical resection. Preoperative stroboscopic examinations demonstrated that the superficial lamina propria is distended primarily on the superior vocal fold surface. Acoustically, these individuals have an abnormally low average speaking fundamental frequency (123 Hz), and they generate abnormally high average subglottal pressures (9.7 cm H20). The presence of elevated aerodynamic driving pressures reflects difficulties in producing vocal fold vibration that are most likely the result of mass loading associated with RE, and possibly vocal hyperfunction. Furthermore, it is hypothesized that in the environment of chronic glottal mucositis secondary to smoking and reflux, the cephalad force on the vocal folds by the subglottal driving pressure contributes to the superior distention of the superficial lamina propria. Surgical reduction of the volume of the superficial lamina propria resulted in a significant elevation in fundamental frequency (154 Hz) and improvement in perturbation measures. In almost all instances, both the clinician and the patient perceived the voice as improved. However, these patients continued to generate elevated subglottal pressure (probably a sign of persistent hyperfunction) that was accompanied by visually observed supraglottal strain despite the normalsized vocal folds. This finding suggests that persistent hyperfunctional vocal behaviors may contribute to postsurgical RE recurrence if therapeutic strategies are not instituted to modify such behavior.

Human Vocalis Contains Distinct Superior and Inferior Subcompartments: Possible Candidates for the Two Masses of Vocal Fold Vibration

1998 ◽  
Vol 107 (10) ◽  
pp. 826-833 ◽  
Author(s):  
Ira Sanders ◽  
Yingshi Han ◽  
Surinder Rai ◽  
Hugh F. Biller
Keyword(s):  
Vocal Fold ◽  
Muscle Fibers ◽  
Vocal Folds ◽  
Medial Surface ◽  
Vocal Fold Vibration ◽  
Muscle Fascicle ◽  
Superior Surface ◽  
Hematoxylin And Eosin ◽  
Thyroarytenoid Muscle ◽  
Large Muscle

It is not understood how different parts of the thyroarytenoid muscle contribute to vocal fold vibration. This study investigated the medial part of the thyroarytenoid muscle, the vocalis compartment, for anatomic differences that might suggest functionally distinct areas. Twenty human vocal folds were frontally sectioned and stained with hematoxylin and eosin. A single section from the middle of each vocal fold was magnified, and the muscle fascicles of the most superficial 25% of the vocalis compartment were then examined. In all 20 specimens the vocalis compartment could be separated into 2 plainly distinct subcompartments: the inferior vocalis compartment was composed of a single large muscle fascicle that contained densely packed muscle fibers of similar size; the superior vocalis compartment was composed of multiple small fascicles in which the muscle fibers were loosely arranged and varied greatly in size. On average, the inferior vocalis subcompartment composed 60% of the medial surface of the thyroarytenoid muscle. The superior subcompartment composed the remaining 40% of the medial surface, but also continued past the vocal ligament to make up the superior surface of the thyroarytenoid muscle. It is concluded that 2 distinct entities make up the vocalis compartment of the thyroarytenoid muscle. Their anatomy is so markedly different it suggests that they may function independently. One possibility is that they reflect the 2 masses observed in the superior and inferior aspects of the vocal fold during vibration.

585-NM Pulsed Dye Laser Treatment of Glottal Papillomatosis

2002 ◽  
Vol 111 (6) ◽  
pp. 486-492 ◽  
Author(s):  
Ramon A. Franco ◽  
William A. Farinelli ◽  
Steven M. Zeitels ◽  
R. Rox Anderson
Keyword(s):  
Anterior Commissure ◽  
Vocal Folds ◽  
Spot Size ◽  
Recurrent Respiratory Papillomatosis ◽  
Dye Laser ◽  
Pulsed Dye Laser ◽  
Depth Of Penetration ◽  
Efficacious Treatment ◽  
Superficial Lamina

Treatment of recurrent respiratory papillomatosis of the glottis is often challenging. The surgeon and patient must cooperatively balance decisions regarding airway safety, effects of multiple general anesthesias, employment disturbance, and vocal dysfunction. A pilot study was done in 41 adult cases (23 patients; 78 vocal folds) without complication to evaluate the effectiveness of a 585-nm pulsed dye laser (PDL; 450-μs pulse width; fluence of 38 to 255 J/cm2; 1- to 2-mm spot size) in the treatment of this disorder. Thirty-seven of the 41 cases (90%) were bilateral disease. Twenty-six of the 41 cases (63%; including 20 cases with involvement of the anterior commissure) were treated by bilateral photocoagulation of the lesions' microcirculation without microflap resection of tissue. Clinical observation revealed that irradiated but unresected disease involuted without development of an anterior commissure web. In the initial 13 of the 41 cases (32%), PDL treatment was followed by cold instrument microflap resection. The PDL enhanced the epithelial excision by improving hemostasis and by creating an optimal dissection plane between the basement membrane and the underlying superficial lamina propria. The PDL at 585 nm was less effective in the management of exophytic lesions because of its limited depth of penetration (approximately 2 mm). In this initial trial, the PDL was a relatively safe and efficacious treatment for glottal recurrent respiratory papillomatosis. Since the lesions involute without complete resection of the diseased epithelium, the anterior commissure can be treated to minimize the number of procedures. To study patterns of recurrence will require longer follow-up.

Measurement of Mucosal Wave Propagation and Vertical Phase Difference in Vocal Fold Vibration

1993 ◽  
Vol 102 (1) ◽  
pp. 58-63 ◽  
Author(s):  
Ingo R. Titze ◽  
Jack J. Jiang ◽  
Tzu-Yu Hsiao
Keyword(s):  
Wave Propagation ◽  
Surface Wave ◽  
Propagation Velocity ◽  
Vocal Fold ◽  
Vocal Folds ◽  
Phase Delay ◽  
Vocal Function ◽  
Vocal Fold Vibration ◽  
Wave Property ◽  
Wave Properties

Examination of the surface wave properties of the vocal fold mucosa is becoming an important part of assessment of vocal function. A key wave property is propagation velocity, which determines the phase delay between the upper and lower margins of the vocal folds. Excised canine larynges were used to measure this phase delay, and therewith propagation velocity. The motion of two flesh points was tracked stroboscopically. Differential displacements between the flesh points were matched to displacements of a model. A least-squared fit of the data to the model provided the numeric values of propagation velocity, which varied from 0.5 m/s to about 2.0 m/s, depending on fundamental frequency. The corresponding phase delay along the medial surface of the vocal folds varied from about 60°/mm to 30°/mm.

Vocal fold vibration viewed from the tracheal side in living human beings

1996 ◽  
Vol 115 (4) ◽  
pp. 329-334 ◽  
Author(s):  
Eiji Yumoto ◽  
Yoshimi Kadota ◽  
Toshihiro Mori
Keyword(s):  
Vocal Fold ◽  
Anterior Commissure ◽  
Vocal Folds ◽  
Lower Surface ◽  
Human Beings ◽  
Oblique View ◽  
Vocal Fold Vibration ◽  
Vocal Process ◽  
Inferior Aspect

The mucosal upheaval where the mucosal wave starts and propagates upward appears on the lower surface of the canine vocal fold during vibration. We investigated the vibratory behavior of the in vivo human vocal fold viewed from the tracheal side. Subjects consisted of 14 men and 6 women who had undergone tracheostomy for various head and neck diseases; their ages ranged from 22 to 70 years, with a mean of 53.9 years. The inferior aspect of the vocal fold during phonation was observed with the aid of a rigid oblique-view endoscope inserted through a tracheostome (inferior glottoscopy). Each subject was asked to sustain the vowel / a/ at a comfortable pitch and loudness (easy phonation) and then at a higher pitch. Inferior glottoscopy could be performed during easy phonation in 19 subjects and during high-pitched phonation in 10 subjects. During easy phonation, the mucosal upheaval appeared on the lower surface of the vocal fold between the anterior commissure and the vocal process in all 19 subjects. During high-pitched phonation, the vocal fold became longer, and the subglottic vault surrounded by the bilateral mucosal upheavals became narrower compared with those during easy phonation. Use of a dilated blood vessel as a landmark in one subject showed the location of the mucosal upheaval on the vocal fold mucosa to actually shift medially toward the oral side during high-pitched phonation. Despite structural differences between the human and canine vocal folds, the infraglottic aspect of the vocal fold vibration observed in the living human larynx was quite similar to that observed in the excised canine larynx (Otolaryngol Head Neck Surg 1996;115:329-34.)

scholarly journals Optimal Management of the Unilateral Recurrent Laryngeal Nerve Involvement in Patients with Thyroid Cancer

Cancers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 2129
Author(s):  
Satoru Miyamaru ◽  
Daizo Murakami ◽  
Kohei Nishimoto ◽  
Narihiro Kodama ◽  
Joji Tashiro ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Recurrent Laryngeal Nerve ◽  
Tumor Resection ◽  
Vocal Folds ◽  
Laryngeal Nerve ◽  
Type I ◽  
Optimal Management ◽  
Reconstruction Procedure ◽  
Vocal Function ◽  
Reconstruction Group

We aimed to determine the optimal management of recurrent laryngeal nerve (RLN) involvement in thyroid cancer. We enrolled 80 patients with unilateral RLN involvement in thyroid cancer between 2000 and 2016. Eleven patients with preoperatively functional vocal folds (VFs) underwent sharp tumor resection to preserve the RLN (shaving group). Thirty-three patients underwent RLN reconstruction with RLN resection (reconstruction group). We divided the reconstruction group into two subgroups based on preoperative VF mobility (normal-reconstruction and paralyzed-reconstruction subgroups). In the cases where RLN reconstruction was difficult, phonosurgeries including arytenoid adduction (AA), with or without thyroplasty type I, or nerve muscle pedicle implantation with AA were performed later (phonosurgery group). We evaluated and compared vocal function among the evaluated periods and different groups. Postoperative vocal function in the shaving and normal-reconstruction subgroups was favorable. There were no significant differences between the two groups. In the paralyzed-reconstruction and phonosurgery groups, postoperative vocal function was significantly improved, and vocal function in the paralyzed-reconstruction subgroup was significantly better than that in the phonosurgery group. For optimal management of unilateral RLN involvement in thyroid cancer, first, sharp dissection should be performed, and if this is impossible, a simultaneous RLN reconstruction procedure should be adopted whenever possible.

Effects of Voice Therapy as Objectively Evaluated by Digitized Laryngeal Stroboscopic Imaging

2002 ◽  
Vol 111 (10) ◽  
pp. 902-908 ◽  
Author(s):  
Renée Speyer ◽  
Pieter A. Kempen ◽  
George Wieneke ◽  
Willem Kersing ◽  
Elham Ghazi Hosseini ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Lesion Size ◽  
Voice Therapy ◽  
Benign Lesions ◽  
Objective Measurements ◽  
Significant Parameter ◽  
Surface Areas ◽  
Vocal Fold Vibration ◽  
Maximal Opening

Objective measurements derived from digitized laryngeal stroboscopic images were used to demonstrate changes in vocal fold vibration and in the size of benign lesions after 3 months of voice therapy. Forty chronically dysphonic patients were studied. By means of a rigid stroboscope, pretreatment and posttreatment recordings were made of the vocal folds at rest and under stroboscopic light during phonation. From each recording, images of the positions at rest and during vibration at maximal opening and at maximal closure were digitized. The surface areas of any lesions and of the glottal gap were independently measured in the digitized images by 2 experienced laryngologists. Referential distances were determined in order to compensate for discrepancies in magnification in the various recordings. After 3 months of voice therapy, significant improvement in lesion size and degree of maximal closure during vibration could be demonstrated in about 50% of the patients. The degree of maximal opening did not prove to be a significant parameter.

Nasal Breathing Through a Damp Gauze Enhances Surface Hydration of the Vocal Folds and Optimizes Vocal Function

2021 ◽  
Author(s):  
Maria Borragan ◽  
Bruno Gomez Mediavilla ◽  
Marian Agudo Legina ◽  
M.Jose Gonzalez Fernandez ◽  
Dario Strangis ◽  
...  
Keyword(s):  
Vocal Folds ◽  
Nasal Breathing ◽  
Vocal Function ◽  
Surface Hydration

Videostrobolaryngoscopy of Mucus Layer during Vocal Fold Vibration in Patients with Laryngeal Tension-Fatigue Syndrome

2002 ◽  
Vol 111 (6) ◽  
pp. 537-541 ◽  
Author(s):  
Tzu-Yu Hsiao ◽  
Chia-Ming Liu ◽  
Kai-Nan Lin
Keyword(s):  
Mechanical Properties ◽  
Vocal Fold ◽  
Rough Surfaces ◽  
Voice Disorders ◽  
Vocal Folds ◽  
Voice Disorder ◽  
Mucus Layer ◽  
Vocal Fold Vibration ◽  
Fatigue Syndrome ◽  
Functional Dysphonia

The mucus layer on the vocal folds was examined by videostrobolaryngoscopy in patients with laryngeal tension-fatigue syndrome, a chronic functional dysphonia due to vocal abuse and misuse. Besides the findings in previous reports (such as abnormal glottal closure, phase or amplitude asymmetry, and the irregular mucosal wave), the vocal folds during vibration had an uneven mucus surface. The occurrence of an uneven mucus layer on vocal folds was significantly greater in subjects with this voice disorder (83% or 250 of 301 patients in this series) than in those without voice disorders (18.5% or 5 of 27). The increase of mucus viscosity, mucus aggregation, and the formation of rough surfaces on the vocal folds alter the mechanical properties that contribute to vibration of the cover of the vocal folds, and thereby worsen the symptoms of dysphonia in patients with laryngeal tension-fatigue syndrome.

Determination of Mechanical Stresses in Vibration and Contact During Flow-Structure-Interaction in Vocal Folds

2011 ◽  
Author(s):  
Pinaki Bhattacharya ◽  
Thomas H. Siegmund
Keyword(s):  
Surface Deformation ◽  
Three Dimensional ◽  
Vocal Folds ◽  
Biomechanical Properties ◽  
Mechanical Stresses ◽  
Physical Models ◽  
Tissue Properties ◽  
Transient Nature ◽  
Superior Surface ◽  
Glottal Flow

Mechanical stresses in vocal folds (VFs) developed during self-oscillation — due to interaction with the glottal flow — play an important role in tissue damage and healing. Contact stresses occurring due to collision between VFs modify both self-oscillation characteristics, as well as stresses. The complexity of the problem is increased due to other factors acting in combination: transient nature of the flow, non-linear and anisotropic biomechanical properties of the VFs, and acoustic loading. Experiments with physical models [1] have attempted to deduce the state of stress in the interior through measurement of superior surface deformation. However, these methods pose challenges in data acquisition. on the other hand, full three-dimensional transient computational analysis of a self-oscillating and contacting VF model requires highly sophisticated algorithms as well as prohibitive resource usage. Not surprisingly, therefore, it has not been conducted until now. We hypothesize that a high-fidelity numerical simulation incorporating realistic tissue properties is essential to accurately determine stresses within VFs during self-oscillation and contact.

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