Paralytic stenosis of the larynx

The aim of the study was to evaluate the effectiveness of various types of surgical treatment of patients with bilateral paralytic stenosis of the larynx. Study involved 28 patients aged 18 to 75 years, suffering from paralytic stenosis of the larynx, who was treated at the ENT department of the multidisciplinary clinic of the Tashkent Medical Academy in the period from 2015 to 2020. The results of treatment with the use of laterofixation of the vocal fold, partial excision of the vocal fold in the posterior third and the vocal process of the arytenoid cartilage showed that after the above methods of surgical intervention, recurrence of stenosis occurs in 20-25% of cases, therefore it is necessary to develop tactics of surgical treatment and postoperative management of this category patients.

METHODS FOR DIAGNOSING THE SEX OF ADULT HUMAN BY ANATOMICAL AND MORPHOLOGICAL FEATURES OF ARYTENOID CARTILAGES

ABSTRACT. Background. One of the main issues of general personality identification is the ascertainment of the sex of impersonated or fragmented bodies. There are sporadic reports of the larynx cartilage sexual dimorphism in the forensic medical literature, among which arytenoid cartilages are absent. The publications have morphometric focus, the practical aspects of gender diagnostics are not considered, which occasion determined the purpose of this work.Aim: To develop a method for determining sex using sexually dimorphic anatomical and morphological arytenoid cartilage features of an adult. Materials and methods. The anatomical and morphological features of arytenoid cartilage from 160 males (80) and females (80) at the age from 20 to 78 years were studied. The visual examination revealed differences related to gender in 9 characteristics. The reliability of traits' sexual dimorphism was verified using the Chi-square test and proportionality coefficients.Results. The informational significance of the features was clarified and the individual observations were digitized using the formula. The possibility of sex determination by arytenoid cartilage was established in 93.75% of cases. In the remaining 6.25%, there was substantiated the conclusion that it is impossible to solve this problem using a given set of features.Conclusion. The developed method for determining gender is highly accurate and can be used in gender diagnostics in the process of a forensic medical larynx examination of a decayed or a fragmented corpse.

Forensic evaluation of age by X-ray morphometric features of the arytenoid cartilage of the human laryngeal complex

The aim of the study was to develop a method for age evaluation based on the mineralization signs of the larynx arytenoid cartilage (AC) during the destroyed human corpse expertise. X-ray images of isolated AC preparations from both sexes (male – 264, female – 106) aged from 19 to 91 years were studied. Morphometry was conducted on: the area (in mm2) and the degree (%) of mineralization of both AC separately and united, a total of 6 features. Results. There is no correlation between the signs of AC mineralization and the length of the human body (r = 0.01-0.201). The correlation of these signs with age is high in men, (r = 0.741-0.781), and moderate in women (r = 0.470-0.508). There is a pronounced correlation between all age-dependent signs of AC (r = 0.948-0.985). According to the discriminant analysis results, the correct classification of the age groups 19-44 and 45-91 years is 82.9% in men, 77.03% in women. Practically reliable and probable diagnostics of men age is possible in 32.58 and 33.33%, of women age – in 5.41 and 37.84% of cases. According to the regression analysis, the age diagnostics in the range from 19 to 91 years in men is possible with an accuracy of ± 10.02 years (R = 0.799; R2 = 0.635), in women – ± 18.864 years (R = 0.506; R2 = –0.249). Forensic determination of the women age by regression models is excluded.

Arytenoid Subluxation Reduction Using 28-Jackson Dilator

Arytenoid dislocation and subluxations commonly are reduced surgically using Holinger and straight Miller-3 laryngoscopes. We present a case of arytenoid cartilage subluxation returned to good position using a 28-Jackson dilator. A 66-year-old man was diagnosed previously with right vocal fold paresis and left vocal fold paralysis following a motor vehicle accident that required a 14-day intubation and tracheotomy maintained for 3 weeks. Evaluation by strobovideolaryngoscopy 3 months following the accident showed severe left vocal fold hypomotility and arytenoid height disparity; laryngeal electromyography showed only mild-to-moderate decreased recruitment in laryngeal muscles. No abnormalities were appreciated on neck computed tomography. Upon palpation of both arytenoid cartilages in the operating room, the left joint was found to be subluxed anteriorly and immobile. A 28-Jackson dilator was used to mobilize and reduce the left arytenoid cartilage, and steroid was injected into the cricothyroid joint. Increased mobility was obtained in the operating room and the patient reported significant improvement in his voice. Six months later, we saw improvement in arytenoid height disparity and left vocal fold movement, better glottic closure, and voice handicap index was improved. A 28-Jackson dilator can be used to manipulate the cricoarytenoid joint without trauma to the vocal process.

Incidental Diagnosis of Pediatric Arytenoid Cartilage Dislocation During Videofluoroscopic Swallowing Study: A Case Report

Arytenoid cartilage dislocation is one of the most common mechanical causes of vocal fold immobility. The most common etiologies are intubation and external trauma, but its incidence is lower than 0.1%. Its symptoms include dysphonia, vocal fatigue, loss of vocal control, breathiness, odynophagia, dysphagia, dyspnea, and cough. Although there are some reports of arytenoid cartilage dislocation in adults, there are only few reports on its occurrence in children. It is particularly difficult to detect the symptoms of arytenoid cartilage dislocation in uncooperative pediatric patients with brain lesions without verbal output or voluntary expression. We report a case of arytenoid cartilage dislocation with incidental findings in a videofluoroscopic swallowing study performed to evaluate the swallowing function.