Medieval Interpretation of Phonation Through the Divine Comedy, by Dante Alighieri

The anatomic and medical knowledge of people throughout history is unexpectedly evident in some of the poems and texts written by intellectuals of the time. This article attempts to understand the conception of laryngology in the Middle Ages by analyzing the Divine Comedy, written by the Italian poet Dante Alighieri (1265-1321) at the beginning of the 14th century. In the text, Dante mentions the throat several times. He recognizes that the larynx has the dual functions of allowing respiration (dead souls recognize that the poet is alive through movement of his throat when breathing) and speech (souls with their throat cut cannot speak). However, Dante does not seem to know of the existence of vocal cords, thinking that it is the tongue that allows for word formation. In general, Dante’s poem indicates that the anatomy and function of the throat were known during the medieval period, although this knowledge was not precise.

Laryngospasm Caused by Removal of Nasogastric Tube after Tracheal Extubation: Case Report

Background: We report a case of laryngospasm during nasogastric tube removal. Laryngospasm is a severe airway complication after surgery and there have been no reports associated with the removal of nasogastric tubes. Case Report: After abdominal surgery, the patient was extubated the tracheal tube, and was removed the nasogastric tube. Thereafter patient went into respiratory arrest. We attempted to ventilate using a face mask, and then through a supraglottic device, but both attempts were unsuccessful. Finally, we re-intubated her and stabilized her vitals. Conclusion: When patients are in emerging from anesthesia, nasogastric tube withdrawal may cause irritation of the vocal cords by gastric acids, and thereby, provoke laryngospasm. This can be avoided by removing it before reversing anesthesia or after the patient is awake.

COBLATION ASSISTED CORDECTOMY FOR VERRUCOUS LESION OF BILATERAL VOCAL CORDS

ABSTRACT Verrucous lesions of vocal cord are irregular whitish lesion with papillomatous surface. In head and neck region, it commonly affects oral cavity and larynx. Laryngeal lesions cause hoarseness and breathing difficulty. Biopsy of the lesion is essential to look for malignancy. Early lesions are amenable for endoscopic resection. Endoscopic resection can be done with microlaryngeal instruments or using CO2 laser/coblator for precise resection. Here we discuss the role of coblator in endoscopic resection of verrucous lesion of vocal cords. KEYWORDS Coblation, Verrucous lesion of vocal cords, verrucous carcinoma

Case Report: Ultrasound Guided Mucosal Fold Lateralization for Laryngeal Webs

The surgical management of Laryngeal webs is challenging and is associated with a high recurrence rate due the presence of opposing raw mucosal surfaces of the vocal cords, especially near the anterior commissure which causes re-scarring. We describe an endoscopic technique of mucosal flap lateralization (MFL) with ultrasound guidance, which prevents the apposition of the anterior raw surfaces of the vocal cords after web incision, thus avoiding recurrence.

The Application of a SaCoVLMTM Visual Intubation Laryngeal Mask for the Management of Difficult Airways in Morbidly Obese Patients: Case Report

We report insertion of the SaCoVLMTM in three awake morbidly obese patients (BMI 46. 7–52.1 kg/m2). The patients were given intravenous atropine and midazolam injections after entering the operating room and then inhaled an anesthetic with 2% lidocaine atomization. After SaCoVLMTM insertion while patients were awake, when the vocal cords were visualized, controlled anesthetic induction commenced with spontaneous ventilation. The entire anesthesia induction and intubation process was completed under visualization, and no adverse events such as hypoxemia occurred. No patient had an unpleasant recall of the procedure. We conclude that the SaCoVLMTM is easy to use, well tolerated and suitable for awake orotracheal intubation in patients with known difficult airways.

Lung Deposition of Surfactant Delivered via a Dedicated Laryngeal Mask Airway in Piglets

It is unknown if the lung deposition of surfactant administered via a catheter placed through a laryngeal mask airway (LMA) is equivalent to that obtained by bolus instillation through an endotracheal tube. We compare the lung deposition of surfactant delivered via two types of LMA with the standard technique of endotracheal instillation. 25 newborn piglets on continuous positive airway pressure support (CPAP) were randomized into three groups: 1—LMA-camera (integrated camera and catheter channel; catheter tip below vocal cords), 2—LMA-standard (no camera, no channel; catheter tip above the glottis), 3—InSurE (Intubation, Surfactant administration, Extubation; catheter tip below end of endotracheal tube). All animals received 100 mg·kg−1 of poractant alfa mixed with 99mTechnetium-nanocolloid. Surfactant deposition was measured by gamma scintigraphy as a percentage of the administered dose. The median (range) total lung surfactant deposition was 68% (10–85), 41% (5–88), and 88% (67–92) in LMA-camera, LMA-standard, and InSurE, respectively, which was higher (p < 0.05) in the latter. The deposition in the stomach and nasopharynx was higher with the LMA-standard. The surfactant deposition via an LMA was lower than that obtained with InSurE. Although not statistically significant, introducing the catheter below the vocal cords under visual control with an integrated camera improved surfactant LMA delivery by 65%.

Distribution Characteristics of Juvenile-Onset Recurrent Respiratory Papillomatosis at First-Time Surgery

Objectives The lesion distribution of juvenile-onset recurrent respiratory papillomatosis (JORRP) during first-time surgery has been rarely reported. The purpose of this study was to describe the anatomical distribution of papilloma across 25 Derkay sites during initial surgery and to assess the impact of the lesion distribution on disease severity. Methods Surgical videos and medical records of 106 patients with JORRP (27 aggressive and 79 nonaggressive cases) were retrospectively reviewed. Lesion locations were recorded using Derkay anatomical sites. Logistic regression was used to analyze the effect of the lesion distribution on disease severity. Results Among the 106 patients, the true vocal cords (90.6% left, 84.0% right) were the most frequently involved site, followed by the false vocal cords (39.6% left, 35.8% right) and the anterior commissure (26.4%). Two patients (1.9%) had tracheal involvement. Patients with false vocal cord involvement (odds ratio [OR] = 3.425, 95% confidence interval [CI] [1.285, 9.132], P = .014) and a younger age at diagnosis (OR = .698, 95% CI [.539, .905], P = .007) were more likely to require more than 4 procedures in the year following first-time surgery. Conclusions Lesions were most common on the true vocal cords. False vocal cord involvement and a younger age at diagnosis were risk factors for disease severity.

THYROID ABSCESS: A CASE SERIES

Thyroid abscess is a rare surgical pathology, accounting for less than 0.7% of surgical pathologies involving the thyroid 1,2 gland. This is due to its rich blood supply and lymphatic drainage, high concentration oodine that inhibits bacterial growth, protective brous capsule, and fascial planes 2–4 separating it from other neck structures. It may lead to complications like septicaemia, paralysis of the vocal cords, retropharyngeal abscess and suppurative media stinitis and 2 may occasionally lead to osteomyelitis or septic thrombophlebitis. It 5 may also lead to tracheal and oesophageal perforation. The 6 left lobe is commonly affected. If left untreated, thyroid abscess can be life threatening resulting in a mortality of 12% 6 or more