Fully Ossified Thyroid Cartilage Found among the Skeletal Remains of A 21-Year-Old Slavic Soldier: Interpretation of a Case

The degree of ossification of the thyroid cartilage in anthropological studies is related to other methods of determining the age of a skeleton. The endochondral ossification process begins at the age of approximately 15–20 years and is generally completed in the fifth or sixth decade of life. In the present case, early and complete mineralization of the thyroid cartilage of a skeleton belonging to a 21-year-old young soldier who died in 1946 was observed. Ossified thyroid cartilage at a very young age is rare and may be associated with specific symptoms, such as compression due to trauma, or may also be related to hormonal dysfunction and various diseases that may cause early mineralization. A macroscopic morphological evaluation and radiographic examination of the thyroid cartilage were performed and a decalcification test was applied to a sample taken from the thyroid cartilage to confirm that the structure was indeed mineralized. There is nothing to exclude that this is simply a physiological anatomical variation. Knowledge of this rare anatomical abnormality at a young age would be useful for the diagnosis of various pathological conditions.

Metastasis of clear cell renal cell carcinoma to the larynx

Renal clear cell metastatic carcinoma of the larynx is an extremely rare diagnosis with poor survival. The objective of this short review is to provide insight into current state of literature on this rare neoplasm. Additionally we include the case of a patient with metastatic process of the thyroid cartilage that was treated with novel targeted therapies which enabled prolonged survival and good quality of life. These findings support their inclusion in treatment protocols of patients with metastatic renal clear cell carcinoma of the larynx, especially in those refusing surgery which is the main treatment option in literature so far.

Successful Treatment of Airway Rupture with Femoro-Femoral Venovenous Extracorporeal Membrane Oxygenation in Traumatic Tracheal Injury: A Case Report

BackgroundTraumatic tracheal injury is a rare type of trauma. In this type of injury, catastrophes may occur owing to a failure to secure the patient's airway. Extracorporeal membrane oxygenation (ECMO) is rescue therapy available for the treatment of urgent cardiorespiratory distress until the patient's vital signs have stabilized. The various applications of ECMO configurations have expanded the scope for this therapy.Case presentationWe describe the case of a 66-year-old man with tracheal rupture with thyroid cartilage fracture due to cultivator handle who was treated with veno-venous ECMO. This case reflects the role and limitations of veno-venous ECMO, in which patient survival was possible with a bi-femoral configuration while also ensuring a clear airway. ConclusionWe shared our experience with bi-femoral veno-venous ECMO as a therapeutic option to contribute to choosing an appropriate approach. Based on our review of the literature, the present case was an uncommon report of survival after tracheal rupture due to trauma without other complications.

Can thickness of subcutaneous fat tissue limit emergency percutaneous cricothyrotomy?

Background Needle cricothyrotomy is a method of maintaining airways in emergency situations. One of identified factors that can make this procedure difficult to perform is ‘difficult neck anatomy’ or short obese neck. Due to the growing problem of obesity, we decided to estimate feasibility of needle cricothyrotomy by measuring the thickness of neck fat tissue in the population. Evaluation of this method is important because it is the only method that can be legally performed by paramedics in Poland. The aim of the study was to estimate feasibility of needle cricoidectomy by evaluating the percentage of population in which the thickness of subcutaneous fat tissue could potentially limit or complicate such a procedure. Methods In this retrospective study we reviewed CT scans of the neck from a database at the Department of Radiology, University Hospital in Cracow. 550 CT scans met inclusion criteria: age of patient over 18 years old, lack of any lesions altering anatomy of measured region of neck, the first CT scan of patient. 50.36% of patients were women. Median age was 61 years (range 18 – 93). The distance from the skin surface at the level of the lower edge of the thyroid cartilage to the cricothyroid ligament (surface - ligament distance, SLD) was measured. Statistical analysis of the data was performed using R software (R version 4.0.3). Results Median SLD was 1.41 (1.01 - 2.04). Subcutaneous fat tissue was thicker than maximal depth of application of cricothyrotomy (3cm) device in 31 patients (5.64%). Conclusions Performing needle cricothyrotomy may be limited in a considerable percentage of population (5.64%).

New Developments in Anterior Laryngeal Recording Technique During Neuromonitored Thyroid and Parathyroid Surgery

A recurrent laryngeal nerve (RLN) injury resulting in vocal fold paralysis and dysphonia remains a major source of morbidity after thyroid and parathyroid surgeries. Intraoperative neural monitoring (IONM) is increasingly accepted as an adjunct to the standard practice of visual RLN identification. Endotracheal tube (ET) surface recording electrode systems are now widely used for IONM; however, the major limitation of the clinical use of ET-based surface electrodes is the need to maintain constant contact between the electrodes and vocal folds during surgery to obtain a high-quality recording. An ET that is malpositioned during intubation or displaced during surgical manipulation can cause a false decrease or loss of electromyography (EMG) signal. Since it may be difficult to distinguish from an EMG change caused by a true RLN injury, a false loss or decrease in EMG signal may contribute to inappropriate surgical decision making. Therefore, researchers have investigated alternative electrode systems that circumvent common causes of poor accuracy in ET-based neuromonitoring. Recent experimental and clinical studies have confirmed the hypothesis that needle or adhesive surface recording electrodes attached to the thyroid cartilage (transcartilage and percutaneous recording) or attached to the overlying neck skin (transcutaneous recording) can provide functionality similar to that of ET-based electrodes, and these recording methods enable access to the EMG response of the vocalis muscle that originates from the inner surface of the thyroid cartilage. Studies also indicate that, during surgical manipulation of the trachea, transcartilage, percutaneous, and transcutaneous anterior laryngeal (AL) recording electrodes could be more stable than ET-based surface electrodes and could be equally accurate in depicting RLN stress during IONM. These findings show that these AL electrodes have potential applications in future designs of recording electrodes and support the use of IONM as a high-quality quantitative tool in thyroid and parathyroid surgery. This article reviews the major recent developments of newly emerging transcartilage, percutaneous, and transcutaneous AL recording techniques used in IONM and evaluates their contribution to improved voice outcomes in modern thyroid surgery.

​Comparative Gross Anatomical and Biometrical Studies on Thyroid Gland of Buffalo, Sheep and Goat

Background: The thyroid gland is vital endocrine gland which secretes three hormones i.e. thyroxin (T4), triiodothyronine (T3) and Calcitonin hormones. The thyroxin (T4) and triiodothyronine (T3) hormones are biologically active and are required for maintenance of normal levels of metabolic activity. The thyroid also produces calcitonin from the parafollicular cells which act directly on osteoclast to decrease the bone resorption which lower the blood calcium level. Deficient or excessive production of thyroid hormones may lead to serious pathological states with outward symptoms. Methods: The gross anatomical and biometrical studies were conducted on thyroid gland of buffalo, sheep and goat (n=12) collected immediately after slaughtering from slaughter house and local meat shop. The weight of thyroid gland was measured by weighing balance, volume by water displacement method, length and width of lateral lobes and isthmus by calibrated scale and inelastic thread and thickness of lateral lobes and isthmus was measured by digital vernier calliper. The data was analysed statistically. Result: The lateral lobes were roughly triangular in buffalo and elongated in sheep and oval in goat. The surfaces were granular and rough in buffalo but smooth in sheep and goat. It extended from thyroid cartilage to 2nd tracheal ring in buffalo, 1st to 6th tracheal ring in sheep and 1st to 7th tracheal ring in goat. The left lobe was larger than the right lobe in all the three species studied. The thyroid gland was biggest in buffalo followed by goat and smallest in sheep. The density of isthmus was more than the lobes in sheep and goat but not in buffalo.

Tissue Mobilization During Double Source of Vibration Semioccluded Vocal Tract Exercises: A Neck and Face Surface Acceleration Study

Purpose This study primarily aimed at observing the possible tissue mobilization on facial, neck, and chest tissues caused by different double source of vibration semioccluded vocal tract exercises (DSV-SOVTEs). Another goal was to inspect the degree of self-perceived sensation of a massage-like sensation. Method Fifty-five participants engaged in a set of several DSV-SOVTEs: (a) phonation with a silicone tube submerged 2 and 8 cm below water surface, (b) Acapella Choice device, (c) lip trills, and (d) tongue trills. A self-perceived massage-like sensation was also assessed. All exercises were performed at three loudness levels. Tissue mobilization signal was captured by four accelerometers placed in four different body regions: (a) over the cheek, (b) over the neck, (c) over the thyroid cartilage, and (d) over the suprasternal notch. Results There is a differential effect of all DSV-SOVTEs on tissue mobilization. All four observed dependent variables from tissue oscillation modulation (frequency, amplitude, jitter, and shimmer) showed significant three-way interactions. In general, amplitude and frequency of tissue oscillation modulation increases with loudness. A self-perceived massage-like sensation showed highly significant differences between DSV-SOVTEs. Conclusions All DSV-SOVTEs do mobilize tissues. Type of exercise, loudness level, and body region produce an effect on all tissue oscillation variables. Acapella device produces the largest amplitude of vibration, lowest frequency, and more regular oscillation of tissue. Water resistance therapy showed the most irregular tissue oscillation. Control of these variables is likely to be relevant to obtain the best outcomes in patients.