Caracterización de estructuras anatómicas de la laringe por ultrasonografía / Characterization of anatomical structures of the larynx by ultrasonography

La laringe es un órgano impar situado en la línea mediana del cuello, compuesto por cartílagos, músculos y ligamentos. La TC y la RM se realizan como técnicas de imagen de primera elección en el estudio de la laringe, no obstante, no están exentas de limitaciones. La ecografía es un método accesible, de alta resolución y presenta una relativa buena visualización de las diferentes estructuras de la laringe. El objetivo del trabajo fue determinar las características de estructuras anatómicas de la laringe identificables ecográficamente. En este trabajo de carácter observacional descriptivo de corte transversal prospectivo se estudiaron 20 pacientes, sin patología laríngea con edades entre 20 y 35 años, ambos sexos. Se realizó ecografía laríngea utilizando transductor ecográfico Phillips® con sonda lineal de 4 a 12 MHz, preset de partes blandas.En todos los casos se pudo identificar y medir los cartílagos tiroides, cricoides y epiglotis; y en gran porcentaje de estos las cuerdas vocales, bandas ventriculares y comisura anterior. El cartílago aritenoides solo fue visible en un 85% de los casos.La ecografía se presenta como un método auxiliar útil en el estudio de la anatomía de la laringe, proponiendo el seguimiento y realización de estudios ulteriores que puedan complementar este estudio y su validez.

The larynx is an odd organ located in the midline of the neck, composed of cartilage, muscles and ligaments. CT and MRI are performed as first-choice imaging techniques in the larynx study; however, they are not without limitations. Ultrasound is an accessible, high-resolution method with a relatively good visualization of the different structures of the larynx. The objective of the work was to determine the characteristics of ultrasoundly identifiable larynx anatomical structures.In this prospective cross-sectional descriptive observational work, 20 patients were studied, without laryngeal pathology aged between 20 and 35 years, both sexes. Laryngeal ultrasound was performed using Phillips® ultrasound transducer with linear probe from 4 to 12 MHz, soft parts presetThyroid cartilage, cricoids and epiglotis could be identified and measured in all cases, and in a large percentage of these the vocal cords, ventricular bands and anterior corner. Aritenoid cartilage was only visible in 85% of cases.Ultrasound is presented as a useful auxiliary method in the study of the anatomy of the larynx, proposing the follow-up and conduct of further studies that may complement this study and its validity

Estudio comparativo de laringes humanas y de cerdos: hacia un modelo de entrenamiento quirúrgico / Comparative study of human and pig larynxes: towards a surgical training model

Introducción: La laringe de cerdo doméstico tiene similitudes con la laringe humana. La capacidad elástica de las cuerdas vocales del cerdo demuestran tener la mayor similitud con la humana comparado con otros animales por lo que se ha propuesto usar las laringes de cerdo como modelo de entrenamiento quirúrgico. Objetivo: Determinar las diferencias y similitudes anatómicas e histológicas entre la laringe del cerdo y la humana. Material y método: Se realizaron mediciones por 4 observadores en 5 laringes porcinas cuyos resultados se compararon con los descritos en la literatura para las laringes humanas. Además se realizaron cortes histológicos para visualizar fibras elásticas, mucinas neutras y mucinas ácidas. Resultados: El cartílago tiroides porcino mide entre las astas superiores 37,55 ±7,30 mm, entre astas inferiores 31,33 ±3,27 mm, desde la prominencia laríngea al borde posterior 34,32 ±7,30 mm. En el cartílago cricoides, desde el borde superior-inferior en el arco anterior 7,28 ±2,21 mm, altura borde superior-inferior pared posterior 27,47 ±3,40 mm, ancho máximo pared posterior 30,99 ±4,51 mm, diámetro interior anteroposterior (borde cefálico) 30,90 ±2,12 mm, diámetro interior anteroposterior (borde caudal) 21,78 ±2,55 mm, diámetro interior derecha-izquierda (borde cefálico) 18,11 ±2,13 mm, diámetro interior derecha-izquierda (borde caudal) 21,10 ±2,40 mm. Histológicamente, la laringe de cerdo y humana presentan leves diferencias en cuanto al epitelio de cada porción de la laringe, a pesar de que el tipo de cartílago es el mismo en ambas especies. Conclusión: Si bien existen diferencias anatómicas e histológicas entre la laringe de cerdo y el humano, el modelo porcino es una alternativa útil, accesible y de bajo costo para el entrenamiento en cirugía laringotraqueal y microcirugía laríngea.

Introduction: The domestic pig larynx has similarities with the human larynx. The elastic capacity of the vocal folds of the pig has the greater similarity with the human one compared with other animals. It has been proposed to use the porcine larynx as a model for surgical training. Aim: To determine the anatomical and histological differences and similarities between the pig larynx and the human larynx. Material and method: Measurements were made by 4 observers in 5 porcine larynxes whose results were compared with those described in the literature. In addition, histological sections were performed to visualize elastic fibers, neutral mucins and acid mucins. Results: The porcine thyroid cartilage measured 37.55 ±7.30 mm between the upper horns, 31.33 ±3.27 mm between lower horns and 34.32 ±7.30 mm from the laryngeal prominence to the posterior margin. In the cricoid cartilage, from the upper-lower edge in the anterior arch 7.28 ±2.21mm, height upper-lower edge posterior wall 27.47 ±3.40 mm, maximum posterior wall width 30.99 ±4.51 mm, anteroposterior inner diameter (head margin) 30.90 ±2.12 mm, inner diameter anteroposterior (caudal edge) 21.78 ±2.55 mm, inner diameter right-left (head edge) 18.11 ±2.13 mm, inner diameter right-left (caudal edge) 21.10 ±2.40 mm. Histologically, the pig and human larynxes present slight differences in the epithelium of each portion of the larynx, despite the fact that type of cartilage is the same in both species. Conclusions: Although there are anatomical and histological differences between the pig larynx and the human larynx, the porcine model is a useful, accessible and low cost alternative for training in laryngotracheal surgery and laryngeal microsurgery.

Prevalence of calcified triticeous cartilage-compatible images on 2500 digital panoramic radiographs of a Brazilian population sample / Prevalência de imagens compatíveis com calcificação da cartilagem tritícea em 2500 radiografias panorâmicas de uma amostra populacional brasileira

Objective: To investigate the prevalence of calcified triticeous cartilage (CTC)-compatible images on digital panoramic radiographs of a significant Brazilian population sample. Methods: In this retrospective study, 2500 digital panoramic radiographs were analyzed by a trained examiner using contrast and brightness adjustments of the Adobe® Photoshop® CC 2015 software. Data were collected and exported for statistical analysis (p-value <0.05 was considered statistically significant). Results: The prevalence of CTC-compatible images was 4.5% (61.1% in women and 38.9% in men). The most prevalent age ranged between 51 and 60 years (32.7%), and bilateral occurrence had a higher prevalence (46.9%). Women between the ages of 61 and 70 years showed a significantly higher prevalence of CTC-compatible images (p=0.027). Conclusion: This study showed a low prevalence of CTC-compatible images, which mainly occurred in women close to 70 years of age.

Objetivo: Investigar a prevalência de imagens compatíveis com calcificação da cartilagem tritícea (CCT) em radiografias panorâmicas digitais de uma significante amostra populacional brasileira. Métodos: Neste estudo retrospectivo, 2500 radiografias panorâmicas digitais foram analisadas por um examinador treinado utilizando ajustes de contraste e brilho através do software Adobe® Photoshop® CC 2015. Os dados foram coletados e exportados para análise estatística (p<0,05 foi considerado como valor estatisticamente significante). Resultados: A prevalência de imagens compatíveis com CCT foi de 4,5% (61.1% em mulheres e 38.9% em homens). A idade mais prevalente variou entre 51 e 60 anos (32,7%), sendo a ocorrência bilateral a mais comum (46,9%). Mulheres com idade entre 61 e 70 anos apresentaram prevalência significativamente maior de imagens compatíveis com CCT (p=0,027). Conclusão: O presente estudo evidenciou uma baixa prevalência de imagens compatíveis com CCT, que ocorreram, principalmente, em mulheres com idade próxima aos 70 anos.

Retrospective Analysis of 73 Hanging and Ligature Strangulation Cases / 法医学杂志

Objective To retrospectively analyze 40 cases of hanging and 33 cases of ligature strangulation in Kunming, to explore the neck injury characteristics and similarities and differences of related asphyxia signs of corpses in hanging and ligature strangulation cases, in order to provide reference for forensic identification. Methods Statistics of hanging and ligature strangulation cases accepted by Kunming Municipal Public Security Bureau from 2000 to 2017 were collected. Data including the gender, age, injury tool, neck injury and related asphyxia signs of the deceased in hanging and ligature strangulation cases were statistically tested by SPSS 23.0. Results There were more males in hanging cases than females. However, there were more females than males in ligature strangulation cases. In hanging cases, suicide was common, while homicide was rare. In ligature strangulation cases, homicide was common, while suicide or accidental death was rare. The average age of the deceased in hanging cases were older than those in ligature strangulation cases. The ligature mark in hanging was usually above the thyroid cartilage. The ligature mark in ligature strangulation was usually at the same level of the thyroid cartilage. The most common vital reactions were exfoliation and subcutaneous hemorrhage at the ligature mark, common among the deceased in hanging cases. Hyoid fracture rate of the deceased in ligature strangulation cases was more common than those in hanging cases. Conclusion The gender, age distribution, position of ligature mark, detection rate of vital reactions at the ligature mark and hyoid fracture rate of the deceased can help distinguish hanging from ligature strangulation.

Trauma laríngeo externo y fractura de cartílago tiroides: revisión de la literatura / External laryngeal trauma and thyroid cartilage fracture: a literature review

RESUMEN El trauma laríngeo constituye un grupo de lesiones infrecuentes, pero de gran importancia clínica dada su alta morbimortalidad. Requiere un alto nivel de sospecha, puesto que muchas de estas lesiones pueden pasar desapercibidas en la evaluación inicial. Se debe sospechar en todo paciente que se presenta con traumatismo cervical y síntomas que van desde la disfonía y el dolor cervical anterior, a la disnea e incluso el compromiso respiratorio severo por obstrucción de la vía aérea. El abordaje de estos pacientes debe iniciar con la evaluación de la vía aérea y asegurar su estabilidad, para luego enfocarse en el diagnóstico y manejo específico de las lesiones. Presentamos a continuación una revisión bibliográfica en cuanto a los mecanismos de trauma, presentación clínica, diagnóstico, clasificación y manejo.

ABSTRACT The laryngeal trauma constitutes a group of infrequent lesions, but with great clinical importance, given its high morbidity and mortality. It requires a high level of suspicion, since many of these injuries may go unnoticed at the initial evaluation. It should be suspected in every patient presenting with cervical trauma and symptoms ranging from dysphonia and anterior cervical pain, to dyspnea or even severe respiratory distress, due to obstruction of the airway. The approach of these patients should begin with the evaluation of the airway and ensure its stability, to then focus on the diagnosis and specific management of the lesions. We present an updated literature review regarding the mechanisms of trauma, clinical presentation, diagnosis, classification and management.

Robotic transoral thyroidectomy for papillary thyroid carcinoma

Transoral robotic thyroidectomy (TORT) is well consistent with the primary goal of remote-access thyroid surgery, which is to avoid a visible cervical scar. Additionally, the extent of transoral thyroidectomy dissection is less than that of other remote-access surgical procedures. Owing to these merits of the transoral approach, several institutions around the world are now performing this procedure. Since transoral thyroidectomy is performed in a confined, narrow space, and is characterized by a close distance from the ports to the working space, more benefits can be derived from multiarticulation of robotic instruments. Especially when performing left lobectomy by TORT, the surgeon can use right-handed robotic instruments over the thyroid cartilage with the merits of multiarticulation. In this study, we present our unique procedure of left lobectomy by TORT in detail.

Clinical Characteristics and Management of Saccular Cysts: A Single Institute Experience

OBJECTIVES: A saccular cyst is defined as a dilated saccule of the larynx, filled with mucus, and is located between the false vocal cords and the thyroid cartilage. Although this uncommon laryngeal condition is benign in nature, it could lead to dyspnea, stridor, and airway obstruction, depending on its size and location. Furthermore, some saccular cysts have been associated with laryngeal carcinoma. This study aimed to characterize this rather uncommon laryngeal condition to aid in determining the proper management of this pathology. METHODS: Medical records were retrospectively reviewed of all patients with saccular cysts diagnosed and treated between 2006 and 2017 at a tertiary otolaryngologic care center. RESULTS: Seven patients with saccular cysts were identified (male:female=2:5; mean age, 34.1 years); two were pediatric patients. Surgical intervention was performed in all patients by laryngo-microsurgery using CO2 laser. There was no recurrence after the initial surgical treatment. CONCLUSION: Saccular cysts can be managed endoscopically using CO2 laser, without requiring an external approach. Therefore, an endoscopic approach should be actively considered for an optimal treatment outcome.

A Case of Protrusion of False Vocal Fold Resulting from the Deformed Thyroid Cartilage

Trauma, congenital malformation and aging process can be a cause of the deviation of laryngeal prominence in the thyroid cartilage. Among these, the senility is the most common cause. Usually, ossification in the thyroid cartilage has occurred symmetrically, but the asymmetrical event leads to the shift of laryngeal prominence. Also, such deformity can provoke protrusion of false vocal fold. A 75-year-old man with hoarseness and globus sense in throat visited our clinic. Five years ago, he experienced a blunt trauma on left midline neck and had a concave deformity in the left thyroid cartilage lamina. Laryngoscopic findings revealed a marked protrusion in the left false vocal fold. We performed the laryngeal microsurgery to discriminate the tumorous condition. The pathology revealed non-pathologic mucosa. We report a unique and didactic case with a brief literature review.

The Inaccuracy of Surface Landmarks for the Anterior Approach to the Cervical Spine in Southern Chinese Patients

STUDY DESIGN: Observational study. PURPOSE: To assess the correlational accuracy between the traditional anatomic landmarks of the neck and their corresponding vertebral levels in Southern Chinese patients. OVERVIEW OF LITERATURE: Recent studies have demonstrated discrepancies between traditional anatomic landmarks of the neck and their corresponding cervical vertebra. METHODS: The center of the body of the hyoid bone, the upper limit of the lamina of the thyroid cartilage, and the lower limit of the cricoid cartilage were selected as representative surface landmarks for this investigation. The corresponding vertebral levels in 78 patients were assessed using computed tomography. RESULTS: In both male and female patients, almost none of the anatomical landmarks demonstrated greater than 50% correlation with any vertebral level. The most commonly corresponding vertebra of the hyoid bone, the lamina of the thyroid cartilage, and the cricoid cartilage were the C4 (47.5%), C5 (35.9%), and C7 (42.3%), respectively, which were all different from the classic descriptions in textbooks. The vertebral levels corresponding with the thyroid and cricoid cartilage were significantly different between genders. CONCLUSIONS: The surface landmarks of the neck were not accurate enough to be used as the sole determinant of vertebral levels or incision sites. Intra-operative fluoroscopy is necessary to accurately locate each of the cervical vertebral levels.

Tumor condroide del cartílago tiroides: reporte de un caso clínico y revisión de la literatura / Chondroid tumor of the thyroid cartilage: case report and literature review

Los tumores condroides de la laringe son poco frecuentes, y generalmente se ubican en el cartílago cricoides. El tratamiento de elección es quirúrgico, con buen pronóstico general. Se presenta el caso de un hombre de 60 años con historia de disfonía. El estudio nasofaringolaringofibroscópico revela una masa laríngea supraglótica. Las imágenes son compatibles con una lesión del cartílago tiroides. La biopsia obtenida por microlaringoscopía directa informa tumor compatible con condroma. Se realiza una resección completa de la masa por abordaje externo, la biopsia corrobora el diagnóstico de tumor condroide de bajo grado. Se describe esta patología mediante revisión bibliográfica.

Chondroid tumors of the larynx are uncommon, and usually located in the cricoid cartilage. Surgery is the treatment of choice, with good prognosis in general. We report the case of a 60-year-old man consulting for dysphonia. The nasopharyngolaryngoscopy showed a supraglottic laryngeal mass. The images were compatible with a thyroid cartilage lesion. The biopsy sample obtained by direct microlaryngoscopy was consistent with a condroma. A complete excision of the lesion was performed by external approach and the biopsy confirmed the diagnosis of a low grade chondroid tumor. We present a review of chondroid tumors of the larynx based on available literature.

Thyroid gland invasion in laryngeal carcinoma

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the prevalence of, and describe transglottic cancer with thyroid cartilage invasion as a possible risk for, thyroid gland invasion in a series of patients with laryngeal carcinoma who underwent total laryngectomy with thyroidectomy.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Retrospective Case Series<br /><strong>Setting:</strong> Tertiary Government Training Hospital<br /><strong>Participants:</strong> 61 laryngeal carcinoma patients who underwent total laryngectomy with hemi- or total thyroidectomy from January 2010 to August 2017.<br /><strong>RESULTS:</strong> Out of 61 patients with laryngeal carcinoma, 11 patients had supraglottic, 11 glottic, 2 subglottic and 37 had transglottic involvement. Eleven had thyroid cartilage invasion, all of whom had transglottic tumors. Of these 11 patients, only 1 had thyroid gland invasion. This was a case of a 78 year-old male patient with poorly differentiated SCC stage IVa transglottic tumor with thyroid cartilage invasion.<br /><strong>CONCLUSION:</strong> Thyroid gland invasion was uncommon in our sample of laryngeal carcinoma patients who underwent laryngectomy and thyroidectomy. Although transglottic involvement with thyroid cartilage invasion may increase the risk of thyroid gland invasion, it could not be confirmed by our series. Perhaps thyroidectomy should not be routinely performed on all patients with laryngeal carcinoma who undergo total laryngectomy but more rigorous studies are needed to establish this.</p>

Thyroid gland invasion in laryngeal carcinoma

OBJECTIVE: To determine the prevalence of, and describe transglottic cancer with thyroid cartilage invasion as a possible risk for, thyroid gland invasion in a series of patients with laryngeal carcinoma who underwent total laryngectomy with thyroidectomy.METHODS:Design: Retrospective Case SeriesSetting: Tertiary Government Training HospitalParticipants: 61 laryngeal carcinoma patients who underwent total laryngectomy with hemi- or total thyroidectomy from January 2010 to August 2017.RESULTS: Out of 61 patients with laryngeal carcinoma, 11 patients had supraglottic, 11 glottic, 2 subglottic and 37 had transglottic involvement. Eleven had thyroid cartilage invasion, all of whom had transglottic tumors. Of these 11 patients, only 1 had thyroid gland invasion. This was a case of a 78 year-old male patient with poorly differentiated SCC stage IVa transglottic tumor with thyroid cartilage invasion.CONCLUSION: Thyroid gland invasion was uncommon in our sample of laryngeal carcinoma patients who underwent laryngectomy and thyroidectomy. Although transglottic involvement with thyroid cartilage invasion may increase the risk of thyroid gland invasion, it could not be confirmed by our series. Perhaps thyroidectomy should not be routinely performed on all patients with laryngeal carcinoma who undergo total laryngectomy but more rigorous studies are needed to establish this.

Surgical approach to the thyroarytenoid branch of the inferior laryngeal nerve through the thyroid cartilage

ABSTRACT PURPOSE: To describe the anatomical course of the intralaryngeal portion of the inferior laryngeal nerve (ILN) and to standardize the surgical access to its thyroarytenoid branch (TAb) through the thyroid cartilage. METHODS: Under surgical microscopy, 33 adult human excised larynges were dissected, to expose the intralaryngeal portion of ILN. The point of entry of TAb, ILN's terminal branch, in the thyroarytenoid (TA) muscle was determined and correlated with thyroid cartilage dimensions. RESULTS: After entering the larynx, the ILN consistently traveled between the thyroid cartilage and the lateral cricoarytenoid muscle in an anterior and slightly cranial course. The distance from the point of entry of the TAb in the TA muscle to the midline (TAb-H) and to the inferior border (TAb-V) of the thyroid cartilage differed according to gender. In females, mean distances of TAb-H and TAb-V were 20.5mm and 5.2mm and in males, 22.3mm and 5.9mm, respectively. CONCLUSION: The intralaryngeal course of the inferior laryngeal nerve presents low variability and measures from landmarks in the thyroid cartilage help to estimate the point of entry of thyroarytenoid branch in thyroarytenoid muscle.

Benign Thyroid Mass Causing Necrosis of Tracheal Cartilage / 대한이비인후과학회지

Thyroid tumors are usually asymptomatic, but occasionally they can cause upper airway obstruction by compressing the trachea in cases of benign mass or invading intraluminal tracheal wall in locally advanced carcinoma. There were a few case reports of rapidly enlarging benign tumors of thyroid causing upper airway distress symptoms, but there has been no case report showing necrosis of tracheal cartilage by benign thyroid mass. When the thyroid cartilage wall is actually invaded by thyroid mass, we should consider of the possibility of malignant transformation. We experienced a case of unilateral benign thyroid mass causing acute airway obstruction and necrosis of tracheal cartilage. Therefore, we present the case with a literature review.

Ultrasonographic Measurement of Thickness of the Thyrohyoid Muscle: A Pilot Study

OBJECTIVE: To evaluate the normal thickness of the thyrohyoid muscle, which is one of the key muscles related to swallowing, by ultrasonography. METHODS: The thickness of the left and right thyrohyoid muscles was measured in normal male and female adults ranging in age from 20 to 79 years by ultrasonography. The groups were classified according to age as follows: subjects ranging in age from 20 to 39 years were classified into group A, subjects ranging in age from 40 to 59 years were classified into group B, and subjects ranging in age from 60 to 79 years were classified into group C. The measurement level was the line that joins the upper tip of the superior thyroid notch and the oblique line of the thyroid cartilage. Also, a correlation with the thyrohyoid muscle was investigated by collecting information regarding height, weight, body mass index (BMI), age, and gender of subjects in the healthy group. RESULTS: The number of subjects in each group was as follows: group A (n=82), group B (n=62), and group C (n=60). Also, the thicknesses of the left and right muscles were 2.72±0.65 mm and 2.87±0.76 mm in group A, 2.83±0.61 mm and 2.93±0.67 mm in group B, and 2.59±054 mm and 2.73±0.55 mm in group C, respectively. Thyrohyoid muscle had a correlation with height, weight, and BMI. The thickness of the left and right thyrohyoid muscles was greater in male subjects than in female subjects and the right side muscle was thicker than the left side muscle. CONCLUSION: The average thickness of the left and right thyrohyoid muscles was 3.20±0.54 mm in male subjects and 2.34±0.37 mm in female subjects. The thickness of the thyrohyoid muscle was positively correlated with height, weight, and BMI, and the thyrohyoid muscle was thicker in male subjects than in female subjects and the right side muscle was thicker than the left side muscle.

Anatomical considerations of the superior thyroid artery: its origins, variations, and position relative to the hyoid bone and thyroid cartilage / 대한해부학회지

The aim of this study was to provide accurate anatomical descriptions of the overall anatomy of the superior thyroid artery (STA), its relationship to other structures, and its driving patterns. Detailed dissection was performed on thirty specimens of adult's cadaveric neck specimens and each dissected specimen was carefully measured the following patterns and distances using digital and ruler. The superior thyroid, lingual, and facial arteries arise independently from the external carotid artery (ECA), but can also arise together, as the thyrolingual or linguofacial trunk. We observed that 83.3% of STAs arose independently from the major artery, while 16.7% of the cases arose from thyrolingual or linguofacial trunk. We also measured the distance of STA from its major artery. The origin of the STA from the ECA was 0.9±0.4 mm below the hyoid bone. The STA was 4.4±0.5 mm distal to the midline at the level of the laryngeal prominence and 3.1±0.6 mm distal to the midline at the level of the inferior border of thyroid cartilage. The distance between STA and the midline was similar at the level of the hyoid bone and the thyroid cartilage. Also, when the STA is near the inferior border of the thyroid cartilage, it travels at a steep angle to the midline. This latter point may be particularly important in thyroidectomies. We hope that anatomical information provided here will enhance the success of, and minimize complications in, surgeries that involve STA.

Intrinsic Vertebral Markers for Spinal Level Localization in Anterior Cervical Spine Surgery: A Preliminary Report

STUDY DESIGN: Prospective clinical study. PURPOSE: To observe the usefulness of anterior cervical osteophytes as intrinsic markers for spinal level localization (SLL) during sub-axial cervical spinal surgery via the anterior approach. OVERVIEW OF LITERATURE: Various landmarks, such as the mandibular angle, hyoid bone, thyroid cartilage, first cricoid ring, and C6 carotid tubercle, are used for gross cervical SLL; however, none are used during cervical spinal surgery via the anterior approach. We present our preliminary assessment of SLL over anterior vertebral surfaces (i.e., intrinsic markers) in 48 consecutive cases of anterior cervical spinal surgeries for the disc-osteophyte complex (DOC) in degenerative diseases and granulation or tumor tissue associated with infectious or neoplastic diseases, respectively, at an ill-equipped center. METHODS: This prospective study on patients undergoing anterior cervical surgery for various sub-axial cervical spinal pathologies aimed to evaluate the feasibility and accuracy of SLL via intraoperative palpation of disease-related morphological changes on anterior vertebral surfaces visible on preoperative midline sagittal T1/2-weighted magnetic resonance images. RESULTS: During a 3-year period, 48 patients (38 males,10 females; average age, 43.58 years) who underwent surgery via the anterior approach for various sub-axial cervical spinal pathologies, including degenerative disease (n= 42), tubercular infection (Pott's disease; n=3), traumatic prolapsed disc (n=2), and a metastatic lesion from thyroid carcinoma (n=1), comprised the study group. Intrinsic marker palpation yielded accurate SLL in 79% of patients (n=38). Among those with degenerative diseases (n=42), intrinsic marker palpation yielded accurate SLL in 76% of patients (n=32). CONCLUSIONS: Intrinsic marker palpation is an attractive potential adjunct for SLL during cervical spinal surgeries via the anterior approach in well-selected patients at ill-equipped centers (e.g., those found in developing countries). This technique may prove helpful when radiographic visualization is occasionally inadequate.

Effectiveness of Palatal Mucosa Graft in Surgical Treatment of Sub-Glottic Stenosis

OBJECTIVES: Mucosal free grafts may be successfully applied in many surgical interventions. This study aims at investigating the feasibility of palatal mucosa graft in sub-glottic field in an animal model. METHODS: This randomized prospective controlled study was conducted with an animal model. Sub-glottic inflammation was created in 15 adult rabbits in each group and sub-glottic stenosis surgery was applied thereafter. The rabbits in group 1 (control group) underwent segmental resection, partial cricoidectomy, and trachea-thyroid cartilage anastomosis; the rabbits in group 2 underwent segmental resection, cricoplasty, and crico-tracheal anastomosis using free buccal mucosa graft; and the rabbits in group 3 underwent segmental resection, cricoplasty, and crico-tracheal anastomosis using free palatal mucosa graft. Re-stenosis was evaluated after 42 days. RESULTS: The percentages of stenosis were 27%±20%, 40%±20%, and 34%±23% for group 1, 2, and 3, respectively and the difference was not statistically significant (P=0.29). Intensive and tight fibrosis was observed in 2 rabbits (13%) in group 1, in 5 rabbits (33%) in group 2, and in 3 rabbits (20%) in group 3. There was not a statistically significant difference between groups (P=0.41). Excessive inflammation was observed in 3 rabbits (20%) in group 1, in 7 rabbits (47%) in group 2, and 3 rabbits (20%) in group 3. There was no a statistically significant difference between groups although inflammation rate was higher in the rabbits which underwent buccal mucosa graft (P=0.18). CONCLUSION: The surgical treatments applied with free mucosa graft reduced anastomosis tension through enabling anastomosis to the distal of cricoid instead of thyroid cartilage. Free palatal mucosa grafts may be used in sub-glottic field, one of the most challenging fields of trachea surgery, due to ease of application and rapid vascularization.

A porcine model for teaching surgical cricothyridootomy / Modelo porcino no ensino da cricotiroidotomia cirúrgica

OBJECTIVE: To evaluate the acceptability of an educational project using A porcine model of airway for teaching surgical cricothyroidotomy to medical students and medical residents at a university hospital in southern Brazil. METHODS: We developed a teaching project using a porcine model for training in surgical cricothyroidotomy. Medical students and residents received lectures about this surgical technique and then held practical training with the model. After the procedure, all participants filled out a form about the importance of training in airway handling and the model used. RESULTS: There were 63 participants. The overall quality of the porcine model was estimated at 8.8, while the anatomical correlation between the model and the human anatomy received a mean score of 8.5. The model was unanimously approved and considered useful in teaching the procedure. CONCLUSION: The training of surgical cricothyroidotomy with a porcine model showed good acceptance among medical students and residents of this institution.

OBJETIVO: Avaliar a aceitabilidade de um projeto de ensino utilizando modelo porcino de vias aéreas no ensino da cricotiroidotomia cirúrgica para estudantes de Medicina e médicos residentes em um hospital universitário no sul do Brasil. MÉTODOS: Foi desenvolvido um projeto de ensino usando modelo porcino para treinamento em cricotiroidotomia cirúrgica. Estudantes de Medicina e residentes receberam aula teórica sobre esta técnica cirúrgica e, em seguida, realizaram no modelo o treinamento prático. Após o procedimento, todos os participantes preencheram um formulário acerca da importância do treinamento em manuseio de vias aéreas e do modelo utilizado. RESULTADOS: Houve 63 participantes. A qualidade geral do modelo porcino foi estimada em 8,8, enquanto a correlação anatômica entre o modelo e a anatomia humana recebeu o escore médio de 8,5 entre os treinandos. O modelo foi unanimemente aprovado e considerado útil no ensino do procedimento. CONCLUSÃO: O treinamento de cricotiroidotomia cirúrgica em modelo porcino apresentou boa aceitação entre os estudantes de Medicina e os residentes desta Instituição.

Transoral CO2 laser surgery for early glottic carcinoma with anterior commissure involvement / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and effect of CO2 laser surgery for early glottic carcinoma with anterior commissure involvement.</p><p><b>METHODS</b>Twenty-seven patients with T1b glottic squamous cell carcinoma who underwent transoral CO2 laser surgery as the primary modality of treatment from January 2008 to August 2013 were reviewed. All patients were males and the age ranged from 46 to 81 years old. The patients did not receive any other treatments. Preoperative enhanced CT scan was performed to assess the status of the tumors and the lamina of thyroid cartilage. All the patients without the lamina of thyroid cartilage involved underwent transoral CO2 laser surgery.</p><p><b>RESULTS</b>Among 27 cases, aside from 1 patient converted to open operation due to inadequate exposure, 26 patients were successfully implemented operation. All the patients were followed-up for 12 to 60 months (median 26 months) and no recurrence. Granulation occurred four to six weeks after operation in all patients. Among them, granulation disappeared automatically three to six months in 22 patients and was resected with local anesthesia in other 4 patients, which the pathological results were inflammatory lesion. All patients did not undergo tracheotomy and nasogastric feeding, with an average stay of three days in hospital after surgery, and had different degree of vocal cord adhesion 6 months later.</p><p><b>CONCLUSIONS</b>Transoral CO2 laser surgery is an ideal procedure for early glottic carcinoma with anterior commissure involvement. Better preoperative evaluation, endoscopic technique and satisfied exposure are keys to the success of operation.</p>