Outcomes of Injection Laryngoplasty for Deep Interarytenoid Groove

Abstract Introduction Deep interarytenoid groove (DIG) may cause swallowing dysfunction in children; however, the management of DIG has not been established. Objective We evaluated the subjective and objective outcomes of interarytenoid augmentation with injection in children with DIG. Methods Consecutive children under 18 years of age who underwent injection laryngoplasty for DIG were reviewed. Data pertaining to demographics, past medical history, past surgical history, and results of pre and postoperative video fluoroscopic swallow study (VFSS) were obtained. The primary outcome measure was the presence of thin liquid aspiration or penetration on postoperative VFSS. The secondary outcome measure was caregiver-reported improvement of symptoms. Results Twenty-seven patients had VFSS before and after interarytenoid augmentation with injection (IA). Twenty (70%) had thin liquid penetration and 12 (44%) had thin liquid aspiration before the IA. Thin liquid aspiration resolved in 9 children (45%) and persisted in 11 (55%). Of the 12 children who had thin liquid aspiration prior to IA, 6 (50%) had resolution of thin liquid aspiration after IA. Conclusions Injection laryngoplasty is a safe tool to improve swallowing function in children with DIG. Further studies are needed to assess the long-term outcomes of IA and identify predictors of successful IA in children with DIG.

Cuerpo extraño en espacio paraglótico

Los cuerpos extraños en la vía aérea son una urgencia muy común en la práctica de la otorrinolaringología. La mayoría suelen encontrarse en población pediátrica donde la gravedad es mayor. En adultos estos episodios suelen ser accidentales, siendo la exploración física fundamental para su diagnóstico. Exponemos aquí el caso de un varón qué presentó una espina de pescado en el área interaritenoidea.

Foreign bodies in the airway are a very common emergency in the practice of otorhinolaryngology, the majority of which are usually found in the pediatric population. In adults, these episodes are usually accidental, and physical examination is fundamental for its diagnosis. We report a case of fish bone impaction in the interarytenoid area.

Características Tomográficas de la Anatomía Laríngea Normal en pacientes que acuden al Servicio de Medicina en Imágenes del Hospital de Clínicas San Lorenzo, Paraguay 2020

RESUMEN Introducción: La tomografía computarizada es el estudio Gold standard para complementar a la endoscopia en el estudio de patologías laríngeas. Por lo tanto, se debe tener conocimiento de la anatomía normal de la laringe. Metodología: Se realizó un estudio observacional descriptivo, de corte transversal retrospectivo. Se recolecto los datos a través del análisis tomográfico, se analizaron 26 tomografías de pacientes que acudieron al Servicio de Imágenes del Hospital de Clínicas sin patología laríngea. Las variables investigadas fueron características tomográficas como: Calcificación cartílagos laríngeos, Altura cartílago tiroideo, Distancia tiro-aritenoidea, Distancia interaritenoidea, Altura y diámetro del espacio preepiglótico. Resultados: Se lograron identificar cada una de las características anatómicas radiológicas buscadas. Además, se realizaron las mediciones correspondientes, detallando el promedio de cada una de las mediciones y clasificándolo por sexo. La altura de cartílago tiroideo la media en hombres fue 28.05±1.2 mm y en mujeres fue 27.8±0.92 mm, para la distancia Tiro-aritenoidea en hombres fue 12.3±1.3 y en mujeres 10.97±0.95 mm, para el diámetro transversal del cartílago tiroideo en hombres fue 16.63±1.58 mm y en mujeres 17.96±1.11 mm. Conclusión: Los promedios de las mediciones realizadas fueron mayor en hombres excepto en el diámetro transversal del cartílago tiroideo, La prevalencia de calcificación de cartílagos laríngeos fue del 54% de los pacientes estudiados.

ABSTRACT Introduction: Computed tomography is the Gold standard study to complement endoscopy in the study of laryngeal pathologies. Therefore, knowledge of the normal anatomy of the larynx is required. Methodology: A retrospective cross-sectional descriptive observational study was carried out. Data were collected through tomographic analysis, 26 tomographies of patients who attended the Imaging Service of the Hospital de Clínicas without laryngeal pathology were analyzed. The variables investigated were tomographic characteristics such as: laryngeal cartilage calcification, thyroid cartilage height, thyro-arytenoid distance, interarytenoid distance, height and diameter of the pre-epiglottic space. Results: Each of the radiological anatomical characteristics sought were identified. In addition, the corresponding measurements were taken, detailing the average of each of the measurements and classifying them by sex. The average thyroid cartilage height in men was 28.05±1.2 mm and in women was 27.8±0.92 mm, for the thyro-arytenoid distance in men was 12.3±1.3 and in women 10.97±0.95 mm, for the transverse diameter of the thyroid cartilage in men was 16.63±1.58 mm and in women 17.96±1. 11 mm. Conclusions: The averages of the measurements taken were higher in men except for the transverse diameter of the thyroid cartilage. The prevalence of laryngeal cartilage calcification was 54% of the patients studied.

Difficult intubation due to interarytenoid adhesion: A case report / 대한마취과학회지

Interarytenoid adhesion of the vocal cords, with a triangular anterior opening and a smaller posterior rounded opening, is one of the complications of intubation. The vocal cords are tethered to each other and they are restricted with narrow abduction, causing difficult intubation. A 57-year-old woman was scheduled to undergo lung wedge resection. The patient had experienced a prolonged intubation 15 years previously. Thereafter, she had undergone two operations and intubation was difficult to perform with using small size endotracheal tubes (6.5 and 6.0 mm inner diameter, respectively). Despite this past medical history, anesthesia was performed without further evaluation because of the patient's refusal. After the failure of an initial trial of intubation with a double lumen endobronchial tube, we tried to intubate with a small sized endotracheal tube (5.0 mm). But it was impossible to pass the tube through the vocal cords. Endobronchial endoscopy revealed interarytenoid adhesion of her vocal cords. After tracheostomy, she received wedge resection. Therefore, the possibility of difficult intubation due to interarytenoid adhesion of the vocal cords should be considered for a patient with a past history of intubation.

Airway Management of a Pediatric Patient with Interarytenoid Adhesion : A case report

Interarytenoid adhesion is a rare complication associated with endotracheal intubation. The vocal cord is fixed to arytenoid cartilage and the movement of vocal cord is limited. Its clinical symptoms are dyspnea and hoarseness, so sometimes it is mistaken for bilateral vocal cord palsy because of its clinical features. We have experienced unanticipated failed intubation followed by hypoxia in interarytenoid adhesion who was scheduled for emergency tracheotomy due to bilateral vocal cord palsy. After failure of cricothyroidotomy, patient was successfully ventilated with jet injector and tracheotomy was done without complication.

A Study of Laryngeal Innervation by HRP Retrograde Labeling and Immunohistochemical Methods / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Classical concept of the laryngeal neuroanatomy has been questioned by some authors. Double innervation of some intrinsic laryngeal muscles has been suggested but controversy still exists. This study investigates the possibility of double innervation of thyroarytenoid and interarytenoid muscle and also the proportion of motor component in the external and internal branch of the superior laryngeal nerve. MATERIALS AND METHODS: Horse radish peroxidase (HRP) retrograde labeling in dogs, and choline acetyltransferase (ChAT) immunohistochemistry in feline and human laryngeal nerves were used. RESULTS: Evidences suggesting the existence of double innervation in thyroarytenoid and interarytenoid muscle and the existence of sensory component in external branch and motor component in internal branch of the superior laryngeal nerve have been observed. CONCLUSION: This new concept of the laryngeal neuroanatomy may be helpeful for understanding some of the neurologic diseases of the larynx such as spasmodic disphonia or variability of the vocal cord position in vocal cord paralysis. Further neuroanatomic and physiologic study is needed.

Function of the interarytenoid(IA) muscle in phonation: in vivo laryngeal model

Thyroarytenoid(TA), lateral cricoarytenoid(LCA), and IA muscles are referred to as the adductors of the vocal fold. The TA is known to shorten the vocal folds and to adduct the membranous vocal fold, and the LCA adducts the inter-vocal process region and IA adducts the posterior commissure. Even though IA has an important role for the positioning of the vocal folds during respiration and phonation together with the action of the posterior cricoarytenoid muscle, little is known about the effect of IA on voice parameters during phonation. An in vivo canine model was used in five mongrel dogs to examine the role of the IA muscle in controlling phonation. In two out of five dogs, sound could not be elicited without stimulating the IA branches of the recurrent laryngeal nerves. When the IA was dynamically and statistically stimulated, subglottic pressure, vocal intensity and fundamental frequency were increased. However, open quotient was not changed markedly. These results suggest that the IA affects the voice parameters mainly by controlling subglottic pressure during phonation.