Two Teflon granulomas of the nasopharynx and paravertebral space mimicking a neoplasm.

Teflon has been proved to be able to extravasate and infiltrate into soft tissue to form an inflammatory giant-cell foreign-body reaction, a so-called Teflon granuloma. We present a rare case report of a patient with two Teflon granulomas of the head and neck, who were first interpreted as a neoplasm.

Endoscopic and Computed Tomography Evaluation of Posterior Glottic Closure During Phonation.

OBJECTIVES/HYPOTHESIS: The anatomy of the posterior glottis, specifically the states of the posterior glottis during phonation, has not been thoroughly explored in laryngology. Conventional wisdom about the posterior glottis indicates that it tends to be completely closed in men but may be open in women. Furthermore, professional singers are expected to have a completely closed posterior glottis. The aim of this study was to investigate whether these generalizations are true by comparing rigid videolaryngostroboscopy results with high-resolution computed tomography (HRCT) and three-dimensional (3D) reconstruction findings. STUDY DESIGN: Prospective study. METHODS: Of the 90 volunteers (58 women, 32 men) examined, 48 were female professional singers, 10 were female nonsingers, 22 were male professional singers, and 10 were male nonsingers. Rigid videolaryngostroboscopy as well as HRCT scans were performed during singing at the average singing fundamental frequency. HRCT images of the larynx and air-column were 3D visualized using the software MIMICS®. The states of the posterior glottis were assessed in both examinations and compared among participants. RESULTS: The sensitivity of endoscopy was 67.5%. Complete closure of the posterior glottis was observed in 62.5% men and 52% women (P = .33). Complete closure of the posterior glottis was observed in 35% nonsingers and 61% professional singers (P = .036). CONCLUSIONS: The closure of the posterior glottis seen on videolaryngostroboscopy does not always correlate with actual closure. There seems to be no link between sex and complete closure of the glottis. However, there is strong evidence that posterior glottis closure can be influenced, to some degree, by vocal training. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:124-129, 2022.

Influence of surface anesthesia of the nasal cavity on oral tissues in the anterior region - a pilot study.

Nasal surface anesthesia is a simple, non-invasive method with a not yet fully understood effect on oral tissues. Should it prove to be successful in dental medicine, it could replace or at least complement the more invasive injection anesthesia, especially in children after dental trauma. The local anesthetic Tenaphin (tetracaine hydrochloride and naphazoline nitrate) was applied to 105 patients prior to ear, nose and throat medical diagnosis or therapy. After different exposure times, the influence on the oral tissues in the anterior region was examined by a dentist in the context of a pilot study. The effect of the mucosal anesthesia increased in the canine and anterior region the further mesial the tooth was located and the longer the application time was. In the buccal and palatinal area the effect increased from apical to incisal. The pulps of the central incisors and the canines were better anesthetized than those of the lateral incisors. Nasal surface anesthesia has the potential to replace the more invasive injection anesthesia in the anterior region of the upper jaw or to complement it. Dosage and exposure time will have to be investigated in more detail.

Surgical Impact of the Montgomery Implant System on Arytenoid Cartilage and the Paralyzed Vocal Fold.

OBJECTIVES/HYPOTHESIS: Medialization thyroplasty (MT) has become a prominent method for treating glottal insufficiency. This study aimed to visualize the biomechanical influence of a medialization implant on arytenoid cartilage, particularly on the length and level of paralyzation in the vocal fold, in patients with unilateral vocal fold paralysis. STUDY DESIGN: Prospective study. METHODS: We recruited 15 patients (10 men, 5 women) with unilateral vocal fold paralysis that underwent MT with a Montgomery® thyroplasty implant. We performed high-resolution computed tomography of the arytenoid cartilage before and after MT and analyzed the three-dimensional images. To visualize the movement of the arytenoid and to measure the lengthening of the vocal fold, we superimposed pre- and postoperative 3D images with MIMICS software. RESULTS: On the affected side, the implant pushed the arytenoid backwards. In addition, the vocal process of the arytenoid was inwardly rotated. These movements resulted in an elongated, augmented vocal fold on the affected side. CONCLUSION: MT led to an elongated, medialized vocal fold on the treated side. After the intervention, the vocal folds on both sides were the same length in the phonatory position.

The Cricothyroid Joint: A Practical Guide for Distinguishing Between Different Joint Types.

OBJECTIVE: Type A cricothyroid joint (CTJ) leads to a higher elongation of the vocal folds than Type B/C CTJ. Therefore, the determination for the CTJ type is important whether to perform a cricoid-thyroid approximation for a pitch elevation in transwomen with gender dysphoria. This study aimed to develop a tool for clinicians and radiologists for distinguishing between Type A (cricoid cartilage protuberance) and Type B/C (flat surface with/without cartilage of the cricoid) CTJs on high-resolution computed tomography (HRCT). STUDY DESIGN: This was a prospective study. METHODS: Analysis of 60 male HRCTs and 60 female HRCTs of the larynx/CTJs. Three-dimensional reconstruction of the laryngeal cartilages, based on visualization of the CTJ in HRCT scans. The intercartilaginous distances (nearest distance between the inner side of the Thyroid and outer side of the cricoid of the CTJ) were measured to compare different types of CTJs. RESULTS: In all HRCT scans, three-dimensional reconstructions of the CTJ were feasible. All Type A CTJs showed the typical cricoid cartilage protuberance (like a volcano) in biplanar images and three-dimensional reconstructions. All Type B/C CTJs showed a flat cricoid joint cartilage in biplanar images and three-dimensional reconstructions. The type distribution was Type A: 61% in male and female larynges; Type B/C: 39% in male and female larynges. The intercartilaginous distances were Type A: 0.71 mm [0.42-0.98] in male larynges and 0.75 mm [0.44-1.40] in female larynges; Type B/C: 1.13 mm [0.36-1.24] in male larynges and 1.32 mm [0.76-2.47] in female larynges. CONCLUSIONS: In HRCT scans, the Type A CTJ showed an intercartilaginous space less than 1 mm. In contrast, the Type B/C CTJ showed an intercartilaginous distance exceeded 1 mm.

Effect of Vocal Fold Implant Placement on Depth of Vibration and Vocal Output.

OBJECTIVE: Most type 1 thyroplasty implants and some common injectable materials are mechanically stiff. Placing them close to the supple vocal fold mucosa can potentially dampen vibration and adversely impact phonation, yet this effect has not been systematically investigated. This study aims to examine the effect of implant depth on vocal fold vibration and vocal output. STUDY DESIGN: Computational simulation. METHODS: Voice production was simulated with a fiber-gel finite element computational model that incorporates a three-layer vocal fold composition (superficial lamina propria, vocal ligament, thyroarytenoid muscle). Implants of various depths were simulated, with a "deeper" or more medial implant positioned closer to the vocal fold mucosa and replacing more muscle elements. Trajectories of surface and within-tissue nodal points during vibration were produced. Outcome measures were the trajectory radii, fundamental frequency (F0 ), sound pressure level (SPL), and smoothed cepstral peak prominence (CPPS) as a function of implant depth. RESULTS: Amplitude of vibration at the vocal fold medial surface was reduced by an implant depth of as little as 14% of the total transverse vocal fold depth. Increase in F0 and decrease in CPPS were noted beyond 30% to 40% implant depth, and SPL decreased beyond 40% to 60% implant depth. CONCLUSIONS: Commonly used implants can dampen vibration "from a distance," ie, even without being immediately adjacent to vocal fold mucosa. Since implants are typically placed at depths examined in this study, stiff implants likely have a negative vocal impact in a subset of patients. Softer materials may be preferable, especially in bilateral medialization procedures. LEVEL OF EVIDENCE: N/A Laryngoscope, 130:2192-2198, 2020.

How Age and Frequency Impact the Thyroid Cartilages of Professional Singers.

OBJECTIVES/HYPOTHESIS: Young professional singers can easily reach very high pitches. In contrast, older singers often complain that they have to exert substantially more laryngopharyngeal force to reach the same high pitch compared with their earlier years. Various factors such as the property changes of the mucosa and ossification that impact the singing apparatus were suggested as explanations in the literature. The aim of this study was to analyze thyroid deformation-and thereby stiffness indirectly-during singing as a potential reason for this phenomenon. STUDY DESIGN: Prospective study. METHODS/DESIGN: We examined 44 female professional singers. High-resolution computed tomography scans were performed during singing at the fundamental mean speaking frequency and the first and second octaves above it. Digital Imaging and Communications in Medicine scan data were rendered and visualized 3-dimensionally using MIMICS software. By superimposition of the different 3-dimensional images, different positions of the thyroid were visualized. The distance from the posterior border of the thyroid was measured in all the examinations. RESULTS: All laryngeal cartilages could be three-dimensionally visualized. The magnitude of the thyroidal deformation significantly depends on pitch and significantly correlates with age (r2 = 0.7, P < 0.001). CONCLUSIONS: The thyroid cartilage is flexible and its formability is especially important during singing. At higher pitches, the cartilage was more deformed. The larynx in older singers showed less thyroid cartilage deformation.

Cricothyroid joint type as predictor for vocal fold elongation in professional singers.

OBJECTIVE: Vocal fold (VF) elongation vocal folds depends on two factors: the activity of the laryngeal muscles and the cricothyroid joint (CTJ). The aim of the study was to show the influence of the CTJ on VF elongation while singing a sustained vowel at different pitches. STUDY DESIGN: Prospective study. METHODS: Forty-nine female professional singers (25 sopranos, 24 altos) were recruited. Three-dimensional images of the larynx derived from high-resolution computed tomography scanning were obtained at the mean speaking fundamental frequency (F0) and one (F1) and two octaves (F2) above this pitch. RESULTS: From F0 to F1, all three CTJ types showed equal elongation of the VF (type A: 14%, type B/C: 13%). From F1 to F2, VF elongation was 8% in singers with type A and 4% in those with type B/C (P < 0.0001). CONCLUSION: The stability of the CTJ directly influences VF during singing. This is the first study to show this relationship in vivo. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:1176-1181, 2018.