Regional blood flow of the canine vocal cord: the microsphere surface technique.

The vocal fold's microcirculation has been well described, but there are few reports regarding the blood flow to this region. A number of methods have been used to evaluate the blood flow to an organ system. Among the most sensitive is the microsphere surface technique, which has been used to measure blood flow in many organ systems, including the cochlea. In this study, the blood flow to the canine vocal fold was assessed using the microsphere surface technique. Overall flow was measured, as well as flow to the lamina propria and muscularis layers. The technique and the results are reported.

The effect of air flow and medial adductory compression on vocal efficiency and glottal vibration.

This study used an in vivo canine model to investigate the effects of varying vocal fold resistance by electrically stimulating the recurrent laryngeal nerve while monitoring medial adductory compression of the vocal folds, glottal airflow, and vocal intensity. The effects of increasing airflow on glottal vibration were also examined stroboscopically and by measurement of open quotient. The results indicated that increasing intensity by medial adductory compression was more efficient than by increasing airflow. Increasing airflow produced a significantly greater open quotient and vocal fold vibratory excursion.

Regional blood flow to the canine vocal fold at rest and during phonation.

Recent reports have suggested that blood flow to the vocal fold decreases during phonation. However, these studies relied on indirect measures of blood flow, such as tissue oxygen tension. Among the differing methods of measuring blood flow, one of the most sensitive is the microsphere surface technique. This technique has been effective in assessing the overall and regional blood flow to a number of different organs, including the cochlea. Employing an in vivo canine model, we injected microspheres into the left atrium. From there, they were distributed and became entrapped in the tissues in proportion to blood flow. We measured the blood flow to the entire vocal fold, as well as the lamina propria and muscularis layers. The results revealed a statistically significant (p less than .002) increase in blood flow on phonation. The increase, however, was due to increased flow to the muscularis layer. The flow to the lamina propria remained unchanged during phonation.

Effect of vocal fold augmentation on laryngeal vibration in simulated recurrent laryngeal nerve paralysis: a study of Teflon and Phonogel.

Flaccid laryngeal nerve paralysis may be treated by vocal fold augmentation with Teflon injection, which is successful to various degrees depending on the subjective interpretation of the patient or clinician. A new material, Phonogel, consisting of cross-linked bovine collagen, is available but not approved for human use in this area. Ten dogs were submitted to videostroboscopy, photoglottography, electroglottography, and acoustic analysis in the normal state, with stimulated recurrent laryngeal nerve paralysis, and with injection of either Teflon or Phonogel. A statistical comparison and the advantages and disadvantages of each material are discussed in relation to this study and its clinical use.

Office-based system for voice analysis.

There has been recent growing interest in the analysis of various electronically recorded signals as potential tools for objective assessment of vocal dysfunction. In the past, analysis of such signals required an expensive multitrack FM recorder, mainframe computer system, customized software, and significant time commitment. This report describes an adaptation of commercially available components that allow digital recording of multiple electronic signals, storage of data, and subsequent signal analysis using an inexpensive personal microcomputer system. Commercially available software for manipulation and examination signals is discussed as adapted for examination of glottographic and acoustic signals. The relatively inexpensive availability of similar computer systems will, hopefully, encourage assessment of the clinical applications of objective techniques of voice quality.

An accurate method of Teflon injection using functional phonosurgery.

A technique for Teflon injection is described that allows the laryngologist to assess vocal fold vibration during general anesthesia. A tracheostomy tube fitted with a rostral air line allows translaryngeal airflow. During endoscopy with a bivalved laryngoscope, the cords are approximated manually. Vocal fold vibration is produced with the cords adducted. The precise site of defects in glottic closure is clearly seen and corrected with Teflon injection. In cases where standard Teflon injection has failed, utilization of this method has allowed substantial voice improvement. The ability to assess vibratory function of the vocal folds during direct suspension laryngoscopy enhances the precision of vocal fold augmentation techniques in difficult rehabilitation cases.

Nonsalivary sinonasal adenocarcinoma.

Thirteen cases of primary non-salivary gland adenocarcinoma of the nasal cavity and paranasal sinuses were studied at UCLA over 20 years. All pathologic specimens were reviewed and those tumors that were histologically distinct from the more common salivary gland-derived tumors were included in the study. Three classifications were identified: well, moderately, and poorly differentiated adenocarcinoma. A distinct variant of sinonasal adenocarcinoma was the intestinal type. The clinical behavior of the latter resembled the well or moderately differentiated types, with behavior mainly predicted by the extent of the disease. These groups have prognostic significance, with the poorly differentiated group having the most virulent course. Nine of 13 tumors occurred in the ethmoid sinuses and all were aggressive locally. Only one case had distant metastases (nodal neck disease in a terminal case). Of five long-term survivors (median five-year follow-up), all had extensive surgical resections and three had full-course radiotherapy. The single most important factor in the treatment of these lesions is adequacy of surgical margins. Four of six patients with confirmed negative margins were cured despite extensive tumors. Three survivors had the cribriform plate taken and one required a combined intracranial/extracranial approach for tumor resection. There were no survivors in four patients treated with primary irradiation.

Photoelectric measurement of laryngeal paralyses correlated with videostroboscopy.

Photoglottography and electroglottography are relatively noninvasive techniques that provide detailed information about vocal fold vibration. However, few significant clinical applications have been made by correlating photoelectric waveforms to specific pathologic changes in laryngeal vibration. Videostroboscopy has recently been used to document vibratory patterns of laryngeal paralyses in a canine model of phonation. A study of PGG and EGG waveforms correlated with videostroboscopy in an in-vivo canine model of phonation with simulated unilateral recurrent or superior laryngeal nerve paralysis is presented. The shift quotient--a new glottographic parameter which identifies flaccid laryngeal paralyses--is presented.

Unilateral proptosis.

Unilateral proptosis is not uncommonly encountered by the otolaryngologist. A thorough understanding of the potential causes and the appropriate diagnostic evaluation will ensure a successful outcome.

The treatment of T3 glottic carcinoma with vertical partial laryngectomy.

Total laryngectomy has traditionally been considered the optimal treatment for patients with advanced glottic carcinoma who present with a fixed true vocal cord. However, using whole-organ sectioning techniques, it has been demonstrated that vertical partial laryngectomy is a sound oncologic procedure for selected fixed vocal cord lesions. During the period 1969 to 1984, 27 patients who presented at UCLA with T3 glottic carcinoma were treated using vertical partial laryngectomy. Follow-up for these patients averaged 4.0 years. The absolute two-year disease-free survival rate for this group was 85% (23 of 27 patients), and the local cancer recurrence rate during a two-year postoperative interval was 11% (three of 27 patients). These encouraging results support the continued use of partial laryngeal surgery for a subgroup of patients with T3 glottic cancer. Successful patient selection requires a careful analysis of disease extent based on data obtained from physical examination, magnetic resonance imaging or computed tomographic scanning, and direct laryngoscopy.

Melanoma of the nasal and paranasal sinus mucosa.

Melanoma involving the nasal and paranasal sinus mucosa is a rare disease that is difficult to treat and generally has a poor prognosis. Data on 17 patients treated at the UCLA Medical Center during the period 1970 to 1985 were reviewed in a retrospective manner. The five-year disease-free survival was 25% (3/12). Surgery, with or without radiation therapy, is the mode of treatment to control disease in most patients. Treatment failures, which include both local recurrence and distant metastases, may occur many years after initial therapy. We found a correlation between the thickness of tumor and the clinical outcome.