Hemicricoidectomy for voice rehabilitation following hemilaryngectomy with ipsilateral arytenoid removal.

The purpose of this article is to describe an approach to reconstruction of the larynx after vertical partial laryngectomy with removal of the ipsilateral arytenoid cartilage. This method addresses the problem of postoperative posterior glottal incompetence (aphonia with or without aspiration). The technique involves resection of the ipsilateral half of the cricoid cartilage, use of an inferiorly based strap muscle flap for vocal fold reconstruction, and placement of a customized stent. This technique may be used at the time of the primary cancer extirpation or as a secondary rehabilitative procedure. Generally, patients who have undergone this procedure have had minimal postoperative breathiness with good phonatory and airway function. We recommend this reconstructive technique for patients with large posterior defects following hemilaryngectomy.     

杓状软骨复位术治疗环杓关节脱位的临床分析

摘要：目的探讨环杓关节脱位的临床特性以及杓状软骨复位的治疗技术。方法回顾性分析2014年7月~2017年4月收治的17例环杓关节脱位患者进行杓状软骨复位治疗的临床资料,分析其病因、治疗手法、诊治时机及疗效。结果17例患者中2例1次复位成功,3例2次复位成功,其余12例均行3~4次复位治疗,其中6例关节活动未能完全恢复正常,但所有患者发音质量GRBAS评分均有明显改善。结论杓状软骨复位是治疗环杓关节脱位的有效治疗方法,病程越短相对复位效果越满意,但较长病程患者进行复位治疗仍有助于嗓音改善。

     

A method of combined horizontal resection of the larynx with removal of the arytenoid cartilage and its primary reconstruction]

A modified technique of combined laryngeal resection in vestibular cancer T3-T4 (involvement of the arytenoid cartilage) was tried in 8 patients. To compensate for laryngeal separative function after the radical surgery, the reconstruction of the posterior laryngeal wall was performed by mobilization of the upper corniculum of the thyroid cartilage. In satisfactory functional results the method did not contribute to the disease aggravation.     

Glottic cancer with extension to the arytenoid

Hemilaryngectomy with removal of a greater part or all of the arytenoid was done in 79 patients with good functional results with an overall cure rate and salvage rate of 94 percent. The survival rate for the primary modality of therapy was 90 percent.     

支撑喉内镜下环杓关节复位——附8例报告

目的 探讨经支撑喉内镜下治疗环杓关节半脱位的手术疗效、复位技巧,并讨论与其相关的病因和诊断.方法 8例因气管内插管致环杓关节半脱位患者,在支撑喉镜下鼻内镜辅助环杓关节复位术,随访0.5～2年,平均15个月.结果 7例1次手术复位成功,声音恢复正常;1例手术失败,声带活动改善不明显.术中术后均未发生其他并发症.结论 支撑喉镜内镜下环杓关节复位手术方法简单、安全、成功率高.     

Supraglottic carcinoma with extension to the arytenoid.

The analysis of supraglottic subtotal laryngectomy with removal of the entire arytenoid cartilage is presented in 59 patients. The survival rate in the patients was 75 percent for primary surgery.     

Spontaneous dislocation of the arytenoid cartilage

Dislocation of the arytenoid cartilage occurs following medical instrumentation involving the laryngeal cavity or laryngeal injury from outside the larynx. We reported a case of spontaneously posterior dislocation of the arytenoid cartilage. A 53 year-old man suffering from suddenly recurring aphonia and its improvement many over 3 months without laryngeal injury or inducement eventually ceased to improve. Laryngoscopic findings showed that the left vocal fold was tensely prolonged and the vocal process of the arytenoid cartilage on the left side was dislocated posterolaterally. X-ray videofluorography of the larynx on repetitive phonation of /he/ showed abnormally high and diagonal displacement of the vocal fold and the upper structure of the arytenoid cartilage on the left side. Palpating the cricoarytenoid joint on the left side showed abnormal swelling with tenderness. Electomyography of the intrinsic laryngeal muscle on the left side showed normal action potential. From these findings, we diagnosed his voice disorder as spontaneously posterior dislocation of the arytenoid cartilage. We manually reduced it by pulling up a balloon inserted from the piriform sinus of the affected side to the esophagus.     

Unilateral degloving injuries of the arytenoid cartilage

Arytenoid cartilage dislocations and avulsions are often seen as a part of severe laryngeal injuries due to blunt trauma. An uncommon type of injury is the unilateral degloving of an arytenoid cartilage following laterally directed trauma to the thyroid cartilage. It may occur without additional cartilaginous or mucosal damage. The arytenoid cartilage is squeezed between the thyroid ala and the cervical spine and stripped of its mucosal covering. It may retain mobility and be exposed only on adduction, or it may lose mobility due to dislocation and be tipped into the laryngeal lumen. Prognosis for vocal cord mobility and voice production is good for the degloving injury alone, but poor if the arytenoid cartilage is also dislocated. Cases are discussed to illustrate the mechanism, treatment, and outcome of such injuries.     

再造含披裂软骨的喉发声管在次全喉切除术中的应用(附7例报告)

目的:于次全喉切除术后重建喉发声功能.方法:7例喉癌病变范围T3N0M0行次全喉切除术,术中保留健侧的披裂软骨及杓间区粘膜,用披裂软骨与下咽粘膜制作具有括约功能的喉发声管.结果:患者术后发声功能良好,无误吸.随访2～5年,死亡2例,健在5例.结论:该术式可保存部分喉功能.     

Motor innervation of the canine arytenoid muscle]

Dual motor innervation by the bilateral recurrent laryngeal nerves (RLNs) has been demonstrated in the human arytenoid muscle (AR). Whether AR of the dog receives dual motor innervation remains to be cleared yet, although the canine larynx is frequently used in experimental studies. To answer this question, the author observed the muscular structure in detail and anastomotic nerve branch between the bilateral RLNs, and then carried out glycogen depletion experiments on AR of dog compared with typical unpaired ARs of monkey and of guinea pig. 1) Muscular structure AR of the dog consisted of three parts of muscle bundles: the transverse arytenoid muscle (TVA), ventricular muscle (VT) and anonymous small bundle provisionally named the smaller interarytenoid muscle (IAm). While TVA and VT were paired type, IAm was unpaired type and lay horizontally on the dorsal aspect of the sesamoid cartilage around the midline. So the canine AR displayed a trigastric muscle as a whole. 2) Anastomotic nerve branch By the vital staining with methylene blue, the arytenoid branch of canine RLN ramified in three directions: anteriorly to the bellies of TVA and VT, medially to the anastomotic branch and superomedially to IAm. By the silver impregnation method of Barker and Ip, the bilateral IAm ramuli were found to form collateral anastomoses and terminate disorderly on the individual fibers. 3) Glycogen depletion experiments When an electrical stimulation was applied to the unilateral RLN in the monkey and the guinea pig, about one half of AR fibers were unstained with PAS staining and, in turn, these unstained fibers were known to be innervated by the ipsilateral RLN. While these unpaired ARs receive dual motor innervation as a whole muscle, every individual fiber is innervated by the unilateral RLN. In the canine VT and TVA, almost 90% of fibers were depleted of glycogen on the belly of the stimulated side, while the reverse was on the nonstimulated side. This finding suggests that most fibers of canine VT and TVA are ipsilaterally and the remaining fibers are contralaterally innervated. About one half of fibers of IAm were unstained and the others were stained. This pattern was similar to that observed in the monkey and the guinea pig. Therefore, IAm receives dual motor innervation from both RLNs as a whole muscle.     

Ultrastructure of the vocal process of the arytenoid cartilage

An investigation of the ultrastructure of the vocal process of the arytenoid cartilage was performed on excised human adult larynges. The results are summarized as follows. 1) The size of the chondrocytes is small and their density is high at the tip of the vocal process. 2) The size of the chondrocytes increases and their density decreases toward the posterior portion of the vocal process. 3) At the tip of the vocal process, the collagenous fibers are thin and run in various directions. 4) The thickness of the collagenous fibers increases and they form thick bundles toward the posterior portion of the vocal process. 5) The elastic fibers are dense at the tip of the vocal process, and their number decreases toward the posterior portion of the vocal process. 6) The elastic fibers, which are slender, branched, and anastomosed to form a loose network, run among the collagenous fibers at the tip of the vocal process. 7) Elaunin fibers are the predominant elastic fibers at the tip of the vocal process. 8) Even in the hyaline cartilage portion of the vocal process, elastic fibers are found. 9) The vocal processes are firm in forming the framework of the glottis and are more pliable toward the tip. 10) The 3-dimensional structure of the gradual changes in stiffness between the vocal fold and the vocal process makes a functional contribution to the roles of the vocal folds and the vocal processes.     

Replacement of the arytenoid following vertical hemilaryngectomy.

A considerable body of literature advocates and defines treatment of vocal cord cancer with posterior extension by hemilaryngectomy. The present study was carried out to determine the feasibility of using a newly devised pedicle flap, composed of thyroid cartilage and inferior constrictor muscle, to replace the ablated arytenoid cartilage. Animal investigation revealed satisfactory viability of the pedicle flap in canines, and in humans, five patients with T2 glottic carcinoma demonstrated excellent postoperative deglutition and return of voice. The results of the study indicate that this surgical technique merits consideration for its use in minimizing protracted glottic incompetence following hemilaryngectomy. The thyroid cartilage-inferior constrictor muscle pedicle flap may also prove useful as partial cricoid replacement in selected cases of subglottic extension and in cricoid reconstruction following trauma.     

Supracricoid partial laryngectomy with CHP and CHEP for local recurrence following irradiation of vocal cord carcinoma

The cases of CHEP and CHP following supracricoid partial laryngectomy in the treatment of the local recurrence after irradiation of vocal cord carcinoma were reported. In both cases the wound was healed by first intention. The cannula was not removed in the patient after CHEP, although the wide of neolarynx and spirometry parameters showed such a possibility. That patient with a huge obesity developed progressive coronary disease after surgery. Sometimes he needs to open the plugged cannula. The spirometry parameters confirmed that the patient after CHP could be decannulationed in the third month after surgery. Because of his psychological resistance that was delayed to the sixth month. The deglutition is efficient in both patients. The oesophagus tube was removed in sixth and seventh weeks after the operation. The patient after CHEP was carried out the objective evaluation of deglutition in the videoroentgenokinematography which showed a small aspiration. In spite of that he didn't develop any pulmonary complication during 2.5 years after surgery. A few cases and short time of observation doesn't allowed us to draw the objective conclusions to the presented question.     

T1 squamous cell carcinoma of the arytenoid.

Twenty-two cases of early squamous cell carcinoma of the arytenoid cartilage staged as T1 according to the 1983 American Joint Committee for Cancer Staging Classification system were reviewed. Eighteen percent of the patients showed no symptoms. In the remaining 82%, the main presenting symptom was pain in the form of sore throat, odynophagia, or otalgia. Radiotherapy and partial laryngeal surgery were the options retained for the treatment of the larynx. A "watch and wait" policy or preventive treatment of the ipsilateral jugulocarotid lymph nodes were the treatment options retained for the neck. Significant differences were noted in terms of local and nodal recurrence between the two programs. Results indicate that partial laryngeal surgery with total arytenoidectomy and preventive treatment of the neck appear to be advisable for this particular type of primary lesion.     

Carcinoid (neuroendocrine) tumor of the arytenoid.

We reviewed three cases of neuroendocrine carcinoid tumors of the larynx, located on the arytenoid cartilage, treated between 1962 and 1985 at the Laennec Hospital, University of Paris (France) V. Staging was performed according to the 1979 American Joint Committee for Cancer Staging Classification. None of the lesions were associated with symptoms of the carcinoid syndrome. Local and nodal recurrences, distant metastasis, and survival were analyzed. Among the 112 reported carcinoid (neuroendocrine) tumors of the larynx, arytenoid location represented 28.6% (32/112) of the cases. A review of these 32 patients was performed to analyze the problems associated with that location.