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Anatomy of the Larynx and Tracheobronchial Tree
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The arytenoid cartilages are irregularly shaped, broadly conforming to a three-sided pyramid with a forward projection, the vocal process, to which the dorsal end of the vocal folds are attached a lateral projection, the muscular process, to which the posterior cricoarytenoid and lateral cricothyroid muscles attach (see Figure 58.5). Between these two processes, the anterolateral surface is irregular and divided into two fossae by a crest running from the apex. The upper triangular fossa gives attachment to the vestibular ligament and the lower to the vocalis and lateral cricoarytenoid muscles. The apex is curved backwards and medially and is flattened for articulation with the corniculate cartilage, which sits atop it. The medial surfaces have no muscular attachments, are covered with mucous membrane and form the lateral boundary of the posterior glottis. The posterior surface of each cartilage is covered by the transverse arytenoid muscle, which inserts onto each cartilage across the midline.
Animal diseases
Published in Jim Cox, Iain Mungall, Rural Healthcare, 2017
Much attention is paid to the presence of an inspiratory noise (‘roaring’) while the horse is exercising. This is due to dysfunction of the left recurrent laryngeal nerve and leads to paralysis of the left arytenoid cartilage. This hereditary dysfunction is common in hunter types and surgery to replace the left crico-arytenoid muscle with a prosthetic ligament (‘tie back’) is usually successful, although it may cause dysphagia.
Paediatric laryngeal disorders
Published in Declan Costello, Guri Sandhu, Practical Laryngology, 2015
Richard J. D. Hewitt, Benjamin E. J. Hartley, Thushitha Kunanandam
Laryngomalacia is the most common congenital laryngeal pathology. The term laryngomalacia was first used by Jackson and Jackson in 19422 to describe the inward collapse of the larynx during inspiration. The underlying aetiology of laryngomalacia is not fully understood and is thought to relate to anatomical, histological and neurological factors. The epiglottis is tall, tubular and omega-shaped, the aryepiglottic folds are shortened, tight and bulky and the arytenoid mucosa is bulky with a tendency to prolapse (Figure 16.1). Immaturity of the laryngeal and supraglottic cartilages tends towards an inherent softness, which also contributes to laryngeal collapse during inspiration. Neurological immaturity is thought to result in arytenoid muscle incoordination and reduced laryngeal tone.
Volumetric measures of the paralyzed vocal fold using computerized tomography; its clinical implication
Published in Logopedics Phoniatrics Vocology, 2021
Abdul-Latif Hamdan, Elie Khalifee, Natally Al Arab, Karl Asmar, Roula Hourani
Computerized tomography (CT) is commonly used in the investigation of patients with vocal fold immobility [1]. A diagnostic yield in the range of 2.9% to 6% has been reported by many authors alluding to its judicious usage as a first diagnostic step despite its sound economic cost-effectiveness [2–4]. Computerized tomographic imaging has also been used in the pre-operative and post-operative assessment of patients undergoing laryngeal framework surgery [5,6]. Hara et al. have reported the added value of three dimensional laryngeal CT scan with multiplanar reconstruction in five patients with unilateral vocal fold paralysis undergoing thyroplasty type I. The digital imaging has facilitated the placement of the thyroid cartilage window and has helped in the success of the surgery [5]. Iwahashi et al. concurred the usefulness of CT in identifying the causes of poor outcome following thyroplasty type I. The study was conducted on 22 patients and the most common causes were inappropriate size of implant, poor positioning and the usage of expanded polytetrafluoroethylene [6]. Other added value of this imaging technique in patients with unilateral vocal fold paralysis include configuration of the glottal gap. Different types of glottal configuration in relation to thickness of the vocal folds on 3 D coronal images have been reported by Yumoto et al. [7]. Computerized tomography has also been used as a prognostic factor in patients with recurrent laryngeal nerve injury. In a study by Mengsteab et al. the authors reported that imaging of ventricular dilation symmetry, an indirect estimate of thyro-arytenoid muscle atrophy, relates significantly to improvement in vocal fold mobility [8]. Hiramatsu et al. have reported the usefulness of three-dimensional computerized tomography in evaluating complex laryngeal structures and in particular movement of the arytenoid cartilages and vocal folds before surgical intervention [9].