China
Africa
Explore chapters and articles related to this topic
Remobilization of the Ankylotic Crico-Arytenoid Joint
Published in Waldemar L. Olszewski, CRC Handbook of Microsurgery, 2019
Until now there appears to have been no special surgical procedure leading to remobilization of the joint. Only Miller and Spector15 tried to perform an experimental arthroplasty of the crico-arytenoid joint in the canine larynx, but failed. They used a piece of molded thick Silastic®, sculptured to an oval-shaped implant of adequate size and inserted it into the joint space. Unfortunately they obtained a complete fixation of the traumatized joints. Histologic investigations revealed considerable fibrosis. They came to the conclusion that “a therapeutic trial of Silastic® implantation cannot be advocated since complete functional loss and the morphologic changes of pericapsular and intraarticular fibrosis occur, even with Silastic® placement.”
Management of Hypopharyngeal Cancer
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Prathamesh S. Pai, Deepa Nair, Sarbani Ghosh Laskar, Kumar Prabhash
The postcricoid area lies behind the larynx and is located below the level of the arytenoid cartilages and extends to the inferior border of the cricoid cartilage. It continues below into the cricopharynx which lies at the upper end of oesophagus. Tumours in this region often involve the cricoarytenoid joints causing vocal cord fixity and/or aspiration. Being a junctional region, obstruction to the passage of food occurs early on and tumours often extend into the oesophagus inferiorly, mandating evaluation of the lower extent of tumour spread.
Stridor
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Laryngeal examination with the endotracheal tube removed provides a superior view and, by using a probe to move the arytenoids independently, the mobility of the cricoarytenoid joints can be assessed. If an interarytenoid scar is present, the arytenoids will not move independently. A posterior laryngeal cleft is excluded by passing the probe between the arytenoids, comparing the lower limit of the interarytenoid groove with that of the posterior commissure. Finally, great care should be taken to pass through the vocal cords if a rigid endoscope is used to inspect the subglottis.
Update on the diagnosis and management of pediatric laryngotracheal stenosis
Published in Expert Review of Respiratory Medicine, 2022
Matthew M Smith, Lauren S Buck
The most important tools in the evaluation of laryngotracheal stenosis are microlaryngoscopy and bronchoscopy (MLB) and flexible bronchoscopy in the operating room under general anesthesia. Similar to the awake flexible fiberoptic evaluation, flexible bronchoscopy allows the physician to assess for the presence of dynamic airway collapse. Following flexible bronchoscopy, a rigid MLB is performed to assess for possible stenoses at the level of the supraglottis, glottis, subglottis, trachea, and mainstem bronchi. At the level of the supraglottis, it is important to look for the presence of laryngomalacia, prolapsed and obstructive arytenoids (dynamic or static), or a prolapsed epiglottic petiole. At the glottis, it is important to palpate the cricoarytenoid joints and posterior glottis with an endoscopic forceps to determine the presence of fixation and scar. This allows the physician to make the diagnosis of posterior glottis stenosis if the cricoarytenoid joints are fixed. If the cricoarytenoid joint(s) and vocal fold(s) are mobile on palpation but immobile on awake endoscopy, then the patient has vocal fold paralysis. It is important to examine the anterior commissure for the presence of a laryngeal web and to palpate posteriorly for the presence of a laryngeal cleft. At the subglottis, the narrowest portion of the pediatric airway, it is important to look for narrowing and determine the size.
Cricoid abscess presenting as progressive dyspnea
Published in Baylor University Medical Center Proceedings, 2022
Emily Newstrom, Timothy Fan, Lauren Welby, Randall Holdgraf
Postoperatively, he was transferred to the SICU for airway monitoring. On postoperative day 2, a modified barium swallow study obtained as part of a standard posttracheotomy evaluation revealed a soft tissue prominence between the trachea and cervical esophagus with associated mass effect. Computed tomography (CT) of the neck revealed glottic narrowing and a 2.7 × 1.0 × 2.2 cm posterior laryngeal fluid collection at the level of the true vocal folds with possible fragmentation of the cricoid cartilage (Figure 1). The patient was taken back to the operating room for repeat direct laryngoscopy. An area of posterior cricoid/glottic fullness was identified and aspirated using an 18-gauge needle via the cricothyroid membrane under direct visualization from above (Figure 2a). The abscess cavity was then incised using a CO2 laser (4 W, line pattern generator) fixed to a micromanipulator, followed by blunt/sharp dissection yielding additional purulence (Figure 2b). Cricoarytenoid joints were injected with 0.5 mL of triamcinolone 40 mg/mL.
Exploring the role of botulinum toxin in critical care
Published in Expert Review of Neurotherapeutics, 2021
Muhammad Ubaid Hafeez, Michael Moore, Komal Hafeez, Joseph Jankovic
ILO (previously VC dysfunction) is characterized by reversible paradoxical VC movement toward adducted position during inspiration. It can manifest as stridor, dyspnea, or even airway compromise requiring intubation [52]. In ICU, it can occur as a complication of endotracheal intubation or recurrent laryngeal nerve (RLN) injury sustained during thyroid or cervical-spine surgery [53]. The underlying etiology can be from local compression or edema around RLN, or direct injury to the nerve or crico-arytenoid joint [51,53]. Central neurogenic causes such as brainstem stroke or multiple sclerosis have also been reported [54]. The successful use of BoNT to improve dysphonia, stridor and potential airway compromise has been described in such cases [50,52]. Unilateral or bilateral OnabotulinumtoxinA injections (0.5–5 U) to thyroaretenoid muscles, using indirect laryngoscopy, operative channel of flexible fiberoptic laryngoscopy or transcutaneous electromyography-guided approach are reported in literature [45,50,52].