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Front of Neck Access
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
The anatomical landmarks for the procedure are thyroid cartilage with laryngeal prominence of the thyroid cartilage/the thyroid notch (Adam's apple). Below the thyroid prominence, the cricoid cartilage ring is easily palpable. Between both cartilages, lies the cricothyroid membrane (CTM), which is the landmark for emergency access. It can be identified by palpation, though there is huge variability in the palpatory method and requires frequent practice. The cricothyroid membrane can also be identified ultrasonographically (Figure 12.1). However, ultrasonographic guidance cannot be advised in an emergency setting.
Fatal Pressure Over Neck by Strangulation
Published in Sudhir K. Gupta, Forensic Pathology of Asphyxial Deaths, 2022
Scientific literature regarding the absolute frequency of these fractures shows great variability. Usually these fractured segments show an inward displacement in most cases. However, both inward and outward fractures are seen in combination in many cases. The side where the thrust from pulp of thumb is applied shows fractures more frequently. Considering the variability of these fractures, opining on the cause or manner of death and the handedness of the assailant solely based on the fracture pattern should not be attempted. These fractures are generally ante-mortem and show hemorrhagic infiltration in the surrounding soft tissues. Vitality of these fractures should be confirmed grossly and microscopically, if in doubt. The autopsy surgeon should be aware of the fact that postmortem fractures may show some artefact hemorrhage around the fracture site. A fracture site has to be dissected for minute details, including position of tear in the periosteum and subperiosteal hemorrhage. Laminar fractures of thyroid cartilage and fractures of cricoid cartilage are rare in manual strangulation, but if present, they indicate severe antero-posterior compression of the neck structures between the external force and the anterior aspect of bodies of cervical vertebrae. Since ossification of hyoid bone and laryngeal cartilages starts late, these structures are elastic in early decades of life and fractures are less frequent in the younger age group. Hyoid bone fractures are more commonly seen in victims of throttling and hanging above 40 years of age due to the calcification of bone.
Anatomy overview
Published in Stephanie Martin, Working with Voice Disorders, 2020
The thyroid cartilage is the largest cartilage, which forms most of the anterior and lateral walls of the larynx. Shaped like a shield, it is essentially composed of two quadrilateral plates of hyaline cartilage, the thyroid laminae, which are fused at the midline anteriorly at a peak known as the laryngeal prominence or Adam’s apple. The degree at which the plates meet varies between men and women, approximately 120 degrees in women and children but 90 degrees post puberty in men, which explains the very pronounced outline of this cartilage in the male. The thyroid laminae protect the vocal folds, which extend across the laryngeal space from the inside of the thyroid cartilage to the arytenoid cartilages. The posterior border of each plate is prolonged upwards and downwards as cornu – the superior and inferior horns, respectively. Muscular attachments (see below) link the superior horn with the hyoid bone and the inferior horn with the cricoid cartilage.
Application of digital modeling and three-dimensional printing of titanium mesh for reconstruction of thyroid cartilage in partial laryngectomy
Published in Acta Oto-Laryngologica, 2022
Hao Tian, Shuichao Gao, Jianjun Yu, Xiao Zhou, Xing Chen, Liang Zuo, Xu Cai, Bo Song, Kun Yu
We found that the deformation of thyroid cartilage and weakened support of the larynx after undergoing open surgery would inevitably lead to a series of adverse consequences. Therefore, the key to fabricate the larynx is to reconstruct the thyroid cartilage. Strength, plasticity, promising compression resistance, and biocompatibility are the most important characteristics for materials used to reconstruct the thyroid cartilage. Therefore, titanium has been widely used in orthopedics, plastic surgery, oral and maxillofacial surgery [15,16]. A previous study suggested that a titanium mesh could also be used to reconstruct the thyroid cartilage [17]. However, the size, shape, and angle of the thyroid cartilage are different in different patients. It is highly complicated to ensure that a personalized titanium mesh is set accurately. We, in the present research, conducted excision of thyroid cartilage along the osteotomy line simulated computationally before surgery and under the guidance of a guide plate made by 3D printing, and then, fixed the titanium mesh with titanium nails in pin holes confirmed computationally before surgery, so as to reconstruct the thyroid cartilage accurately.
Chondrolaryngoplasty in transgender women: Prospective analysis of voice and aesthetic satisfaction
Published in International Journal of Transgender Health, 2021
Mateus Morais Aires, Daniela de Vasconcelos, Bruno Teixeira de Moraes
All patients were submitted to chondrolaryngoplasty under general anesthesia and orotracheal intubation, by the same team of otolaryngologists (the authors), using the same surgical technique. A median transverse anterior cervical incision of 3 cm was made in a previous cervical cutaneous fold over the larynx and an upper and lower subplatysmal flap was created. After dieresis of the muscle planes, the thyroid cartilage was exposed. The external and internal perichondrium from the region of the laryngeal prominence to be resectioned were detached. The height of the thyroid cartilage was then measured and the midpoint of the distance between the thyroid notch and the lower margin of the thyroid cartilage (projection of the anterior commissure of the vocal folds) was identified, an area that must be preserved to avoid disinsertion of the vocal folds. After delimiting a safe margin of 3 mm above the midpoint of the height of the thyroid cartilage, the laryngeal prominence and the upper portion of the cartilage were resectioned in a “V” shape, also including the upper border along the thyroid notch. For this resection, a scalpel blade number 15 and/or a 2 mm surgical cutting burr was used (if calcified cartilage, especially in patients aged over 40). After resection, a crucial step in this procedure was to smooth the edges and flatten the residual laryngeal prominence with a 4 mm diamond burr. The external and perichondrium were repositioned over the excised cartilage area, without placing suture. Finally, the planes were then closed, followed by intradermal suture, without placing a drain (Figures 2 and 3).
Application of a thyroid cartilage window technique for transoral resection of early glottic cancer involving the anterior commissure
Published in Acta Oto-Laryngologica, 2021
Qingxiang Zhang, Xiaohong Chen, Shuangba He, Lifeng Li
A thorough understanding of the biological behavior of the anterior commissure carcinoma, and the way of tumor spreads within the local region is critical to determine the individualized treatment strategy [4]. The anterior commissure is lack of perichondrium on the inner surface of the thyroid cartilage, which has been thought that this anatomical feature facilitates the spread of carcinoma arising from the anterior commissure into the thyroid cartilage and beyond the laryngeal framework [3,12]. Moreover, the tight fibrous tissue of the anterior commissure tendon which was defined as Broyle’s ligament, should be considered as a solid barrier to occlude the spread of cancer [13]. However, this protective barrier is not an absolute occlusion for tumor spreading and the cartilage invasion occasionally occurs in the clinical setting [5]. The thyroid angle at the attachment of the anterior commissure tendon is the most important invasion site in glottic tumors [14]. The other risky sites are the upper margin of the thyroid ala, which is often invaded through the pre-epiglottic space; the lower margin of the thyroid ala, which is at risk when the tumor has a subglottic extension [15]. Therefore, the management of thyroid cartilage is inevitable in order to radically cure the lesion.