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Head and Neck
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The laryngeal cavity is shaped like an hourglass, composed of the laryngeal vestibule above the vestibular folds (false vocal folds), and the infraglottic cavity inferior to the vocal folds (which include the vocal ligaments) (Plate 3.44). The vestibular fold and the vocal fold (true vocal fold) are separated by a space called the laryngeal ventricle, which is quite variable in extent. The glottis includes the vocal folds and the space between them, which is designated the rima glottidis.
Surgical outcome of different surgical modalities for adult recurrent respiratory papillomatosis
Published in Acta Oto-Laryngologica, 2023
The operating room records of the patient were reviewed, including age, gender, smoking status, symptoms at the first procedure, length of follow-up time, localization of the papillomas, histological findings(evidence of dysplasia), number of surgical procedures, the type and date of the surgical treatment(Microdebrider, or CO2 laser or KTP laser), recurrence rate. The treatment intervals were calculated based on these dates. Anatomical Derkay severity scores were captured for all patients preoperatively. The survival curves were plotted based on the recurrence events and follow-up time, through which we could compare the recurrence trends of patients who used three different surgical modalities. According to Derkay et al. [9] the aerodigestive tract is divided into 25 subsites with each given a score if the disease is present (0 is no lesion, 1 is a surface lesion, 2 is raised lesion, and 3 is a bulk lesion). The surgical technique of the three modalities was standardized. All procedures were performed under general anesthesia in the operating theater, laryngeal cavity was exposed directly under laryngoscopy. We recorded the distribution location and range of the lesion, a specimen is sent for pathological biopsy before removing the tumor using microdebrider or CO2 laser or KTP laser, the laryngeal cavity became unobstructed and no obvious residual mass was used as the termination criterion for surgery.
Tracheotomy as a predictor of remission and demise for juvenile-onset recurrent respiratory papillomatosis
Published in Acta Oto-Laryngologica, 2022
Zijie Niu, Yang Xiao, Lijing Ma, Xiaoli Qu, Yuge Wang, Sihan Zhou, Jun Wang
The disease often appears in the vocal cords, false vocal cords, epiglottic larynx, and subglottis. The main clinical manifestation is hoarseness. If papillomas obstruct the airway seriously, it could cause dyspnea and even threaten children’s life. The laryngeal cavity of young children is narrow, which increases the probability of dyspnea. Tracheotomy is a classic treatment to keep the airway adequate in emergency and enhance the safety during the operation [2]. Nonetheless, tracheotomy disrupts airway mucosa, which will increase the squamo-columnar junction, provide a site suitable for seeding of virus particles and papillomas, and even promote lower airway dissemination of papillomas [3,4]. The pros and cons of tracheotomy seem to be recognized, and it has become an accepted view that tracheotomy should be avoided in patients with JORRP and every effort should be made to remove the tracheal cannula when it is unavoidable [5]. Although it has been reported that tracheotomy may be associated with poor prognosis [6], there is relatively limited information assessing the exact impact of tracheotomy on prognosis for JORRP.
A novel puncture needle designed for endoscopic keel placement to treat anterior glottic webs
Published in Acta Oto-Laryngologica, 2021
Jian Chen, Haitao Wu, Peijie He
The tailored puncture needle was designed and modified from a maxillary sinus puncture needle in our hospital, which consisted of a needle, an inner core, and a guide (Figures 1(A) and 2(A)). Specifically, we punctured the anterior neck soft tissues into the endolarynx using the needle at first. The inner core was then withdrawn and replaced by the guide (Figure 1(B,C)). A hook was designed on the edge of the guide and could pull the suture out of the laryngeal cavity (Figure 1(C,D)). The surgical procedures were as follows. The laryngeal cavity was exposed under general anesthesia using the suspension laryngoscopy and surgical microscope. The web was incised using a CO2 laser firstly (Figure 2(B)). A reinforced 0.3 mm-thick silicon keel with a 3–0 polypropylene suture passing along was prepared. The puncture needle with its inner core was then inserted into the subglottic cavity (Figure 2(C)), after which the inner core was removed and the catheter sheath was left in place (Figure 2(D)). The guide was introduced into the laryngeal cavity through the catheter sheath subsequently (Figure 2(E)). The distal suture was caught by the hook of the guide and sent outside through the catheter sheath (Figure 2(F)). The proximal suture above the superior thyroid incisurae was sent out by the same approach (Figure 2(G)). The two sutures were tied and secured externally on the anterior neck over a silicone tube after the keel had been placed correctly (Figure 2(H)).