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Vocal Cords (vocal + cord)
Terms modified by Vocal Cords Selected AbstractsAwake intubation using the LMA-CTrachÔ in patients with difficult airways,ANAESTHESIA, Issue 4 2009A. M. López Summary We studied 21 patients with known difficult airways who underwent awake tracheal intubation using the LMA CTrachÔ. Patients were given midazolam, atropine, a continuous infusion of remifentanil and topical lidocaine applied to the oropharyx. We limited the number of insertion attempts to three and the time to adjust the view to 5 min. In case of failure, we performed awake fibreoptic tracheal intubation. We found insertion of the device was successful and well tolerated in all patients. Vocal cords could be seen immediately in nine patients and following corrective manoeuvres in 10 patients. Tracheal intubation was successful in 20 patients: 19 cases under direct vision and in one blindly. In one patient with undiagnosed lingual tonsil hyperplasia, tracheal intubation was impossible using the device. No patient had an unpleasant recall of the procedure. We conclude that the LMA CTrach is easy to use, well tolerated and suitable for awake orotracheal intubation in patients with known difficult airways. [source] Laryngeal Amyloidosis in 10 Patients,THE LARYNGOSCOPE, Issue 10 2004Herbert H. Dedo MD Abstract Objectives: Review the location, symptoms, treatment, and outcomes in 10 consecutive laryngeal amyloid (LA) patients. Study Design: Pre and retrospective evaluation after treatment. Methods: Analysis of visual and phonatory pathology and detailed description of surgery. Results: Amyloid on the undersurface of both true vocal cords (TVCs) was found in two cases, uni- or bilaterally submucosally in the false vocal cords (FVCs) in eight cases, extending down into the lateral TVC in four cases, or on the undersurface of the TVCs as well in one case. The chief complaint was hoarseness and not shortness of breath. The amyloid was resected with a CO2 laser by way of microdirect laryngoscopy (MDL) on one side at a time to try to prevent anterior commissure scarring. Removal of most of the FVC improved the voice, but removal of the whole FVC to the inner thyroid perichondrium was found to be necessary to avoid recurrence from supraglottic deposits. Removal of at least 2 mm of the upper edge of a 3 to 4 mm thick submucosal deposit to the thyroarytenoid (TA) muscle along with the overlying mucosa on at least one side was necessary to improve hoarseness when amyloid was present on the undersurface of both TVCs. Partial regrowth occurred in a few months to years after partial removal. Seven patients had had one to seven prior removals. Any hard amyloid in the lateral TVC (floor of ventricle) as an inferior extension from FVC amyloid needed to be at least partially removed to avoid hoarseness from a convex vocal cord. The voice improved postoperatively in all patients. Follow-up after the first operation was 6 months to 16 years, with an average of 6.5 years. Four FVC patients required re-excision on the same side after the first operation, but none has required a third removal as of yet. [source] Three-dimensional reconstruction of immunolabeled neuromuscular junctions in the human thyroarytenoid muscleTHE LARYNGOSCOPE, Issue 11 2003Andrew D. Sheppert MD Abstract Objectives/Hypothesis: The objective was to reveal the location of the neuromuscular junctions in a three-dimensional reconstruction of the human thyroarytenoid muscle within the true vocal fold. Study Design: Immunohistochemical analysis of serially sectioned human true vocal folds was performed, followed by reconstruction in three dimensions using computer imaging software. Methods: Six fresh human larynges from autopsy were harvested, fixed in formalin, and embedded in paraffin. Eight vocal cords were studied from these six larynges. Five-micron serial sections were collected throughout the entire vocal cord in an axial plane at 500-,m intervals. Immunohistochemical analysis was performed with anti-synaptophysin antibody. A computer-controlled imaging and reconstruction system was used to create a three-dimensional reconstruction from the serial sections and to represent the location of the clustered band of neuromuscular junctions within each true vocal fold. The vocal cord was divided into equal thirds from anterior to posterior for statistical analysis. Results: The most neuromuscular junctions (74%) we're located in the middle third, and the least (7%) were found in the anterior third. The difference in anterior-to-posterior distribution was statistically significant in all eight specimens by ,2 analysis (P < .001). Conclusion: The distribution of neuromuscular junctions is not random within the human thyroarytenoid muscle. Because neuromuscular junctions are most highly concentrated in a band within the mid belly of the muscle, botulinum toxin type A (Botox) injection in patients with spasmodic dysphonia should be targeted to this region. [source] Fascia Augmentation of the Vocal Fold: Graft Yield in the Canine and Preliminary Clinical Experience,THE LARYNGOSCOPE, Issue 5 2001Sanford G. Duke MD Abstract Introduction Glottal insufficiency resulting from vocal fold bowing, hypomobility, or scar is frequently treated by injection augmentation. Injection augmentation with fat, collagen, gel foam, polytef, and recently, fascia lata has been previously reported. Variable graft yield and poor host-tissue tolerance have motivated the continued search for an ideal graft substance. Study Design A prospective trial of autologous fascia augmentation of the vocal cord in the human and in an animal model. Methods Autologous fascia injection augmentation (AFIA) was evaluated in 8 canines and 40 patients at our institution between 1998 and 2000. The animal study compared graft yield from AFIA with autologous fat yield. The outcome measure was graft yield calculated from histological examination of larynges 12 weeks after injection augmentation. Clinical trial outcome measures included symptom surveys, acoustical voice analyses, and subjective voice assessments. Mean follow-up was 9 months. Results In the canine larynx, the mean graft yield for AFIA was 33% (range, 5%,84%) compared with autologous lipoinjection (47%; range, 7%,96%;P = .57). Subjective improvement in vocal quality was reported by 95% of patients (38 of 40) after AFIA. Preoperative and postoperative voice analysis data were obtained from 26 patients. Subjective voice rating demonstrated a significant improvement after AFIA (P <.0001). Acoustical parameters of jitter, shimmer, noise-to-harmonic ratio, phonatory range, and degree unvoiced improved significantly (P <.05) in all patients after fascia augmentation. Conclusions Based on the animal study, we concluded that graft yields are excellent but variable for AFIA. The result is similar in variability and overall yield to autologous lipoinjection. Subjective and objective analyses of voice outcomes after AFIA are universally improved. Fascia appears to be an excellent alternative to lipoinjection in properly selected cases of glottic insufficiency. [source] NERVE STIMULATION IN THYROID SURGERY: IS IT REALLY USEFUL?ANZ JOURNAL OF SURGERY, Issue 5 2007Thorbjorn J Loch-Wilkinson Background: Monitoring of the recurrent laryngeal nerve (RLN) has been claimed in some studies to reduce rates of nerve injury during thyroid surgery compared with anatomical dissection and visual identification of the RLN alone, whereas other studies have found no benefit. Continuous monitoring with endotracheal electrodes is expensive whereas discontinuous monitoring by laryngeal palpation with nerve stimulation is a simple and inexpensive technique. This study aimed to assess the value of nerve stimulation with laryngeal palpation as a means of identifying and assessing the function of the RLN and external branch of the superior laryngeal nerve (EBSLN) during thyroid surgery. Methods: This was a prospective case series comprising 50 consecutive patients undergoing total thyroidectomy providing 100 RLN and 100 EBSLN for examination. All patients underwent preoperative and postoperative vocal cord and voice assessment by an independent ear, nose and throat surgeon, laryngeal examination at extubation and all were asked to complete a postoperative dysphagia score sheet. Dysphagia scores in the study group were compared with a control group (n = 20) undergoing total thyroidectomy without nerve stimulation. Results: One hundred of 100 (100%) RLN were located without the use of the nerve stimulator. A negative twitch response occurred in seven (7%) RLN stimulated (two bilateral, three unilateral). Postoperative testing, however, only showed one true unilateral RLN palsy postoperatively (1%), which recovered in 7 weeks giving six false-positive and one true-positive results. Eighty-six of 100 (86%) EBSLN were located without the nerve stimulator. Thirteen of 100 (13%) EBSLN could not be identified and 1 of 100 (1%) was located with the use of the nerve stimulator. Fourteen per cent of EBSLN showed no cricothyroid twitch on EBSLN stimulation. Postoperative vocal function in these patients was normal. There were no instances of equipment malfunction. Dysphagia scores did not differ significantly between the study and control groups. Conclusion: Use of a nerve stimulator did not aid in anatomical dissection of the RLN and was useful in identifying only one EBSLN. Discontinuous nerve monitoring by stimulation during total thyroidectomy confers no obvious benefit for the experienced surgeon in nerve identification, functional testing or injury prevention. [source] Short-term voice quality results following percutaneous medialisation of the paralysed vocal cord under local anaesthesia using calcium hydroxyapatite gel: how we do itCLINICAL OTOLARYNGOLOGY, Issue 4 2008Y. Karagama First page of article [source] Stylet Bend Angles and Tracheal Tube Passage Using a Straight-to-cuff ShapeACADEMIC EMERGENCY MEDICINE, Issue 12 2006Richard M. Levitan MD Abstract Objectives Malleable stylets improve maneuverability and control during tube insertion, but after passage through the vocal cords the stiffened tracheal tube may impinge on the tracheal rings, preventing passage. The goal of this study was to assess insertion difficulty with styletted tubes of different bend angles. Methods Tube passage was assessed with four different bend angles (25°, 35°, 45°, and 60°) using straight-to-cuff,shaped tubes. In two separate airway procedure classes, 16 operators in each class (32 total) placed randomly ordered styletted tubes of the different angles into eight cadavers (16 total). Operators subjectively graded the ease of tube passage as no resistance, some resistance, or impossible to advance. Results No resistance was reported in 69.1% (177/256) at 25°, in 63.7% (163/256) at 35°, in 39.4% (101/256) at 45°, and in 8.9% (22/256) at 60°. Tube passage was impossible in 2.3% of insertions (6/256) at 25°, in 3.5% (9/256) at 35°, in 11.3% (29/256) at 45°, and in 53.9% (138/256) at 60°. The odds ratios of impossible tube passage for 35°, 45°, and 60° vs. 25° were 1.52 (95% confidence interval [CI] = 0.55 to 4.16), 5.32 (95% CI = 2.22 to 12.71), and 48.72 (95% CI = 21.35 to 111.03), respectively. Conclusions Bend angles beyond 35° with straight-to-cuff styletted tracheal tubes increase the risk of difficult and impossible tube passage into the trachea. The authors did not compare different stylet stopping points, stylets of different stiffness, or tracheal tubes with different tip designs, all variables that can affect tube passage. [source] CO2 laser surgery in the treatment of glottic cancerHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 7 2005Giovanni Motta MD Abstract Background. The aim of the study was to assess the effectiveness of CO2 laser endoscopic surgery in the treatment of glottic carcinoma limited to the true vocal cords or involving the adjacent regions. Methods. Seven hundred nineteen patients (687 men and 32 women; mean age, 60.4 years; range, 33,86 years) with glottic carcinoma (432 T1N0M0, 236 T2N0M0, 51 T3N0M0) underwent CO2 laser surgery (mean follow-up, 5 years; range, 2,17 years). Statistical comparison was carried out with Wilcoxon test, considering p < .05 the minimum significance value. Results. Overall actuarial survival, adjusted actuarial survival, and percentage of patients with no evidence of disease at 5 years were 85%, 97%, and 85%, respectively, in patients with T1a disease; 84%, 96%, and 83% in those with T1b disease; 77%, 86%, and 61% in those with T2 unilateral tumors; 77%, 88%, and 55% in those with T2 bilateral tumors; and 64%, 72%, and 60% in those with T3 disease. The statistical analysis showed the following: significant differences in the comparison of T1 versus T2 and T2 versus T3 tumors (p < .01), with the exception of no evidence of disease in the comparison of T2 versus T3 (p > .05); and no significant differences in the comparison of unilateral and bilateral tumors (p > .05). Actuarial local control, actuarial nodal control, and actuarial distant metastasis control at 5 years were 85%, 98%, and 99%, respectively, in patients with T1 disease; and 66%, 82%, and 91% in patients with T2 disease; and 66%, 83%, and 95% in patients with T3 disease. The laryngeal preservation rate was 97.3% in the T1 group, 82.5% in the T2 group, and 80.5% in T3 group. Conclusions. CO2 laser endoscopic surgery is effective in the treatment of glottic carcinoma not infiltrating the cartilaginous skeleton; the results achieved are competitive with those of open conservative operations, if we take into account the possibilities afforded by salvage surgery and the rate of laryngeal preservation achieved in the study patients. © 2004 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Larynx morphology and sound production in three species of TestudinidaeJOURNAL OF MORPHOLOGY, Issue 2 2004Roberto Sacchi Abstract Although the ability to vocalize is widespread among tortoises, the mechanisms of sound production in chelonians remain undescribed. In this study, we analyze the morphology and histology of the larynx of three species of Testudinidae (Testudo hermanni, T. graeca, and T. marginata) in order to ascertain the presence of vibrating acoustic structure, and based on our findings we propose a general model for phonation in tortoises. The structure of the larynx of the three tortoises analyzed is simple: three cartilages (the cricoid and two arytenoids) form the skeleton of the larynx, while two pairs of muscles (the dilators and constrictors) control the widening and closing of the glottis. The larynx is supported in the oral cavity by the hyoid cartilage, which in tortoises assumes the same functions of the thyroid cartilage of mammals. Two bands of elastic fibers are inserted in the lateral walls of the larynx just upstream of the glottis, and can be stretched away from the hyoid by the movements of the arytenoids. Their position and structure suggest that these bands are capable of vibrating during exhalation, and therefore may be considered vocal cords. The cricoid of T. marginata and T. graeca hold two diverticula, not previously reported, which might function as a low-frequency resonating chamber, improving the harmonic structure of tortoise calls. The structure of the larynx is compared with that of other vertebrates and the relationships between morphology and phonation are discussed. This is the first detailed description of anatomical structures possibly devoted to vocalization in chelonians. J. Morphol. 261:175,183, 2004. © 2004 Wiley-Liss, Inc. [source] Review article: the gastrointestinal complications of myositisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2010E. C. EBERT Aliment Pharmacol Ther,31, 359,365 Summary Background, The inflammatory myopathies are a group of acquired diseases characterized by a proximal myopathy caused by an inflammatory infiltrate of the skeletal muscle. The three major diseases are dermatomyositis, polymyositis and inclusion body myositis. Aims, To review the gastrointestinal manifestations of myositis. Methods, Over 110 articles in the English literature were reviewed. Results, Dysphagia to solids and liquids occurs in patients with myositis. The pharyngo-oesophageal muscle tone is lost and therefore patients develop nasal speech, hoarseness, nasal regurgitation and aspiration pneumonia. There is tongue weakness, flaccid vocal cords, poor palatal motion and pooling of secretions in the distended hypopharynx. Proximal oesophageal skeletal muscle dysfunction is demonstrated by manometry with low amplitude/absent pharyngeal contractions and decreased upper oesophageal sphincter pressures. Patients exhibit markedly elevated creatine kinase and lactate dehydrogenase levels consistent with muscle injury. Myositis can be associated with inflammatory bowel disease, coeliac disease and interferon treatment of hepatitis C. Corticosteroids and other immunosuppressive drugs comprise the mainstay of treatment. Inclusion body myositis responds poorly to these agents and therefore a myotomy is usually indicated. Conclusion, Myositis mainly involves the skeletal muscles in the upper oesophagus with dysphagia, along with proximal muscle weakness. [source] Study to assess the laryngeal and pharyngeal spread of topical local anesthetic administered orally during general anesthesia in childrenPEDIATRIC ANESTHESIA, Issue 8 2010FRCA, RICHARD BERINGER BMedSci Summary Background:, Topical local anesthesia of the airway of anaesthetized children has many potential benefits. In our institution, lignocaine is topically instilled blindly into the back of the mouth with the expectation that it will come into contact with the larynx. The volume and method of application varies between clinicians. There is no published evidence to support the plausibility of this technique. Aim:, To determine whether this technique of instillation results in the local anesthetic coming into contact with key laryngeal structures and whether this is influenced by volume or additional physical maneuvers. Methods/Materials:, Sixty-three healthy anaesthetized children between 6 months and 16 years old had lignocaine stained with methylene blue poured into the back of their mouths. The volume and subsequent physical maneuver were determined by randomization. A blinded observer assessed staining of the vocal cords, epiglottis, vallecula and piriform fossae by direct laryngoscopy. Airway complications were recorded. Results:, Fifty-three of the 63 children had complete staining of all four areas. Four children had one area unstained, and all others had at least partial staining of all four structures. Nine children coughed following induction of anesthesia. Coughing was more likely in children with incomplete staining (P = 0.03), low volume lignocaine (P = 0.003) and following a head lift (P = 0.02). Conclusion:, Oral administration of lignocaine without use of a laryngoscope frequently results in widespread coverage of key laryngeal structures and may reduce the risk of coughing. [source] Diagnosis of vocal cord dysfunction in asthma with high resolution dynamic volume computerized tomography of the larynxRESPIROLOGY, Issue 8 2009Peter W. HOLMES ABSTRACT Background and objective: Vocal cord dysfunction (VCD) often masquerades as asthma and reports have suggested that up to 30% of patients with asthma may have coexistent VCD. Diagnosis of VCD is difficult, in part because it involves laryngoscopy which has practical constraints, and there is need for rapid non-invasive diagnosis. High speed 320-slice volume CT demonstrates laryngeal function during inspiration and expiration and may be useful in suspected VCD. Methods: Endoscopy and high resolution 320-slice dynamic volume CT were used to examine and compare laryngeal anatomy and movement in a case of subglottic stenosis and in a patient with confirmed VCD. Nine asthmatics with ongoing symptoms and suspected VCD also underwent 320-slice dynamic volume CT. Tracheal and laryngeal anatomy and movement were evaluated and luminal areas were measured. Reductions in vocal cord luminal area >40%, lasting for >70% duration of inspiration/expiration, were judged to be consistent with VCD. Results: Studies of subglottic tracheal stenosis validated anatomical similarities between endoscopy and CT images. Endoscopy and 320-slice volume CT also provided comparable dynamic images in a patient with confirmed VCD. A further nine patients with a history of severe asthma and suspected VCD were studied using CT. Four patients had evidence of VCD and the median reduction of luminal area during expiration was 78.2% (range 48.2,92.5%) compared with 10.4% (range 4.7,30%) in the five patients without VCD. Patients with VCD had no distinguishing clinical characteristics. Conclusions: Dynamic volume CT provided explicit images of the larynx, distinguished function of the vocal cords during the respiratory cycle and could identify putative VCD. The technique will potentially provide a simple, non-invasive investigation to identify laryngeal dysfunction, permitting improved management of asthma. [source] Paradoxical vocal fold motion dysfunction in asthma patientsRESPIROLOGY, Issue 5 2009Kursat YELKEN ABSTRACT Background and objective: Paradoxical vocal fold motion dysfunction (PVFMD) is a disorder of the larynx characterized by adduction of the vocal cords during the respiratory cycle leading to symptoms of extrathoracic airway obstruction. PVFMD mimics asthma and patients with PVFMD (PVFMD+) are often diagnosed incorrectly as refractory asthma and receive unnecessary treatment. This study determined the prevalence of PVFMD in asthma patients and describedthe relationship between asthma and PVFMD. Methods: A descriptive study of 94 asthmatic patients and 40 control subjects, all of whom were examined via laryngoscopy and had pulmonary function tests were performed. Results: The prevalence of PVFMD was 19% (n = 18) in the asthmatic group and 5% (n = 2) in the control group (P < 0.001). No relationship was found between presence of PVFMD, asthma attacks and asthma severity (P > 0.05). Laryngopharyngeal reflux and allergy were significantly more prevalent in the PVFMD+ group than in the group without PVFMD (PVFMD,) (P < 0.05). The most common symptoms in the PVFMD+ patients were difficulty in breathing (88%), inspiratory stridor (66%) and a choking sensation (50%) and the most common symptoms in PVFMD, asthmatic patients were cough (63%), dyspnoea (55%) and wheezing (51%). Conclusions: Asthma seems to facilitate the formation of the paradoxical dysfunction in the larynx as the prevalence of PVFMD in asthma patients is significantly higher than in patients with out asthma. [source] Laryngeal Amyloidosis in 10 Patients,THE LARYNGOSCOPE, Issue 10 2004Herbert H. Dedo MD Abstract Objectives: Review the location, symptoms, treatment, and outcomes in 10 consecutive laryngeal amyloid (LA) patients. Study Design: Pre and retrospective evaluation after treatment. Methods: Analysis of visual and phonatory pathology and detailed description of surgery. Results: Amyloid on the undersurface of both true vocal cords (TVCs) was found in two cases, uni- or bilaterally submucosally in the false vocal cords (FVCs) in eight cases, extending down into the lateral TVC in four cases, or on the undersurface of the TVCs as well in one case. The chief complaint was hoarseness and not shortness of breath. The amyloid was resected with a CO2 laser by way of microdirect laryngoscopy (MDL) on one side at a time to try to prevent anterior commissure scarring. Removal of most of the FVC improved the voice, but removal of the whole FVC to the inner thyroid perichondrium was found to be necessary to avoid recurrence from supraglottic deposits. Removal of at least 2 mm of the upper edge of a 3 to 4 mm thick submucosal deposit to the thyroarytenoid (TA) muscle along with the overlying mucosa on at least one side was necessary to improve hoarseness when amyloid was present on the undersurface of both TVCs. Partial regrowth occurred in a few months to years after partial removal. Seven patients had had one to seven prior removals. Any hard amyloid in the lateral TVC (floor of ventricle) as an inferior extension from FVC amyloid needed to be at least partially removed to avoid hoarseness from a convex vocal cord. The voice improved postoperatively in all patients. Follow-up after the first operation was 6 months to 16 years, with an average of 6.5 years. Four FVC patients required re-excision on the same side after the first operation, but none has required a third removal as of yet. [source] Three-dimensional reconstruction of immunolabeled neuromuscular junctions in the human thyroarytenoid muscleTHE LARYNGOSCOPE, Issue 11 2003Andrew D. Sheppert MD Abstract Objectives/Hypothesis: The objective was to reveal the location of the neuromuscular junctions in a three-dimensional reconstruction of the human thyroarytenoid muscle within the true vocal fold. Study Design: Immunohistochemical analysis of serially sectioned human true vocal folds was performed, followed by reconstruction in three dimensions using computer imaging software. Methods: Six fresh human larynges from autopsy were harvested, fixed in formalin, and embedded in paraffin. Eight vocal cords were studied from these six larynges. Five-micron serial sections were collected throughout the entire vocal cord in an axial plane at 500-,m intervals. Immunohistochemical analysis was performed with anti-synaptophysin antibody. A computer-controlled imaging and reconstruction system was used to create a three-dimensional reconstruction from the serial sections and to represent the location of the clustered band of neuromuscular junctions within each true vocal fold. The vocal cord was divided into equal thirds from anterior to posterior for statistical analysis. Results: The most neuromuscular junctions (74%) we're located in the middle third, and the least (7%) were found in the anterior third. The difference in anterior-to-posterior distribution was statistically significant in all eight specimens by ,2 analysis (P < .001). Conclusion: The distribution of neuromuscular junctions is not random within the human thyroarytenoid muscle. Because neuromuscular junctions are most highly concentrated in a band within the mid belly of the muscle, botulinum toxin type A (Botox) injection in patients with spasmodic dysphonia should be targeted to this region. [source] Suspension Laryngoscopy for Endotracheal Stenting,THE LARYNGOSCOPE, Issue 1 2003Hans Edmund Eckel MD Abstract Objectives/Hypothesis Airway stents have recently been used to establish and maintain patent airways in patients with malignant central airway obstruction, but insertion modalities remain controversial to date. The study seeks to determine the role of suspension laryngoscopy in interdisciplinary airway stenting. Study Design Retrospective, single-institution analysis of a case series treated by a multidisciplinary airway team. Methods Ninety-three consecutive patients with malignant obstruction of the trachea and/or tracheobronchial bifurcation underwent endotracheal stenting through a suspension laryngoscopy approach for the relief of impending respiratory distress. Feasibility, mortality, survival, and complications were analyzed as main outcome measures. Results Stenting through a suspension laryngoscopy approach was feasible 91 of 93 patients (97.8%). Fifteen patients needed repeated stenting, and in all, 121 stents were implanted during the observation period. This approach allowed for the repeated insertion of rigid bronchoscopes of graded sizes to establish an airway and for precise stent positioning. Optical instruments and stent introducer systems could easily be used while adequate ventilation was continuously maintained. Silicone stents of maximal size were inserted without injury of the vocal cords during intubation. Median survival for all patients was 8 months. No intraoperative airway complications were observed, and no patient died secondary to stenting. Conclusions Suspension laryngoscopy and jet ventilation provide an ideal setting for the precise placement of tracheal and bifurcation airway stents. Laryngologists should actively participate in interdisciplinary airway stenting programs. [source] CASE REPORT: The unrecognised difficult extubation: a call for vigilanceANAESTHESIA, Issue 9 2010J. Antoine Summary Tracheal extubation remains a critical and often overlooked period of difficult airway management. A 66-year-old man, scheduled for C5,C7 anterior fusion, with an easy view of the vocal cords, presented with a sublaryngeal obstruction that required a reduced tracheal tube size. Despite correct tube placement, intra-operative ventilation remained difficult. At the end of surgery a pulsatile tracheal compression was fibreopticially observed above the carina. After discussion with the attending otolaryngologist, neuromuscular blockade was antagonised and the patient was able to maintain normal minute volumes while spontaneously ventilating. With the otolaryngologist present, and with the patient conscious, the trachea was successfully extubated over an airway exchange catheter. A subsequent CT scan revealed an impingement of the trachea by the innominate artery and a mildly ectatic ascending and descending aorta that, in conjunction with tracheomalacia and neuromuscular blockade, could explain the observed signs and symptoms. [source] Manikin study of fibreoptic-guided intubation through the classic laryngeal mask airway with the Aintree intubating catheter vs the intubating laryngeal mask airway in the simulated difficult airway,ANAESTHESIA, Issue 8 2010A. M. B. Heard Summary In this randomised crossover manikin study of simulated difficult intubation, 26 anaesthetists attempted to intubate the trachea using two fibreoptic-guided techniques: via a classic laryngeal mask airway using an Aintree intubating catheter and via an intubating laryngeal mask airway using its tracheal tube. Successful intubation was the primary endpoint, which was completed successfully in all 26 cases using the former technique, and in 5 of 26 cases using the latter (p < 0.0001). The former technique also proved quicker to reach the vocal cords with the fibrescope (median (IQR [range])) time 18 (14,20 [8,44]) s vs 110 (70,114 [30,118]) s, respectively; p = 0.008); and to first ventilation (93 (74,109 [52,135]) s vs 135 (79,158 [70,160]) s, respectively; p = 0.0038)]. We conclude that in simulated difficult intubation, fibreoptic intubation appears easier to achieve using a classic laryngeal mask airway and an Aintree intubating catheter than through an intubating laryngeal mask airway. [source] Distortion of the vocal cords by a laryngeal mask airwayANAESTHESIA, Issue 8 2010O. O'Connell No abstract is available for this article. [source] Tracheal intubation with restricted access: a randomised comparison of the Pentax-Airway Scope and Macintosh laryngoscope in a manikinANAESTHESIA, Issue 10 2009T. Asai Summary Ten anaesthetists assessed the ease of tracheal intubation (time to see the glottis, to intubate the trachea and to ventilate), using the Pentax Airway Scope and Macintosh laryngoscope in a manikin, in three simulated circumstances of restricted laryngoscopy: (1) the patient lying supine on the ground; (2) the patient lying supine on the ground with the head close to a wall; (3) the patient confined to a car driver's seat. For the Pentax Airway Scope, intubation was successful (within 2 min) in all three circumstances. For the Macintosh laryngoscope, intubation was successful in all cases in circumstance (1), eight in circumstance (2), and five in circumstance (3). In circumstances (2) and (3), the Pentax Airway Scope needed significantly shorter time to see the vocal cords (median [95% confidence interval] for difference: 4.5 [0.5,9.5] s in circumstance (2), and 12.5 [7.0,32.5] s in circumstance (3)), shorter time to intubate (median [95% confidence interval] for difference: 21.0 [5.5,38.5] s in circumstance (2), and 40.5 [17.5,64.0] s in circumstance (3)), and shorter time to ventilate the lungs (median [95% confidence interval] for difference: 18. 3 [4.5,36.0] s in circumstance (2), and 47.5 [16.0,84.5] s in circumstance (3)). These results indicate that, in situations where access to the patient's head is restricted, the Pentax Airway Scope is more effective than the Macintosh laryngoscope. [source] Evaluation of the LMA SupremeÔ in 100 non-paralysed patients,ANAESTHESIA, Issue 5 2009T. M. Cook Summary We studied the LMA SupremeÔ in 100 elective, anaesthetised, healthy patients assessing: ease of use, airway quality, anatomical and functional positioning, airway leak and complications. Insertion was successful on first, second or third attempt in 90, nine and one patient respectively. Thirty manipulations were required in 22 patients to achieve a clear airway. Median [interquartile (range)] insertion time was 18 [10,25 (5,120)] s. During ventilation, an expired tidal volume of 7 ml.kg,1 was achieved in all patients. Median [interquartile (range)] airway leak pressure was 24 [20,28 (13,40)] cmH2O. On fibreoptic examination via the device, vocal cords were visible in 83 patients (85%). During maintenance, five patients (5%) required 13 airway manipulations. There was one episode of minor regurgitation, without aspiration. Other complications and patient side-effects were mild and few. The LMA Supreme is easily and rapidly inserted, providing a reliable airway and good airway seal. Further studies are indicated to assess safety and performance compared to other supraglottic airway devices. [source] Awake fibrecapnic intubation: a novel technique for intubation in head and neck cancer patients with a difficult airway,ANAESTHESIA, Issue 5 2006J. M. Huitink Summary Awake fibreoptic intubation is the gold standard for difficult airway management but failures are reported in the literature in up to 13% of cases. In case of failure, a tracheotomy is often indicated. We describe a novel technique for intubation in head and neck cancer patients with a difficult airway that we call awake fibrecapnic intubation. The aim of this study was to investigate the feasibility of this technique. We studied prospectively 15 consecutive intubations in head and neck cancer patients before diagnostic or therapeutic surgical procedures. After topical anaesthesia, a fibrescope was introduced into the pharynx. Spontaneous respiration was maintained in all patients. Through the suction channel of the fibrescope a special suction catheter was advanced into the airway for carbon dioxide measurements. When four capnograms were obtained, the fibrescope was railroaded over the catheter and after identification of tracheal rings, a tracheal tube was placed. Tracheal intubation was successful in all patients without bleeding or complications, with a median (range) time to intubation of 3 (2,15) min. Identification of the vocal cords and glottis was difficult in four patients due to extensive anatomical abnormalities or poor visibility; even in these patients, a capnogram was obtained within 4 s. [source] Tracheal intubating conditions after induction with sevoflurane 8% in childrenANAESTHESIA, Issue 8 2000A comparison with two intravenous techniques We studied tracheal intubating conditions in 120 healthy children, aged 3,12 years, in a blinded, randomised clinical trial. Children were randomly allocated to one of three groups: group PS, propofol 3 mg.kg,1 and succinylcholine 1 mg.kg,1 (n = 40); group PA, propofol 3 mg.kg,1 and alfentanil 10 µg.kg,1 (n = 40); group SF, sevoflurane 8% in 60% nitrous oxide in oxygen for 3 min (n = 40). Tracheal intubating conditions were graded according to ease of laryngoscopy, position of vocal cords, coughing, jaw relaxation and movement of limbs. Overall intubating conditions were acceptable in 39 of 40 children in the propofol/succinylcholine group, 21 of 40 children in the propofol/alfentanil group and 35 of 40 children in the sevoflurane group. Children receiving propofol and succinylcholine or sevoflurane had better intubating conditions overall than those given propofol and alfentanil (p < 0.01). In conclusion, anaesthetic induction and tracheal intubation using sevoflurane 8% for 3 min is a satisfactory alternative to propofol with succinylcholine in children. [source] Laryngeal epithelial thickness: a comparison between optical coherence tomography and histologyCLINICAL OTOLARYNGOLOGY, Issue 5 2009M.L. Kaiser Objectives:, Optical coherence tomography, an imaging modality using near-infrared light, produces cross-sectional tissue images with a lateral pixel resolution of 10 ,m. However, normative data is first needed on epithelial thickness for lesion characterisation, and, to date, little exists. The purpose of our study is to measure normal laryngeal epithelial thickness by in vivo optical coherence tomography, and compare these values to those obtained from fixed ex-vivo laryngectomy specimens. Design and Setting:, Prospective at a single medical center in California, United States. Participants: A total of 116 patients undergoing operative endoscopy. Main outcome measures:, Optical coherence tomography images of clinically normal laryngeal subsites were selected. Calibrated measurements of epithelial thickness at various laryngeal subsites were recorded. Measurements of epithelial thickness from corresponding areas were obtained using optical micrometry on histologically normal regions of 15 total laryngectomy specimens. Descriptive statistics were performed. Results:, Mean epithelial optical coherence tomography thicknesses were: true vocal cords (81 ,m), false vocal cords (78 ,m), subglottis (61 ,m), aryepiglottic folds (111 ,m), laryngeal epiglottis (116 ,m) and lingual epiglottis (170 ,m). Epithelial thicknesses in fixed tissues were: true vocal cords (103 ,m), false vocal cords (79 ,m), aryepiglottic folds (205 ,m) subglottis (61 ,m), laryngeal epiglottis (38 ,m) and lingual epiglottis (130 ,m). Conclusions:, Optical coherence tomography does not have the artifacts associated with conventional histologic techniques. The inevitable development of office-based optical coherence tomography devices will increase the precision of laryngeal measurements and contribute to the clinical application of this technology in diagnosing laryngeal disease. [source] Paediatric airway stenosis: laryngotracheal reconstruction or cricotracheal resection?CLINICAL OTOLARYNGOLOGY, Issue 5 2000B.E.J. Hartley Modern surgical management of paediatric laryngotracheal stenosis includes a wide variety of surgical procedures. These can broadly be divided into two groups. First, laryngotracheal reconstruction (LTR) procedures in which the cricoid cartilage is split and the framework is expanded with various combinations of cartilage grafts and stents; and second, cricotracheal resection (CTR) where a segmental excision of the stenotic segment is done and an end-to-end anastomosis is performed. In this article we review the literature and our experience and discuss the relative indications for CTR and LTR in children. High decannulation rates have been reported for CTR; however, it remains a more extensive procedure than LTR involving extensive tracheal mobilization. If the tracheostomy site is included in the resection then a significant length of trachea is excised. Alternatively, LTR with cartilage grafting can precisely correct a specific stenosis with minimum morbidity and high decannulation rates for grade 2 and selected grade 3 stenosis. For the more severe stenosis treatment with LTR has been less successful. Retrospective data from this institution suggests that the children with grade 4 stenosis treated with LTR are more likely to require a subsequent open procedure to achieve decannulation than those treated with CTR. LTR is a less extensive procedure and is preferred for grade 2, selected grade 3 stenosis. CTR is the preferred option for grade 4 and severe grade 3 stenosis with a clear margin between the stenosis and the vocal cords. [source] Visco-elastic changes of vocal fold mucosa related to high and low relative air humidityCLINICAL OTOLARYNGOLOGY, Issue 4 2000R.J.B. Hemler Objective. To study the effects of high and low relative air humidity (RH) on the visco-elastic properties of the vocal fold cover. Materials and methods. The vocal fold mucosa of sheep larynges was microdissected. The mucosal specimens were attached on one side to an oscillator and on the other side to a force transducer. A sinusoidal oscillation (stress) was applied to the specimen and the transduced force (strain) was recorded in two different conditions of a continuous passing airflow: either dry air (RH = 0%) or humid air (RH = 100%). Of the recorded stress and strain curves the gain and phase-shift between the curves were computed and from these parameters stiffness and viscosity were calculated. In both air conditions the deep surface of the specimen was in contact with a saline bath. Results. Stiffness and viscosity both increased significantly more in dry air than in humid air. This increased stiffness and viscosity returned to baseline values after rehydration. Conclusion. We conclude that these findings indicate that changes in the RH of the airflow passing over the vocal cords influences the visco-elastic properties of the vocal cord cover. [source] | |||||||||||||||||||||||||