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At least 235 records · Page 13Linked to original sources
PubMed1989

Carcinoma in situ and T-1 squamous cell carcinoma of the glottis: the Mississippi Baptist Medical Center experience.

This report is a retrospective analysis of 62 patients treated for early glottic carcinoma during the six-year period of January 1982 through December 1987. The authors report that the cancer has been controlled in 100% of patients. For invasive stage 1 tumors the radiation cure rate is 42 of 45 patients or 93%, and voice quality after treatment was usually normal. Surgically treated tumors are usually confined to one vocal cord. Primary surgery with laser or cord stripping ultimately led to tumor control and voice preservation in all eleven patients treated although two required salvage with radiotherapy and mild but acceptable hoarseness was a usual sequel.

Adult↗
PubMed1986

[Dilatation of the glottis in bilateral vocal cord paralysis. Review of various surgical procedures and a report of personal experience using a functional lateral fixation surgical technic].

For the treatment of bilateral vocal cord paralysis, the author's technique consists of preservation of the posterior crico-arytenoid ligament as a hinge as well as turning and tilting of the arytenoid cartilage laterally. It is held in this position with three permanent retention sutures, two of them armed with heavy knots. These knots will reinforce the lateral rotation of the arytenoid cartilage. These sutures run in the submucosa horizontally along the anterior surface of the arytenoid cartilage and are fixed through burr holes on the posterior margin of the thyroid cartilage. This method developed from the original "King Procedure" leaves the laryngeal mucosa maximally undisturbed so that in 80% of the cases preliminary tracheotomy became unnecessary. During a period of 27 years, 110 patients were operated; 27 of them had a previously created tracheostoma. Out of the remaining 83, 16 had tracheotomy directly before surgery. Of the remaining 67 patients, four required postoperative tracheotomy for a few days only, while 63 did not require this additional treatment. The average hospital stay was 11 days. In the majority of cases the operation could be performed under local anaesthesia which helped to establish proper voice function.

Adolescent↗
PubMed1987

[Initial experiences with collagen as a soft tissue implant in glottis insufficiencies].

Zyderm Collagen Implant has been used successfully for several years as a soft tissue implant to fill tissue irregularities and other skin defects. In 1984 Ford reported the first experiences of the use of injectable collagen in glottic insufficiency. We are carrying out clinical studies on the efficacy and safety of Zyderm II implants in the treatment of glottic insufficiency. Therapeutic success depends on careful adherence to correct indications and contra-indications, careful explanation to the patient, voice therapy, correct injection technique and adequate patient supervision.

Collagen↗
PubMed1985

[Laryngomicrosurgical treatment of synechias in the area of the glottis].

Initial clinical experiences of a new method for the treatment of glottic synechiae developed in animal experiments are reported. Adhesions were divided by a microsurgical technique without opening the larynx. A plastic keel was fixed by stitching it from inside out between the separated cicatrial membranes. The keel was removed after 5 to 6 weeks. The adhesions were successfully relieved.

Cicatrix↗
PubMed1997

[Laser surgery of laryngeal cancer (T1 glottis). New therapeutic alternative].

The standard treatment for patients with T1a vocal cord cancer has been radiotherapy. From October 1995 selected patients have undergone laser surgery and up until March 1997 we had treated 16 patients. The results so far have been satisfactory with only one recurrence. Some of the patients have experienced a slight to moderate degree of hoarseness postoperatively. Laser treatment is more cost-effective than radiotherapy and in larger series the incidence of residual disease and recurrence seems to be equal to or even better than when following radiotherapy. The procedure demands considerable skill with laser surgery of the larynx and should be limited to 1-2 surgeons at two hospitals in this country where the annual incidence of T1a glottic cancers is approximately 30.

Carcinoma↗
PubMed1993

[Functional structure of the human vocal cord].

19 laryngeal specimens (11 male, 8 female) were cut in horizontal serial sections, parallel to the free edge of the vocal cord. After staining, the structures of the glottis were measured microscopically and statistical analysis of the sex-related differences performed. The results show that the glottis can be divided not only into the well-known anterior and posterior glottis, but into five histological and functional distinctive portions. Within the anterior glottis, these parts are the freely vibrating midportion of the vocal cord, which is connected to the stiff laryngeal frame via an anterior and posterior transition zone. Within the posterior glottis there are two parts: the vocal process of the arytenoid cartilage (which is, according to Hirano, also the cartilage portion of the vocal cord) and the lateral wall of the posterior glottis. Statistical analysis of the data revealed significant sex differences, not only in the absolute measures but also on comparing the relative dimensions in respect of the total glottic length. The posterior glottis accounts for 37% of the total glottic length in men and for 42% in women and is therefore longer than generally accepted. We found statistically significant sex-related differences in the length of the posterior glottis, which is absolutely longer in men but relatively longer in women. The reason for this is the difference in the length of the midportion of the vocal cord. This zone is twice as long in men (8.5 mm) than in women (4.6 mm) and accounts for 37% of the total glottic length in men compared to 29% in women. As this portion is the most vibrating part of the vocal cord this could be an explanation for the unsolved phenomenon why the fundamental frequencies are 1:2 between men and women while all dimensions of the larynx are 1.5:1. The vibrating midportion of the vocal cord is connected to the stiff laryngeal framework by highly differentiated transition zones: the nodulus elasticus anterior and posterior. The lamina propria of the midportion shows a three-layered structure, orientated parallel to the free edge of the vocal cord. In the transition zones the deep layer of the lamina propria consists of interwoven bundles of collagen and elastic fibres, thus having the function of a "cushion ball" (Hirano). A functionally important portion is the vocal process of the arytenoid cartilage. The complex movements of the vocal process during abduction and adduction of the vocal cords produce a severe mechanical strain on the mucous membrane covering this part of the glottis.

Aged↗
PubMed1994

Laryngeal behavior in unilateral superior laryngeal nerve paralysis.

Laryngeal behavior in unilateral superior laryngeal nerve (SLN) paralysis was investigated in animal models and clinical cases. The occurrence of an oblique glottis caused by rotation of the posterior glottis to the paralytic side was the main focus of this study. The animal model study employed live dogs. When the SLN on one side was sectioned, spontaneous phonation did not cause a significantly oblique glottis. When the unaffected SLN was electrically stimulated during spontaneous phonation, an oblique glottis occurred. When the SLN was unilaterally stimulated during spontaneous phonation with both SLNs sectioned, a markedly oblique glottis occurred. In the clinical study, larynges of 17 patients with SLN paralysis were examined during a test task in which a low-pitched phonation was followed by a high-pitched phonation. The purpose of this task was to activate the unaffected cricothyroid muscle during the test phonation. Five patients could not perform the test task. The glottis obviously rotated in 9 patients, whereas no significant rotation of the glottis occurred in 3. One of the latter 3 had an incomplete paralysis, and the other 2 had marked scarring around the laryngeal framework. We conclude that a unilateral SLN paralysis causes a rotation of the posterior glottis to the paralytic side when the unaffected cricothyroid muscle is markedly activated. The test consisting of low-pitched phonation followed by high-pitched phonation is a relatively simple and accurate diagnostic procedure for unilateral SLN paralysis.

Adult↗
PubMed1991

[Curability of laryngeal cancer in relation to the starting point].

In 1960-1987, 2387, 2352 cases of larynx cancer were treated and observed. In 1484 (63.1%) cases the cancer of the epiglottis was found, in 851 (36.2%)--in glottis and in 17 (0.7%) in subglottis. Cancers of supraglottis, in 60.0% cases. were in state III and IV of clinical advance and cancers of glottis in the same state were found in 20.6% of cases. Generally 52.4% of cases of epiglottis cancer were cured of and 74.4% of glottis cancer. Relative survivals were accordingly: 59.0% and 87.0%. In the period of 5-year observation 47.6% of cases of epiglottis cancer died and 25.6% died of glottis cancer. The chances of recovering of epiglottis and glottis cancer are similar when the cancer is in the same state of clinical advance. 76.3% of objects with epiglottis cancer and 83.8% of glottis cancer in the early state (I and II) of clinical advance survived for 5 years and 37.6% objects sick of epiglottis cancer and 38.7% with glottis cancer in clinical state III and IV.

Epiglottis↗
PubMed2004

Inspiratory activation of the vocal cord adductor, part I: human study in patients with restricted abduction of the vocal cords.

OBJECTIVES/HYPOTHESIS: In patients with restricted abduction of the vocal cords, it has generally been accepted that glottis narrowing with laryngeal stridor during inspiration is attributed to static and passive obstruction of the glottis. However, active glottis narrowing can also be contributory. We tested the hypothesis that the vocal cord adductor is activated during inspiration in patients with restricted abduction of the vocal cords. STUDY DESIGN: Electromyographic evaluation of vocal cord adductor activity in patients with restricted abduction of the vocal cords. METHODS: Five patients with restricted abduction of the vocal cords who had stridor with mild to severe dyspnea during wakefulness were anesthetized with propofol. We recorded the adductor muscle electromyogram during breathing through a laryngeal mask airway while observing the vocal cord movement endoscopically. In three patients who had undergone tracheostomy, we also recorded adductor firing patterns not only while closing but also while opening the tracheostoma. RESULTS: The adductor was activated during inspiration, and the glottis was narrowed in accordance with inspiratory stridor. This adductor inspiratory activity was abolished by opening the tracheostoma in the tracheostomized patients. CONCLUSION: Not only static or passive glottis narrowing but also active narrowing may contribute to inspiratory flow limitation in patients with restricted abduction of the vocal cords. This active glottis narrowing is probably induced by an airway reflex.

Adolescent↗
PubMed1988

Relative strengths of the chest wall muscles.

We hypothesized that during maximal respiratory efforts involving the simultaneous activation of two or more chest wall muscles (or muscle groups), differences in muscle strength require that the activity of the stronger muscle be submaximal to prevent changes in thoracoabdominal configuration. Furthermore we predicted that maximal respiratory pressures are limited by the strength of the weaker muscle involved. To test these hypotheses, we measured the pleural pressure, abdominal pressure (Pab), and transdiaphragmatic pressure (Pdi) generated during maximal inspiratory, open-glottis and closed-glottis expulsive, and combined inspiratory and expulsive maneuvers in four adults. We then determined the activation of the diaphragm and abdominal muscles during selected maximal respiratory maneuvers, using electromyography and phrenic nerve stimulation. In all subjects, the Pdi generated during maximal inspiratory efforts was significantly lower than the Pdi generated during open-glottis expulsive or combined efforts, suggesting that rib cage, not diaphragm, strength limits maximal inspiratory pressure. Similarly, at high lung volumes, the Pab generated during closed-glottis expulsive efforts was significantly greater than that generated during open-glottis efforts, suggesting that the latter pressure is limited by diaphragm, not abdominal muscle, strength. As predicted, diaphragm activation was submaximal during maximal inspiratory efforts, and abdominal muscle activation was submaximal during open-glottis expulsive efforts at midlung volume. Additionally, assisting the inspiratory muscles of the rib cage with negative body-surface pressure significantly increased maximal inspiratory pressure, whereas loading the rib cage muscles with rib cage compression decreased maximal inspiratory pressure. We conclude that activation of the chest wall muscles during static respiratory efforts is determined by the relative strengths and mechanical advantage of the muscles involved.

Abdominal Muscles↗
PubMed2005

Prevention of posterior glottic stenosis by mitomycin C.

OBJECTIVES: Posterior glottic stenosis (PGS) is a disabling disease commonly induced by endolaryngeal injury from intubation or surgery. Few experiments on PGS prevention, however, have been performed. The purpose of this study was to investigate the preventive effect of mitomycin C (MMC) on PGS in a randomized, controlled animal study. METHODS: Twenty-six rabbits underwent laser injury of 6 W, continuous-focus mode on the posterior glottis. There were 6 uninjured controls. Thirteen animals were treated by a single topical use of 0.4 mg/mL MMC solution on the injured posterior glottis for 5 minutes, and 13 were sham-treated controls. The posterior glottis of all groups was blindly evaluated by telescopic examination under direct laryngoscopy 2 months after injury and was harvested for histologic analyses. RESULTS: Scar, granulation tissue, and synechia formation of the posterior glottis were clearly induced by laser injury. Microscopic examination showed increased collagen content and fibroblast proliferation in the region. The use of MMC significantly decreased the incidence of such gross and microscopic changes of the posterior glottis (p < .05). CONCLUSIONS: This study suggests that topical MMC can be helpful in preventing the progression of PGS from mucosal injury of the posterior glottis.

Animals↗
PubMed2006

Influence of glottic aperture on the tracheal flow.

The extra-thoracic mouth-throat area has a major influence on the aerosol delivery to the proximal or peripheral intra-thoracic airways. To characterize the particle deposition in this area, it is important to investigate first the flow structures in this crucial--in relation to the aerosol deposition--region. The glottis, which is delimited by the vocal cords and therefore has the narrowest passage, generates a laryngeal jet and a reverse flow downstream the glottis. It is generally assumed that the glottis has different shapes and cross-sectional areas at different moments during the respiratory cycle and also depends on the average inspiratory flow rate. Therefore, the influence of a circular glottal aperture, with a cross-sectional area of 90 mm2 and an elliptical and triangular shape, both with an area of 45 mm2, on the flow is investigated. However, the area of the circular aperture is twice as big as the area of the elliptical one, it has almost no influence on the flow structures. On the other hand, the triangular glottal aperture shifts the laryngeal jet in the direction of the posterior wall, and generates two pairs of counter rotating secondary vortices downstream the glottis, where the circular and elliptical only aperture generates one pair of vortices. The difference in pressure drop is more dominated by the cross-sectional area than by the shape of the glottis. This suggests the need for rendering geometry of future upper airway models even more realistic as the appropriate three-dimensional (3D) medical imaging techniques are becoming available.

Biomechanical Phenomena↗