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At least 55 records · Page 3Linked to original sources
PubMed1998

Videoendoscopic assessment of dynamic laryngeal function during exercise in horses with grade-III left laryngeal hemiparesis at rest: 26 cases (1992-1995).

OBJECTIVE: To evaluate laryngeal function by means of videoendoscopy during high-speed treadmill exercise in racehorses with grade-III left laryngeal hemiparesis at rest and to determine outcome of treatment. DESIGN: Retrospective study. ANIMALS: 26 racehorses. PROCEDURE: Videoendoscopy of the larynx was performed while horses were at rest and exercising on a treadmill. Horses were classified as having grade-IIIA, -IIIB, or -IIIC laryngeal hemiparesis on the basis of the degree of arytenoid cartilage abduction maintained during exercise. Postoperative racing performance was determined by evaluating race records and conducting telephone surveys. RESULTS: 20 (77%) horses had grade-IIIC laryngeal hemiparesis (i.e., severe dynamic laryngeal collapse during exercise). Eighteen underwent surgery, and racing performance was improved in 9. Five (19%) horses had grade-IIIB laryngeal hemiparesis (i.e., left arytenoid cartilage and vocal fold were maintained in an incompletely abducted position during exercise). Four underwent surgery, and racing performance was improved in 1. One (4%) horse had grade-IIIA laryngeal hemiparesis (i.e., full abduction of arytenoid cartilage during exercise); surgery was not performed. CLINICAL IMPLICATIONS: Videoendoscopy is useful in determining dynamic laryngeal function in racehorses with grade-III laryngeal hemiparesis at rest.

Animals↗
PubMed2003

Hoarseness after laryngeal blunt trauma: a differential diagnosis between an injury to the external branch of the superior laryngeal nerve and an arytenoid subluxation. A case report and literature review.

Arytenoid subluxation is a well-known cause of hoarseness due to incomplete glottic closure with intact inferior laryngeal nerves after severe laryngeal trauma. We report the case of a young man presenting after laryngeal blunt trauma with hoarseness, easy fatigue during phonation, marked difficulty with his high-pitch and singing voice and decreased phonation time, but intact function of both inferior laryngeal nerves, intact endolaryngeal mucosa sensibility and normal CT scans of the larynx and the neck. Due to the asymmetric anteromedial position of the right arytenoid with incomplete glottic closure, the primary diagnosis was arytenoid subluxation, and the patient was referred for instantaneous relocation therapy. The stroboscopic and electromyographic diagnosis of a unilateral paresis of the external branch of the right superior laryngeal nerve caused the therapy to be changed. Without repositioning, the patient had a total recovery of voice quality when the paresis receded 2 months later. In conclusion, the unilateral paresis of the external branch of the superior laryngeal nerve after laryngeal blunt trauma is reported here for the first time. Although the clinical findings are familiar sequelae of thyroid surgery, they may be misdiagnosed as arytenoid subluxation after laryngeal blunt trauma. Stroboscopy and electromyography permitted the correct diagnosis.

Adult↗
PubMed2006

Effect of recurrent laryngeal nerve section on the laryngeal muscles of adult rabbits.

OBJECTIVE: To examine the effect of recurrent laryngeal nerve section on myonuclear addition and myofiber remodeling in adult rabbit laryngeal muscles. STUDY DESIGN AND SETTING: Unilateral section of the recurrent laryngeal nerve was performed on adult rabbits. Rabbits were labeled with bromodeoxyuridine, euthanized, and the laryngeal muscles were examined for bromodeoxyuridine (brdU) and neonatal myosin heavy chain (MyHC) expression. RESULTS: One week after nerve section, brdU-positive myonuclei were significantly increased on the denervated and contralateral sides. Neonatal MyHC expression significantly increased. By 24 weeks, the upregulation of myonuclear addition returned to control levels. CONCLUSION: Laryngeal muscle denervation results in significant upregulation of myonuclear addition. Denervation also resulted in a significant upregulation of neonatal MyHC expression. SIGNIFICANCE: Laryngeal muscles can be successfully reinnervated after long periods of denervation. This significant and maintained increase in myonuclear addition may contribute to the ability of laryngeal muscles to survive for extended periods following interruption of the recurrent laryngeal nerve.

Animals↗
PubMed2001

The study of laryngeal muscle activity in normal human subjects and in patients with laryngeal dystonia using multiple fine-wire electromyography.

The normal human larynx performs numerous complex tasks with nearly complete reliability. These tasks require precise timing of movements that are effected by the laryngeal muscles. The most specific method to examine these muscles is by electromyography. Although many studies on laryngeal electromyography have been reported using multichannel recordings, none has provided a detailed analysis of each laryngeal muscle's role during a variety of common tasks and the spectrum of normative values. Simultaneous eight-channel, fine-wire electromyographic recordings were made in 11 human subjects. The timing patterns of the laryngeal muscles during the coordinated efforts for phonation and other common glottic functions were examined. In addition, normative values for latencies and amplitudes of response were determined. During simple phonation, a "set pattern" for the thyroarytenoid, lateral cricoarytenoid , and interarytenoid muscles was found. The thyroarytenoid and lateral cricoarytenoid muscles demonstrated a burst at onset preceding phonation and then decreased activity, whereas the interarytenoid sustained glottic position during phonation. The coordination of the laryngeal muscles was similarly determined for connected speech, respiration, Valsalva maneuver, cough, throat-clear task, and swallow. These patterns of response, the latencies for activities, and the amplitudes of response in normal subjects provided the basis to examine the abnormal laryngeal function in a group of 59 patients with four clinical varieties of laryngeal dystonia (adductor, tremor, abductor, and mixed). The findings include abnormal patterns of response, increased latencies, and increased amplitudes of recruitment in many tasks including nonphonatory tasks. Although specific distinctions were noted in each group, the responses were remarkably similar, indicating that all clinical varieties of laryngeal dystonia should be classified as mixed dystonia with a clinical preponderance for one or more types of behavior.

Adult↗
PubMed2001

Intubating laryngeal mask airway, laryngeal tube, 1100 ml self-inflating bag-alternatives for basic life support?

Insufficient oxygenation, ventilation and gastric inflation with subsequent regurgitation of stomach contents is a major hazard of bag-valve-face mask ventilation during the basic life support phase of cardiopulmonary resuscitation (CPR). The European Resuscitation Council has recommended smaller tidal volumes of approximately 500 ml as an effort to reduce gastric inflation; furthermore, the intubating laryngeal mask airway and the laryngeal tube have been recently developed in order to provide rapid ventilation and to secure the airway. The purpose of our study was to examine whether usage of a newly developed medium-size self-inflating bag (maximum volume, 1100 ml) in association with the intubating laryngeal mask airway, and laryngeal tube may provide adequate lung ventilation, while reducing the risk of gastric inflation in a bench model simulating the initial phase of CPR. Twenty house officers volunteered for our study. When using the laryngeal tube, and the intubating laryngeal mask airway, respectively, the medium-size (maximum volume, 1100 ml) versus adult (maximum volume, 1500 ml) self-inflating bag resulted in significantly (P<0.05) lower mean+/-S.E.M. lung tidal volumes (605+/-22 vs. 832+/-4 ml, and 666+/-27 vs. 887+/-37 ml, respectively), but comparable peak airway pressures. No gastric inflation occurred when using both devices with either ventilation bag. In conclusion, both the intubating laryngeal mask airway and laryngeal tube in combination with both an 1100 and 1500 ml maximum volume self inflating bag proved to be valid alternatives for emergency airway management in a bench model of a simulated unintubated cardiac arrest victim.

Adult↗
PubMed2003

The use of modified VBM laryngeal tube compared to Laryngeal Mask Airway during spontaneous ventilation.

We have compared the use of the laryngeal mask airway with the new modified laryngeal tube in a prospective randomized controlled study. Sixty ASA 1 or 2 patients, aged 18 to 65 years, scheduled for elective surgery and breathing spontaneously under general anaesthesia, were studied. After preoxygenation, anaesthesia was induced with fentanyl and propofol. The patients were randomized to receive either a laryngeal mask airway or a laryngeal tube. Anaesthesia was maintained with nitrous oxide, oxygen and isoflurane. We recorded the speed and the ease of insertion, the number of attempts needed to successfully secure the airway and intraoperative complications, such as partial airway obstruction needing airway manipulation. The airway devices were removed with the patients fully awake at the end of surgery. Systolic arterial blood pressure, heart rate and end-tidal CO2 were recorded at various time intervals. Postoperative complications were recorded. We found that the incidence of partial airway obstruction needing intraoperative airway manipulation was higher with the laryngeal tube than with the laryngeal mask airway. We conclude that during spontaneous ventilation the modified laryngeal tube is not as reliable in providing a satisfactory airway and we consider it is not a suitable alternative to the laryngeal mask airway.

Adult↗
PubMed1982

Opioids increase laryngeal resistance and motoneuron activity in the recurrent laryngeal nerve.

[D-Ala2,Met5]enkephalinamide (DAME), [D-Ala2,Leu5]enkephalinamide (DALE) and morphine sulfate (MS) increase activity in the recurrent laryngeal nerve (RLN) within 1 s subsequent to right atrial administration. The activation of the RLN was correlated with a large increase in the resistance to airflow in the in situ isolated larynx. Single unit recurrent laryngeal motoneuron recordings showed that the increase in laryngeal resistance was caused by the continuous activation and recruitment of expiratory motoneurons. Results obtained with opioids mimicked those of phenyldiguanide (20-40 micrograms/kg RA), an agent known to stimulate pulmonary J-receptors. Opioid-induced increases in laryngeal resistance were blocked by bilateral section of the RLN and pretreatment with naloxone (100 micrograms/kg RA). Naloxone had no effect on PDG responses. During the initial period of laryngeal motoneuron activation, the phrenic nerve (PN) was inhibited, however, the activation of the RLN was not dependent upon PN inhibition. It was concluded that stimulation of pulmonary opiate receptors, which may be associated with vagal afferents, elicit a reflex activation of expiratory recurrent laryngeal motoneurons resulting in an increase in laryngeal resistance.

Animals↗
PubMedDate not supplied

CT findings of laryngeal tuberculosis: comparison to laryngeal carcinoma.

PURPOSE: Our goal was to describe the appearance of laryngeal tuberculosis using CT, with the intent of identifying features distinguishing laryngeal tuberculosis and carcinoma. METHOD: CT scans of 12 patients with laryngeal tuberculosis were analyzed retrospectively. Clinical symptoms, laryngoscopic exams, and presence of pulmonary tuberculosis on chest radiographs were also reviewed. RESULTS: In laryngeal tuberculosis, bilateral involvement was noted in nine patients (75%), while unilateral involvement was seen in three (25%). Diffuse thickening of the free margin of the epiglottis was a characteristic and frequent finding in tuberculosis (n = 6, 50%). No deep submucosal infiltration of the preepiglottic and paralaryngeal fat spaces was seen even when there was extensive involvement of the laryngeal mucosa. Cartilage destruction was not found in any case. CONCLUSION: Characteristic CT findings of laryngeal tuberculosis include bilateral involvement, thickening of the free margin of the epiglottis, and good preservation of the preepiglottic and paralaryngeal fat spaces even in the presence of extensive mucosal involvement. By comparison, laryngeal carcinoma presented unilateral involvement, infiltration of the preepiglottic and paralaryngeal fat spaces by a submucosal mass, cartilage destruction, and extralaryngeal invasion.

Adult↗
PubMed2005

Detailed investigation of the relationship between the inferior laryngeal nerve including laryngeal branches and ligament of Berry.

BACKGROUND: Studies about the anatomic relationship between the inferior laryngeal nerve (ILN) and the ligament of Berry are insufficient, despite controversy in the literature. In addition, the relationship between the laryngeal branches of the ILN and the ligament of Berry has not been investigated. STUDY DESIGN: Sixty specimens (120 sides) were examined for this study, including 41 male and 19 female cadavers between the ages of 40 and 89 years at death. RESULTS: The nerve trunk or its anterior and posterior laryngeal branches run posterolateral to the ligament in 51 and 39 sides, respectively. The nerve trunk or both its laryngeal branches passed posteromedial to the ligament in 12 and 7 sides, respectively. In seven sides, the anterior branch of the ILN was located posterolateral and the posterior branch was posteromedial to the ligament. In three sides, the anterior (motor) branch of the ILN penetrated the ligament of Berry. In one right side, a nonrecurrent laryngeal nerve arose from the vagal nerve at the level of ligament of Berry. The nerve divided into the anterior and posterior laryngeal branches just above posterior surface of the ligament; both branches extended parallel to it. CONCLUSIONS: We have shown that the nerve was located not only posterolateral to the ligament but also posteromedial to it. Additionally, unlike other authors, we have shown that the anterior (motor) branch of the recurrent laryngeal nerve penetrated the ligament of Berry in 2.5% of 60 specimens.

Adult↗
PubMed1993

Correlation between the laryngeal brain stem evoked response and the laryngeal chemoreflex in the porcine model.

The laryngeal brain stem evoked response (LBR) represents the neural activity involved in laryngeal reflex pathways. The laryngeal chemoreflex (LCR) is a centrally mediated response consisting of apnea and hemodynamic changes that result from laryngeal stimulation. The purpose of this study is to determine the characteristics of the LBR that are predictive of LCR severity in the porcine model. The duration of apnea resulting from stimulation of the supraglottic larynx defined LCR severity. The LBR tracings were recorded from electrodes flanking the brain stem following direct electrical stimulation of the superior laryngeal nerve. The LBR peak latencies from piglets demonstrating prolonged LCR apnea were compared to those without an exaggerated LCR response. Two LBR peak latencies demonstrated a statistically significant difference between the two piglet groups. These peak latencies appear to be indicators of susceptibility to exaggerated laryngeal reflex sensitivity. Thus, the LBR may prove useful in identifying and evaluating subjects predisposed to conditions associated with dysfunctional laryngeal reflex activity.

Animals↗
PubMed2004

[Induction chemotherapy and laryngeal preservation in pharyngolaryngeal carcinomas. Study of a 124 serie's patients and patient's follow up with laryngeal preservation].

OBJECTIVE: To try and determine the value of chemotherapy and its subsequent effect on laryngeal preservation in patients presenting with laryngeal and pharyngeal carcinomas. One group was initially treated with surgery and radiotherapy. The second group was treated with chemotherapy and subsequent salvage surgery and/or radiotherapy. Their survival rates and laryngeal preservation rates were compared. PATIENTS AND METHODS: From 251 patients the authors have retrospectively studied 124 patients with induction chemotherapy. The survival rate has been compared with a control group of 127 patients who was treated by initial surgery and radiotherapy. RESULTS: The survival rate at 5 years for the patients initially treated by surgery and radiotherapy was 64.1%. The survival for patients with a total clinical response following chemotherapy was 49.8% at 5 years. Survival with no total clinical response following chemotherapy treated by secondary radiotherapy was 25.7% at 3 years. The initial rate of laryngeal preservation is 32.2% but this rate fell to 22% after local recurrencies. CONCLUSION: The group with total clinical response after induction chemotherapy with laryngeal preservation have a non significantly difference in their survival compared with the group initially treated by surgery and radiotherapy. In contrary patients with non complete clinical response have a survival of 25.7% at 3 years. The rate of local recurrency of patients with laryngeal preservation is 32.5% and gives a finally rate of laryngeal preservation of 21%. These recurrencies decrease the survival rate.

Adult↗
PubMed2002

Laryngeal mask anesthesia with intraoperative laryngoscopy for identification of the recurrent laryngeal nerve during thyroidectomy.

OBJECTIVES/HYPOTHESIS: A critical step in thyroidectomy involves definitive identification of the recurrent laryngeal nerve (RLN). Using the laryngeal mask airway, identification of the RLN can be facilitated by stimulation of the nerve while monitoring vocal cord movement with a fiberoptic laryngoscope. We present this technique as an effective and safe means to identify the RLN during thyroid surgery, with significant advantages over existing techniques in appropriately selected patients. STUDY DESIGN: Retrospective case series. METHODS: We performed thyroidectomy on 8 patients (13 RLN identifications) in which laryngeal mask airway anesthesia with fiberoptic laryngoscopy was used to identify the RLN. Results are reviewed with regard to postoperative vocal cord function, as well as intraoperative and postoperative courses with laryngeal mask airway anesthesia. RESULTS: In all 13 cases in which the RLN was sought, it was definitively identified by witnessing brisk vocal cord movement on a video screen with stimulation of the RLN. No patient had postoperative vocal cord paresis or paralysis. Overall recovery from laryngeal mask airway anesthesia was uneventful and had advantages when compared with general anesthesia with endotracheal intubation. CONCLUSIONS: Laryngeal mask airway anesthesia with intraoperative fiberoptic laryngoscopy to identify the RLN is effective and safe in carefully selected patients. Advantages include decreased postoperative throat discomfort, absence of coughing during emergence from anesthesia, and elimination of the possibility of vocal cord mobility impairment secondary to RLN ischemia from the endotracheal tube balloon. In addition, this technique is applicable in operations besides thyroid surgery, in which definitive identification of the RLN is indicated.

Adult↗
PubMed1988

[Auxiliary motor innervation of the laryngeal muscles via the internal branch of the superior laryngeal nerve].

According to our present knowledge of the neuromuscular innervation of the intrinsic laryngeal muscles, the cricothyroid muscle is innervated by the external branch of the superior laryngeal nerve (NLS), whereas all other remaining muscles get their supply from the inferior laryngeal (recurrent) nerve. Mainly in the phoniatric literature, however, opinions differ concerning an additional motoric laryngeal innervation. In human larynges, excised for large unilateral carcinoma, horseradish peroxidase (HRP) was injected into the internal branch of the NLS. Anterograde labelling of axons was demonstrated histochemically. In adjacent sections of the different muscles, end plates and axons were stained histochemically with silver impregnation and acetylcholinesterase. Evidence is presented of motor innervation of the internal branch of the NLS in some laryngeal muscles. With retrograde HRP-tracing in sheep, motoneurons were detected in the nucleus ambiguus, although the recurrent nerve and the external branch had been divided and excised. Thus, histologically an additional neuromuscular supply via the internal branch of the NLS is demonstrated.

Animals↗
PubMed1991

Afferent activity in the external branch of the superior laryngeal and recurrent laryngeal nerves.

We investigated the presence of respiratory-modulated receptors in the recurrent laryngeal nerve (RLN) and the external branch of the superior laryngeal nerve (ExtSLN) in anesthetized, spontaneously breathing dogs. Of 39 receptors recorded from the ExtSLN, the vast majority responded with a slowly adapting discharge to compression of the cricothyroid muscle, and only 1 responded to probing of the laryngeal mucosa. Ten receptors showed a respiratory modulation. All 30 receptors recorded from the RLN responded to probing of the laryngeal lumen, most of them (60%) with a rapidly adapting response. Seven of the slowly adapting receptors exhibited a respiratory modulation; 38% of the receptors tested were stimulated by water, and only 15% by smoke. No receptors stimulated by laryngeal cooling were identified in either nerve. Our study indicates that in the RLN and the ExtSLN there are relatively few afferents responding to changes in transmural pressure and mechanical irritation, as compared to the internal branch of the SLN. The relative scarcity of receptors responding to transmural pressure and irritant stimuli is consistent with previous observations in dogs that indicate a preponderant role for afferents in the internal branch of the SLN in the reflex responses to laryngeal stimulation.

Afferent Pathways↗
PubMed1992

[Laryngeal carcinoma with laryngeal abscess].

We had encountered 5 cases of laryngeal carcinoma associated with abscess. Four of them were advanced laryngeal cancer with abscess induced by mechanical injury, and one with post-radiation laryngeal perichondritis & abscess formation. Management included total laryngectomy in 3 patients, partial laryngectomy in 1 patient, and resection of post-radiation abscess in one. Laryngeal abscesses are seen rarely today. Endeavour should be made to decrease such complication. The authors had presented their experience in the management of laryngeal carcinoma associated with laryngeal abscess, together with a review of the history and some of the current ideas about this problem.

Abscess↗
PubMed2004

[Clinical application of laryngeal endoscopy in the minimally invasive surgery of laryngeal diseases].

OBJECTIVE: To study the value of laryngeal endoscopic system in the treatment of laryngeal diseases with minimally invasive surgery. METHOD: This paper was to summarized retrospectively the clinical experience of 34 cases suffered from laryngeal diseases treated by minimally invasive surgery with laryngeal endoscopic system. The remain tumor and hemorrhage were treated by microwave machine. The malignant tumors were treated by radiotherapy with 60Co in 40 Gy, postoperatively. RESULT: The tumors were totally resected and no serious complications were revealed. Followed-up these 34 cases, 26 cases with benign pathological changes who had hoarseness preoperatively recovered to normal 1-month after operation. In 2 cases with vocal cord carcinoma at the early stage, the functions and construction of throat were retained and no recurrence was founded after 6-12 month postoperatively. CONCLUSION: The laryngeal endoscopic system is valuable in treating laryngeal pathological regions and early stage carcinoma for its minimally invasion, wide operative field, good illuminative degree and normal construction and function reserved.

Adolescent↗
PubMed1995

Laryngeal preservation for advanced laryngeal and hypopharyngeal cancers.

OBJECTIVE: To compare a single institutional experience with combination chemotherapy and radiation for laryngeal preservation with historical age-, sex-, stage-, and site-matched controls who underwent laryngectomy for cancer of the larynx or hypopharynx. DESIGN: Fifty-five patients with stage III or IV laryngeal and hypopharyngeal squamous carcinoma were prospectively entered into a protocol to receive three cycles of cisplatin (+/- bleomycin sulfate) and fluorouracil and radiation therapy from 1986 to 1991 (group 1). Following two cycles of chemotherapy, the clinical tumor response was assessed and responders received a third cycle of chemotherapy followed by definitive radiation therapy. Nonresponders underwent surgical salvage. Two patients in the surgical control group were matched to each protocol patient (n = 110, group 2) regarding site, stage, sex, and age (+/- 7 years) without knowledge of patient outcome. SETTING: A tertiary cancer referral center, The University of Texas M. D. Anderson Cancer Center, Houston. RESULTS: Following chemotherapy, the tumor response rate for group 1 was complete in 38% and partial in 31%. With a median follow-up of 24 months (group 1) and 37 months (group 2), the Kaplan-Meier 2-year disease-specific survival for group 1 and 2 was 63% and 74%, respectively (P = .251). Among group 1 patients, 67% retained their larynges. Local recurrences were more frequent among the laryngeal preservation group (P = .001), whereas distant metastasis was more frequent among controls (P = .35). Thirty-three percent (18/55) of group 1 patients required total laryngectomy. Examining these subsets of patients showed that of the 67% (n = 37) of patients who retained their larynges, their 2-year survival was 56%, not significantly different from their respective controls (n = 74), 71%. Additionally, 2-year survival among the 18 group 1 patients who required salvage laryngectomy was 75% as compared with 80% for their matched controls (n = 36). CONCLUSIONS: These results document the results of chemotherapy and radiation therapy in the treatment of patients with advanced laryngeal and hypopharyngeal cancers in preserving the larynx. Although local control is significantly compromised among these patients, there is no compromise in overall survival when combined with prompt surgical salvage.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

Laryngeal motor control in frogs: role of vagal and laryngeal feedback.

Using decerebrate frogs (Rana catesbeiana), we investigated the role of vagal and laryngeal sensory feedback in controlling motor activation of the larynx. Vagal and laryngeal nerve afferents were activated by electrical stimulation of the intact vagal and laryngeal nerves. Pulmonary afferents were activated by lung inflation. Reflex responses were recorded by measuring efferent activity in the laryngeal branch of the vagus (Xl) and changes in glottal aperture. Two glottic closure reflexes were identified, one evoked by lung inflation or electrical stimulation of the main branch of the vagus (Xm), and the other by electrical stimulation of Xl. Lung inflation evoked a decrementing burst of Xl efferent activity and electrical stimulation of Xm resulted in a brief burst of Xl action potentials. Electrical stimulation of Xl evoked a triphasic mechanical response, an abrupt glottal constriction followed by glottal dilatation followed by a long-lasting glottal constriction. The first phase was inferred to be a direct (nonreflex) response to the stimulus, whereas the second and third represent reflex responses to the activation of laryngeal afferents. Intracellular recordings of membrane potential of vagal motoneurons of lung and nonlung types revealed EPSPs in both types of neurons evoked by stimulation of Xm or Xl, indicating activation of glottal dilator and constrictor motoneurons. In summary, we have identified two novel reflexes producing glottic closure, one stimulated by activation of pulmonary receptors and the other by laryngeal receptors. The former may be part of an inspiratory terminating reflex and the latter may represent an airway protective reflex.

Action Potentials↗