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An endotracheal tube presses against distinct pressure points within the airway. These areas are the shaft of the tube against the arytenoids and posterior cricoid and the cuff-tube tip in the trachea. An ulcerative injury occurs at these interfacing points from motion occurring between tube and tissue. Minimizing this inherent movement is possible by tube modification and, in the presented animal model, prevents injury.
The posterior cricoarytenoid muscle is unique histochemically, ultrastructurally, and functionally. It has been suggested that the posterior cricoarytenoid muscle undergoes early aging. Aging in peripheral nerves has been reported to resemble a "dying back" neuropathy in that the most severe and earliest age-related changes occur at the most distal levels of the nerve fibers. The lengths and terminal axonal branching of neuromuscular junctions in 17 human posterior cricoarytenoid muscles aged 4 days to 95 years were determined. Both neuromuscular junction lengths and the numbers of axonal terminal branches in the very young group differed significantly from values in two older groups. In contrast to results reported for some other muscles, there was no significant age-related change in these parameters in the posterior cricoarytenoid muscle during adult life. This difference may be related to the repetitive contraction of the posterior cricoarytenoid muscle.
The authors report a case of chronic bulbar muscular dysfunction in a thyrotoxic man, with complete remission of the symptoms after the use of propranolol, with and without concomitant use of propylthiouracil. Some aspects of this unique complication of hyperthyroidism are discussed.
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OBJECTIVE: To evaluate the supraglottic horizontal partial laryngectomy in the treatment of laryngeal cancers. METHODS: Some researches and modifications are performed on the standard supraglottic horzontal partial laryngectomy: the wounded area in the laryngeal cavity is covered with the lateral membrane of thyroid cartilage; the laryngeal cavity is closed as its anterior wall by folding and sewing up the sternohyoid muscles. From 1983 to 1993, 92 patients (80 men and 12 women) with quamous cell carcinoma of larynx were treated with supraglottic horizontal partial laryngectomy. The patients age ranged from 39 to 72 years; 72% aged from 50 to 59. There were 72 cases (78.3%) in the stages III and IV. RESULTS: The 3 and 5 year survival rates of the patients were 75% and 72% respectively. Most cases have acquired good speech and swallow function with 2-4 weeks; 84.8% (78 patients) were extubated. CONCLUSION: The authors believed that partial laryngectomy was safe and beneficial to some patients with laryngeal cancers.
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Larynx is a part of the respiratory system and is supposed to be a complex apparatus responsible for the phonation-creation of voice. However, the extensive anatomical knowledge about the larynx does not correspond to an obscure speculation about creation of voice. Therefore the function of the larynx can be compared with the function of electro-acoustic transducers and on this basis certain roles can be ascribed hypothetically to the functional details of phonation system. The thyroidal cartilage seems to be ideal for such a comparison. Diffusion of acoustic signal by densing and diluting of an elastic milieu is due to the initial stimulus mediated by a solid and elastic sound. In case of vocal system, the initial stimuli occur stimultaneously at two sounds that behave as membranes of coaxial mechanic-acoustic resonators in the function of a radiator. Vocal cords represent a membrane of more subtile system, and the thyroid cartilage is a membrane of more robust system. The mechanism of oscillation is the subject of the present communication. It was concluded that the thyroid cartilage is not only a passive shield protecting the fine glottic structures, but on the contrary an active element of this mechanic-acoustic radiator. The recorded movements of the thyroid cartilage enabled to subtract the presence of neuroreflexive activity accompanying the vocal cycle. The anatomical structures in the vicinity of the thyroid cartilage indicate possible modifications of its motion so that the laryngeal articulation can be supposed.
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A 2-year-old girl developed severe inspiratory and expiratory stridor 2 months after onset of pauciarticular juvenile rheumatoid arthritis (JRA). Direct laryngoscopy demonstrated that both vocal cords were immobile and approximated to each other in the midline secondary to arthritis of the cricoarytenoid joints. High dose corticosteroid therapy resulted in clinical and laryngoscopic improvement and tracheostomy was avoided. Cricoarytenoid arthritis can be a life threatening complication in JRA. Early institution of corticosteroids appears to be the treatment of choice.
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