Cricoid pressure--a more comfortable technique.
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Anesthesiology↗
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Elective cricothyroidotomy: a clinical and histopathological study.
Elective cricothyroidotomy was carried out on 61 adult patients in the ICU between June 1977 and October 1980. This procedure replaced elective tracheotomy in those patients who were judged to require respirator treatment for a period longer than 72 h. Twenty-six of the patients were examined by the ENT department. Of these, 19 were bronchoscoped more than 3 months after the cricothyroidotomy. Autopsies were carried out on 25 of the 30 patients who died. Histology of the larynx was available in 20 of the cases; in eight of these, a slight inflammation of the perichondrium was found and in two cases, the cartilage of the larynx was more seriously affected. Complications were few and mild. No damage to the vocal cords due to cricothyroidotomy was detected, and there have been no cases of stenosis in the larynx or trachea. Contraindications to cricothyroidotomy are endotracheal intubation for a period longer than 72 h, respiratory difficulties after previous endotracheal intubation, and acute infections of the larynx. Cricothyroidotomy is faster and much easier than tracheotomy. The authors believe that every doctor who works in intensive care should be able to carry out this procedure.
Adult↗
[Achalasia and elevated pressure at the cricopharyngeal sphincter: comments on a case].
A case of uncommon occurrence, such as the so called primary achalasia and hypertension of the cricopharyngeal sphincter is hereby described, as well as its successful treatment by means of an extramucous miotomy of the cricopharyngeal sphincter. The anatomy and physiology of the upper esophageal sphincter is described, as well as its pathogenesis. The published literature is also reviewed.
Cricoid Cartilage↗
[Chondronecrosis of the cricoid after prolonged intubation (author's transl)].
On the basis of 4 cases of partial chondronecrosis of the cricoid after prolonged intubation, the authors review the literature which contains very few similar cases. With regard to pathogenesis, in the light of experimental studies and clinical findings, they emphasize the importance of two lesional factors: excessive diameter of the intubation tube and excessive deflection of the patients' head. All of these factors increase the pressure applied by the tube to the region inferior to the posterior commissure. These parameters would appear to be more important than the duration of intubation itself. The prognosis of these lesions is related to the extent of necrosis: poor when the latter involves the major part of the chaton, generally good when it is limited to partial lysis of the cartilage which may be associated with arytenoid sequestration. Calibration procedures were used in each case. It should be borne in mind that such methods are inadequate for the treatment of massive chondronecrosis which requires repeated operation.
Adult↗
Surgical treatment of laryngeal stenosis.
In this study of the surgical treatment of acquired definite stenoses and atresia of the larynx, the author made the following classification: (i) stenoses due to bilateral paralysis of the recurrent nerve; (ii) stenoses caused by cicatrization of endolaryngeal structures, complete atresia of the larynx with obliteration of the lumen (a) the cartilaginous skeleton of the larynx is still preserved, (b) cases in whom for various reasons the cartilaginous skeleton had been destroyed and the lumen of the larynx assumed the shape of a narrow fissure covered with mucosa; and (iii) cases without cartilaginous skeleton or mucosa where only a cicatricial tissue has remained. As a basis for this research 120 cases were used. Two surgical techniques in bilateral paralysis of the recurrent nerve are described in detail. A combined extra- and intralaryngeal method of submucosal exenteration of the larynx and arytenoidectomy on one half, and cordopexy and disarticulation of the arytenoid was carried out on 30 patients. The second technique, which is still in a clinically experimental phase, is called arytenoidectomy and cordopexy via intercricothyroidolaryngotomy. It was used on only two patients, while greater experience has been gained through experiments carried out on animals (horses and dogs). In 22 patients treated for cicatricial stenoses and atresia various kinds of plastic reconstructive procedures were used. In all 22 patients treated for cicatricial stenoses and atresia various kinds of plastic reconstructive procedures were used. In all 120 cases the respiratory function of the larynx was satisfactorily restored. The voice of all these patients was altered and the phonatory function in 65 per cent of cases remained significantly impaired.
Cicatrix↗
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↗
The human chondrocranium at the end of the embryonic period, proper, with particular reference to the nervous system.
The chondrocranium at stage 23 (27-32 mm C.-R., 8 postovulatory weeks) was studied in detail to fill the descriptive gap between 7 and 9 weeks. Serial sections of ten embryos, all belonging to the same developmental stage, were investigated and compared. Graphic and Perspektomat reconstructions were made from three embryos. The chondrocranium forms a continuous mass of well-formed cartilage, which blends with early cartilage in the nasal, orbital, and otic regions, around the future foramen rotundum, and at the site of the parietal lamina. The chondrocranium and "membrane" bones cover a relatively small portion of the brain, namely 1) the medulla and pons, 2) the caudal half of the lateral portion of the cerebellar primordium, and 3) the rostroventral part of the cerebral hemispheres. The relationships of the cranial nerves were are also investigated. The degree of cranial development is intermediate between that at stage 20 (21 mm) studied by Lewis (the only other skull so far studied adequately in a staged embryo) and that of fetuses of 40 and 43 mm investigated by Macklin. On the whole, the resemblances to the fetal skulls are greater: ossification is beginning in the tectum posterius (to form the supraoccipital), and most of the "membrane" bones (except the parietal, tympanic, lacrimal, and nasal) show osseous areas. The foramen rotundum is present. The lower angle between the chordal and prechordal parts of the basal stem ranges from 129 degrees (which resembles that at stage 20, namely 122 degrees) to 115 degrees (which is the same as that at 40-43 mm). An orbito-parietal commissure is not yet present. The lower border of the larynx is at the level of the lower border of the fourth cervical vertebra. In the larynx, the thyroid laminae have usually not fused, the hyoid cartilage possesses greater and lesser cornua, the cricoid cartilage displays its signet-ring form, and the arytenoids are identifiable as condensed mesenchyme with some early cartilage. The cartilage of the first pharyngeal arches is covered in its ventral three-fourths by an osseous mandibular plate. Morphological variations within stage 23 are minor and appeared not to be related closely to each other, so that it was not possible to arrange the embryos in a linear developmental series based on their level of cranial morphogenesis.
Brain↗
Cricoarytenoid subluxation, computed tomography, and electromyography findings.
A case of cricoarytenoid subluxation secondary to endotracheal intubation and documented by computed tomography (CT) and electromyography (EMG) is reported. Successful endoscopic reduction of the displaced arytenoid is confirmed by CT. The normal anatomy and physiology of the cricoarytenoid joint is presented and the literature regarding this rarely reported injury is reviewed. Based on this review and the case reported, a treatment plan is proposed.
Arytenoid Cartilage↗
The degradation of articular collagen by neutrophil proteinases.
The action of the serine proteinase (EC 3.4.21--)of human neutrophil leucocytes, elastase and cathepsin G, on cartilage and tendon was investigated. With cartilage, both enzymes first degraded the proteoglycan, then solubilized collagen by an attack on the terminal peptides, destroying the inter- and intramolecular cross-links. There was little degradation of the helical region of the type II collagen. Elastase also solubilized type I collagen from tendon, though this was less susceptible than cartilage collagen, and attacked the terminal peptides and perhaps the helical region of type I skin collagen in solution. Cathepsin G had little or no effect on type I collagen of skin or tendon. Since massive infiltration of joint tissues by neutrophil leucocytes is a prominent feature of inflammatory joint disease, it may well be that elastase and cathepsin G make a significant contribution to the tissue damage that occurs.
Achilles Tendon↗
Scintigraphic evaluation of the hyoid bone and the thyroid--cricoid cartilage.
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Adolescent↗
Cricoid split for subglottic stenosis in infancy.
Historically, tracheostomy has been used for infants with airway obstruction caused by congenital or acquired subglottic stenosis. Postoperative morbidity and mortality with this provisional operation led Cotton, in 1980, to substitute anterior cricoid split as the primary definitive procedure. Within the past three years, anterior cricoid split has been performed in 4 infants, aged 3 to 9 months, with acquired (3 patients) or congenital (1 patient) subglottic stenosis requiring ventilation through an endotracheal tube. Following cricoid split, the trachea is stented for 12 to 14 days by a nasotracheal tube, with extubation and rigid bronchoscopy in the operating room with the patient under anesthesia to confirm healing and patency. During an 18- to 24-month follow-up in these 4 patients, morbidity has been minimal, patency has persisted, and stridor has not recurred. Accordingly, a conclusive operation, cricoid split, rather than a temporizing tracheostomy may be employed for certain obstructive tracheal lesions early in life.
Cricoid Cartilage↗
A histologic study of the growth of the subglottis after endolaryngeal trauma.
In young rabbits the histologic features of the growth of the subglottis were studied after an endolaryngeal trauma. This lesion of the larynx leading to a subglottic stenosis, caused specific pathologic changes of the cricoid cartilage and the subepithelial tissues. Activation of chondrocytes resulted in proliferation and regeneration of destructed cartilage. The normal subepithelial structures were replaced by granulation tissue differentiating into a thick fibrous scar and into cartilage. This ectopic cartilage together with the repaired cricoid formed a composite thickened 'ring'-like cartilaginous structure in the adult stage.
Age Factors↗
Congenital cricoid stenosis. Pathogenesis, diagnosis and method of treatment.
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Cricoid Cartilage↗
The thyroid cartilage as a spring.
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Adult↗
Cricoid resection and thyrotracheal anastomosis in the growing primate.
Although many procedures have been described for the correction of subglottic stenosis in the infant and child, none has been universally satisfactory. Cricoid resection and thyrotracheal anastomosis have been successful in adults, and we considered that the same techniques could be applied to correct subglottic stenosis in infants and children. A feasibility study was undertaken using young primates as a surgical model. The operation in each was accomplished uneventfully, although one animal later developed a complication possibly due to the use of a tissue adhesive. In practice, this complication could have been corrected without compromising the surgical outcome.
Animals↗
Cricothyroidotomy: a decade of experience in Denver.
In an attempt to evaluate cricothyroidotomy as described by Brantigan and Grow in 1976, the authors have reviewed the literature and compared it to the decade of experience following Brantigan and Grow's report. The records of over 1,000 patients requiring ventilatory assistance were reviewed. A comparison of this experience with Brantigan and Grow's original series and subsequent reports was used to establish the criteria and technique for cricothyroidotomy. It appears that while cricothyroidotomy has specific advantages, it also has disadvantages and a higher incidence of airway stenosis than either of the procedures it was designed to replace (low tracheotomy or endotracheal intubation). For this reason, its use has been severely restricted in Colorado, where it was popularized.
Adolescent↗
The effect of vocal cord paralysis on the cricoarytenoid joint.
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Animals↗