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At least 991 records · Page 55Linked to original sources
PubMed2005

Laryngeal muscle responses to mechanical displacement of the thyroid cartilage in humans.

Speakers may use laryngeal sensory feedback to adjust vocal fold tension and length before initiating voice. The mechanism for accurately initiating voice at an intended pitch is unknown, given the absence of laryngeal muscle spindles in animals and conflicting findings regarding their existence in humans. Previous reports of rapid changes in voice fundamental frequency following thyroid cartilage displacement suggest that changes in vocal fold length modulate laryngeal muscle contraction in humans. We tested the hypothesis that voice changes resulting from mechanical perturbation are due to rapid responses in the intrinsic laryngeal muscles. Hooked wire electrodes were used to record from the thyroarytenoid, cricothyroid, and sternothyroid muscles along with surface electrodes on the skin overlying the thyroid cartilage in 10 normal adults. Servomotor displacements produced consistent changes in the subjects' vocal fundamental frequency at 70-80 ms, demonstrating changes in vocal fold length and tension. No simultaneous electromyographic responses occurred in the thyroarytenoid or cricothyroid muscles in any subjects. Instead, short-latency responses at 25-40 ms following stimulus onset occurred in the sternothyroid muscles, simultaneous with responses in the surface recordings. The sternothyroid responses may modulate long-latency changes in voice fundamental frequency (approximately 150 ms). The absence of intrinsic laryngeal muscle responses is consistent with a lack of spindles in these muscles. Our results suggest that other sensory receptors, such as mucosal mechanoreceptors, provide feedback for voice control.

Adult↗
PubMed1986

Experience with anterior cricoid split for difficult neonatal extubation.

The anterior cricoid split has been used as an alternative to tracheotomy in neonates who have been difficult to extubate. The procedure is described in detail. We review our experience with eight patients who underwent an anterior cricoid split, and we have correlated success with preoperative data in an attempt to establish criteria for patient selection.

Cricoid Cartilage↗
PubMed1987

Treatment of congenital cricoid stenosis.

Congenital cricoid stenosis is a rare malformation generally diagnosed at autopsy. Out of a total of fourteen cases reported by others, only five were treated successfully. Over a 10-year period, seven patients presented with congenital cricoid stenosis at the Sophia Children's Hospital in Rotterdam. On the basis of these numbers we surmise that this anomaly is less rare than is commonly thought. All seven patients were treated successfully. A new method of treatment is described, consisting of a combination of microsurgical laryngofissure and prolonged intubation with a new, low-friction, atoxic, soft, silicone rubber nasotracheal tube. The specially designed intubation material is also recommended for the treatment of iatrogenically damaged airways. The results indicate that this method constitutes a major advance not only in the treatment of cricoid stenosis but also in the treatment of damaged airways.

Child, Preschool↗
PubMed1985

The anterior cricoid split procedure for the management of subglottic stenosis in infants and children.

Severe acquired subglottic stenosis occurs most commonly in infants and children who require long-term ventilatory support with indwelling endotracheal tubes for underlying respiratory disease. A variety of operative and endoscopic procedures have been advocated for this problem including endoscopic fulguration, cryotherapy, direct incision or excision, and several types of extensive direct laryngotracheoplasties. The failure rate with these procedures is high. We have treated 22 patients including 12 neonates and 10 older children with acquired airway injury and obstruction with a simple cricoid split. In 15 patients the airway obstruction was completely relieved and these youngsters were extubated without difficulty. An additional 3 patients failed initial extubation which was subsequently successful, however, after repeat intubation for a short period of time. Endoscopic follow-up shows complete healing of the incised area. In 2 neonates the procedure was unsuccessful, and tracheotomy was needed. One of these had additional severe airway injury in the distal tracheobronchial tree secondary to selective bronchial intubation in the newborn period. Two older children also required tracheotomy because of severe airway scarring unrelieved by this procedure. The cricoid split is a simple and successful way of dealing with subglottic stenosis, especially in the newborn premature infant. A significant advantage is that it disturbs the anatomy very little, allowing for more extensive laryngotracheoplasty in the future should it fail.

Age Factors↗
PubMed1987

Anterior cricoid split for subglottic stenosis.

Subglottic stenosis is a common problem that often results from ventilatory support necessary in the premature infant. Previous methods of treatment include tracheostomy with dilatation of the stenosis, steroid injections, and procedures to stent the trachea. Results of these methods have been unsatisfactory because of the multiple procedures needed to obtain an adequate airway as well as the high mortality from long-term tracheostomy in infants. In the past 2 years, seven infants have undergone an anterior cricoid split for tight subglottic stenosis and airway obstruction. Of the seven patients, six were premature, five of whom required ventilatory support ranging from 4 to 30+ days. Each child presented in respiratory distress with symptoms present in five children from 1 to 11 months (mean 3.8) after birth. Bronchoscopy identified the site of obstruction in each case as subglottic, with a narrow lumen, usually less than 2.5 mm in diameter. Anterior cricoid split was performed at ages ranging from 2 to 11 months (mean 5.0). All children were extubated at 10 to 14 days and subsequently discharged home asymptomatic; none required postoperative tracheostomy. Complications developed in five children, including atelectasis, otitis media, phlebitis, and tracheocutaneous fistula in two, one of whom required operative closure. One child was rebronchoscoped at 3 weeks postoperatively for bronchospasm, which resolved on aminophylline. The subglottic trachea was normal. At follow-up ranging from 2 to 21 months (mean 8.3), no child has symptoms referrable to the subglottic region. In one patient, a brief period of respiratory distress recurred 3 months postoperatively due to tracheomalacia.(ABSTRACT TRUNCATED AT 250 WORDS)

Cricoid Cartilage↗
PubMed1987

Evaluation of an emergency cricothyrotomy instrument.

An emergency cricothyrotomy device was placed in 11 anesthetized dogs in order to assess airway damage and problems in placement, ventilation, and design. Posterior airway perforation without esophageal damage occurred in three animals. Submucosal hematomas or cricoid cartilage injury occurred in seven animals. As placement by an untrained operator was surprisingly difficult, prior operator training with this device is recommended. When properly installed, an excellent emergency airway was achieved. Some minor design shortcomings are noted and suggestions for improvement are made.

Airway Obstruction↗
PubMedDate not supplied

Cricopharyngeal dysfunction in childhood: treatment by dilatations.

A 3-year-old child with cricopharyngeal dysfunction is reported. Swallowing difficulties, nasal regurgitation, and gagging developed at 2 months of age. Repeated aspirations and over 40 episodes of pneumonia necessitating multiple hospitalizations occurred up to 2 years of age, along with pharyngeal pooling of saliva and inability to swallow solid food. Barium was held up at the cricopharyngeal level, and a prominent esophageal impression was seen at the same level. Symptoms were completely alleviated after two esophageal dilatations by mercury dilators, and the relief persisted for the 6 months of follow-up. The diagnosis of cricopharyngeal dysfunction is discussed, and the necessity for manometric studies, in the face of often misleading radiologic appearance, is emphasized. It is suggested that early use of esophageal dilatations might prevent prolonged morbidity and afford long-term symptomatic relief.

Child, Preschool↗
PubMed2006

Virtopsy hemorrhage of the posterior cricoarytenoid muscle by blunt force to the neck in postmortem multislice computed tomography and magnetic resonance imaging.

In forensic autopsies, one of the most important and common signs of violence to the neck is hemorrhages of the soft tissues. The Institute of Forensic Medicine in Bern evaluates the usefulness of postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) of forensic cases prior to autopsy. The aim of this study was to prove the sensitivity of postmortem MSCT and MRI in the detection of hemorrhages of the neck muscles. A full body scan prior to and a detailed scan of the explanted larynx after autopsy were performed. MSCT detected multiple fractures of the larynx. Detailed MRI was able to demonstrate the hemorrhage of the left posterior cricoarytenoid muscle. The minor hemorrhage of the right posterior cricoarytenoid muscle could not be detected with certainty. Although more experience is required, we conclude that combined MRI and MSCT examination is a useful tool for documentation and examination of neck muscle hemorrhages in forensic cases.

Asphyxia↗
PubMedDate not supplied

A study of the premature neonatal airway.

Children born prematurely are now enjoying improved survival with advances in neonatology and ventilatory support. A study of upper airway size in specimens from 39 prematurely born children reveals 7.7% having a cricoid ring diameter greater or equal to the diameter of the tracheal rings. The more commonly expected relationship of the cricoid ring being smaller than the tracheal rings existed in the rest. This may be of importance in instrumentation or intubation of the airway in premature neonates. The gestational age was a better indicator of cricoid ring diameter than birth weight. From these findings a formula for reliably predicting the cricoid diameter is proposed, aiding the clinician in endotracheal tube or airway instrument selection. The combined lung weights were directly related to airway diameter irrespective of measurements of tracheal or cricoid rings. This has not been previously reported and would imply the existence of laryngo-tracheo-broncho-pulmonary hypoplasia in the premature infant.

Birth Weight↗
PubMed1975

Comparison of four different methods for the recovery of dotriacontane-16,17-14C from small animal respiratory tissue.

The efficiency and accuracy of four different methods of tissue preparation for the recovery of dotriacontane-16,17-14C (DOT-16,17-14C) from rat respiratory tissue were compared by means of liquid scintillation counting. A DOT-16,17-14C standard solution was placed on the respiratory epithelium of the nasal apex, larynx, trachea and main bronchi. Combustion of the lyophilized organs in a Packard sample oxidizer revealed the highest recovery and accuracy (93--100%), sample oxidizing by combustion without lyophilization the lowest recovery and accuracy (73--92%). Tissue solubilization by the commercially available tissue solubilizer TS-1 revealed a better recovery and accuracy (89--95%) than tissue maceration by boiling in methanolic KOH and toluene extraction (74--91%). Depending on the laboratory equipment, lyophilization or tissue solubilization is preferred; maceration and toluene extraction as well as combustion without freeze-drying are disregarded for further investigations because of the cumbersome procedure as well as the low recovery and accuracy, respectively.

Animals↗
PubMed1989

Cricoarytenoid subluxation: complication of blind intubation with a lighted stylet.

Transillumination of the cervical airway with the light wand for blind intubation is a valuable adjunct to anesthesiologists and emergency room physicians, particularly for management of the complicated airway in which direct visualization of the larynx is not possible. However, as an alternative to traditional methods, this technique should be practiced in simple cases before it is attempted in more difficult airway cases. The technique is easy to learn but requires practice to master. The incidence of complications remains low but complications may be serious when they occur. We present a case of cricoarytenoid subluxation after blind intubation with a lighted stylet.

Adult↗
PubMed1984

Anterior cricoidotomy for congenital and acquired subglottic stenosis in infants and children.

Anterior cricoidotomy or "cricoid split" was described in 1980 as an open incisional procedure for failed extubation in neonates. In the past year, we modified the technique to an endoscopic-percutaneous cricoidotomy in 22 patients. We broadened the eligible population to include children with a mature membranous stenosis or a congenital subglottic stenosis. Our overall success rate of 80% (73% in the premature group) demonstrates that a cricoidotomy can be used in children older than the neonatal group and suggests that a cricoidotomy does not need to be an open operative procedure, and should be considered before a tracheotomy in the child with a subglottic injury or narrowing.

Child↗
PubMed1982

[Esophageal atresia associated with cricoid stenosis. Apropos of a case].

We study the chart of a new born with an oesophageal atresia. The weight of baby is two pounds and half and clinic look seems moderate: a gastrostomy and feeding jejunostomy are decided. After anaesthetic induction, intubation is impossible, and the tube knocks just under the vocal cords. Dilatations are no possible, and a straight approach is undertaken to cut stenosis and allow an extended intubation. Immediate and distant post operative series have brought the authors on abstract of their attitude after a review of literature.

Constriction, Pathologic↗