[Laryngoplasty for the defects of the thyroid cartilage and cricoid cartilage].
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Humans↗
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[Invasion of cricoid cartilage by T2-T3 laryngeal cancer].
This paper reports a study of microscopic infiltration of the cartilage of the cricoid carried out in 335 patients with T2-T3 carcinomas of the larynx who had undergone total laryngectomy. The results of the investigation revealed microscopic infiltration of the cricoid cartilage in 12% (14/335) of the cases examined. The incidence, however, was much higher in those cases of extension to the hypoglottis (28% vs 5%, p < 0.0001) or in cases of an even greater extension of the tumor (13% vs 7%). In the 161 patients with neoplasias situated in the glottis, there was cricoid invasion in 30 cases regardless of the tumor class. However, with regard to cases with extension to the hypoglottis, a higher incidence of cricoid infiltration (20% vs 8%, p < 0.002) for all T classes was observed. As for as those cases with neoplasias in the supraglottis are concerned, there were no patients classified T2 (0/50) with cricoid infiltration against 8% in T3 subjects (10/124). In these subjects extension to the hypoglottis led to microscopic invasion of the cricoid cartilage in a greater number of patients (31% vs 3%, p < 0.0001). These observations confirm that microscopic infiltration of the cartilagenous skeleton of the larynx, especially of the cricoid, is relatively frequent. Factor of even higher risk are occurrence in the glottis and, in all the situations examined, extension to the hypoglottis. In addition, except in cases of vestibular T2, there is a 5 to 8% possibility of microscopic infiltration of cricoid cartilage even in the absence of clinical signs of hypoglottic invasion.(ABSTRACT TRUNCATED AT 250 WORDS)
Carcinoma↗
Congenital subglottic stenosis: the elliptical cricoid cartilage.
Various malformations of the cricoid cartilage produce congenital subglottic stenosis. The elliptical cricoid cartilage first was demonstrated histopathologically in horizontal sections of six postmortem specimens and now has been identified clinically in ten patients. The clinical diagnosis of the elliptical cricoid cartilage, suggested by anteroposterior soft tissue neck films, is confirmed at direct laryngoscopy. Delineation of the precise location, extent, and histopathology of subglottic stenosis provides the basis for rational management.
Child, Preschool↗
[Experimental study on repair of cricoid cartilage defect with cartilage grafts in rabbits].
OBJECTIVE: To investigate the effect of free cartilage fragment in repair of cricoid cartilage defect. METHOD: One-third of cricoid cartilage was cut and repaired with free thyroid cartilage fragment and pedicled cartilage in rabbits. The pathological changes of the cartilages were observed. RESULT: 1. The free thyroid cartilage fragments were absorbed in two months, and were replaced by scars. 2. The pedicled cartilage fragments were not absorbed and healed with the cricoid cartilage. 3. No evidence of growth impairment of surgery-induced cricoid cartilage was observed. CONCLUSION: In rabbits, both free cartilage fragments and pedicled cartilage fragments could repair the defect of cricoid cartilage effectively.
Animals↗
Anterior cervical pain syndromes: hyoid, thyroid and cricoid cartilage syndromes and their treatment with triamcinolone acetonide.
Fifty-one patients who presented with anterior cervical or throat pain, without apparent cause, were selected for study at the ENT outpatient department from January 1987 to January 1992. Their clinical symptoms, probable aetiologies and treatment were studied. The most common diagnosis was hyoid syndrome, followed by thyroid cartilage syndrome and cricoid cartilage syndrome. These last two syndromes have not been previously reported because they were coined in Ramathibodi Hospital for patients who had similar clinical patterns localized to the thyroid and cricoid cartilages respectively. Treatment using intralesional triamcinolone acetonide injection was effective in all cases. There was no recurrence after one-five years follow-up.
Adult↗
The intrinsic response of the cricoid cartilage to vertical division.
The explanation for the separation in the cricoid cartilage after the anterior cricoid split procedure has been a matter of speculation. Whether it is caused by extrinsic factors such as stenting, contraction of laryngeal muscles, fibrosis, or whether it is due to the intrinsic nature of the cricoid cartilage itself has yet to be defined. Whole organ in vitro cultures of juvenile gerbil cricoid cartilages were utilized to study the intrinsic response of cricoid cartilage to anterior vertical division. Our results showed the cricoid cartilage to immediately separate, and that separation to markedly increase during whole organ culture. These results suggest that while extrinsic factors may modify the gap after the anterior cricoid split procedure, the intrinsic nature of the cricoid cartilage itself results in the gap formation.
Animals↗
Equine cricoid cartilage densitometry.
The density of the cricoid cartilage from 29 equine larynges collected from an abattoir was determined by dual photon absorptiometry (DPA). Densities of the right and left cricoid cartilages were highly correlated. No correlation was found between age of the horse and the density of the cricoid cartilage.
Absorptiometry, Photon↗
Cricoid cartilage pressure decreases lower esophageal sphincter tone.
BACKGROUND: Cricoid cartilage pressure induced to prevent pulmonary aspiration from regurgitation of gastric contents has been recommended, and its efficacy requires a force greater than 40 Newtons. For regurgitation to occur, both an increase in gastric pressure and relaxation of the lower esophageal sphincter (LES) are necessary. However, the effect of cricoid cartilage pressure on the LES is unknown. This study evaluated the effects of cricoid cartilage pressure on LES in human volunteers. METHODS: Lower esophageal sphincter and esophageal barrier pressures (which equals LES pressure-gastric pressure) were measured using a manometric method in eight unanesthetized volunteers (4 men, 4 women) classified as American Society of Anesthesiologists physical status 1. The force applied to the cricoid cartilage was measured continuously, and LES pressure was recorded at a cricoid force of 20 and 40 Newtons. RESULTS: Cricoid pressure decreased LES pressure from 24 +/- 3 mmHg to 15 +/- 4 mmHg at a force of 20 Newtons (P < 0.05) and to 12 +/- 4 mmHg with a force of 40 Newtons (P < 0.01). CONCLUSIONS: These findings may explain the occurrence of pulmonary aspiration before tracheal intubation despite application of cricoid cartilage pressure.
Adult↗
Dimensions & weight of the cricoid cartilage in northwest Indians.
BACKGROUND & OBJECTIVES: Information on the diameters of the cricoid cartilage in northwest Indian children and adults is scanty. As injury to the mucous membrane of the larynx could occur when an endotracheal tube or a laryngoscope, selected on the basis of western data, is introduced into the larynx of patients. It was, therefore, considered necessary to study the diameters of the cartilage. METHODS: Cricoid cartilages were obtained from 100 male and 58 female adults, 25 male and 25 female children and adolescents on whom medico-legal postmortems were done. In addition, cartilages of 25 dead newborns were studied. Measurements taken included height and thickness of the lamina and anterior arch, anteroposterior and transverse diameters, circumference, length and breadth of the cricoarytenoid facets and angle between their long axes. RESULTS: With advancing age, there was an increase in the weight and in most of the measurements of the cartilage in the newborns, children and adolescents, and adults. Sexual dimorphism in weight and measurements became evident only after the age of 17 yr. INTERPRETATION & CONCLUSION: The weight and other measurements of the cricoid cartilage in northwest Indians are smaller than those recorded in the western populations. The tubes of appropriate size should therefore be used for intubation in different age groups particularly in children based on measurements taken in Indians. Use of the western measurements/standards for this purpose is not recommended. In case of a highly decomposed body, the measurements and weight of the cartilage may be useful in gender determination.
Adolescent↗
[Study of mechanisms of lightening aspiration and increasing decannulation rate in anastomosis of cricoid cartilage and base of tongue (epiglottis)].
OBJECTIVE: To study laryngopharyngeal anastomosis and fixing methods of super-cricoid laryngectomy with reconstruction of functions in lightening aspiration and increasing decannulation rate. METHODS: Recovering conditions of laryngeal functions in 66 patients who underwent supracricoid laryngectomy and anastomosis of cricoid cartilage and base of tongue (epiglottis) in recent eight years were summarized. Some relevant caliber distances in 21 residual larynges were measured. RESULTS: All cases restored their phonation. In 36 cases that underwent anastomosis of cricoid cartilage and base of tongue, 15 cases without aspiration, 18 with mild aspiration, 3 moderates. Decannulation rate is 94.4%. In 30 cases who underwent anastomosis of cricoid cartilage and base of tongue, 10 with mild aspiration, 17 moderate, 3 serious. All cases overcame aspiration within 3 weeks. 7 cases were cannulated. 3, 5, 10 year survival rates were 80.3%, 74.4%, and 3/7. The longitudinal and transverse calibers of epiglottis were 1.5-2.0 times longer than that of the entrance of cricoid cartilage. After anastomosis of cricoid cartilage and base of tongue (epiglottis), the epiglottis can exactly cover the entrance of cricoid cartilage to prevent aspiration fully and increase decannulation rate. Previously the cricoid cartilage was anatomized and fixed under the hyoid bone. Because some spaces exist between cricoid cartilage, base of tongue and epiglottis, aspiration is likely to occur. That hyoid bone covers the entrance of cricoid cartilage will bring constriction of the new laryngeal orifice and make decannulation difficult. Hyoidectomy and anastomosis of cricoid cartilage and base of tongue (epiglottis) overcame the two shortcomings and had good effects. CONCLUSION: Cricoid-hyoid-anastomosis was the main reason of severe aspiration and low decannulation rate. The ideal methods to lighten aspiration and increase decannulation rate are hyoidectomy and anastomosis of cricoid cartilage and base of tongue (epiglottis).
Adult↗
Lateral division of the rabbit cricoid cartilage: its effect on cartilage growth.
Laryngotracheoplasty often includes bilateral lateral division of the cricoid cartilage, despite the theoretical risk that cartilage growth centers might be located in the lateral cricoid. To investigate the effect of lateral cricoid cartilage division on subsequent cartilage growth, 60 five-week-old New Zealand white rabbits were divided into four groups of 15 animals each. Group I was comprised of unoperated controls. The remaining animals underwent anterior (group II), anterior and posterior (group III), and anterior, posterior, and bilateral lateral (group IV) division of the cricoid cartilage. Animals were killed 20 weeks after surgery, and the cross-sectional area of each animal's cricoid cartilage and of each animal's airway was determined. There was no statistically significant difference in mean cartilage cross-sectional area between any of the four groups; the group IV mean was larger than that of any other group, though the difference was not significant. There was no significant difference in airway cross-sectional area between any of the groups operated on. From these results, lateral cricoid division in the growing animal does not appear to interfere with subsequent normal growth of the larynx.
Animals↗
[Study of reserving unilateral arytenoid cartilage to improve voice quality in supracricoid partial laryngectomy with anastomosis of cricoid cartilage, base of tongue and epiglottis].
OBJECTIVE: To study the surgical technique of reserving unilateral arytenoid cartilage and the effects on improving voice quality in supracricoid partial laryngectomy with anastomosis of cricoid cartilage,base of tongue and epiglottis. METHOD: Twenty-six glottic carcinomas (T1b 11 cases,T2 12 cases, T3 3 cases ) were summarized from Jan. 1995 to Oct. 2003. Both vocal cords were affected. On arytenoid reserved side, invasion of vocal cord was below 2/3 and there was 3 mm safety distance to vocal process; also posto-inferior 1/3 part of thyroid cartilage was preserved to prevent injury of laryngeal recurrent nerve and assure normal motion of arytenoid cartilage. On non- reserved side, the half larynx was excised completely. Anastomosis of cricoid cartilage,base of tonge and epiglottis was used to reconstruct laryngeal function. RESULT: All cases restored their normal swallow during postoperative 7 to 23 days. Twenty-five cases were decannulated and the decannulation rate was 96.1% (25/26). All cases restored phonation. Different degree of hoarseness existed. In 18 cases the loudness of voice made them be competent for indoor communication and the speech could be easily understood; in 8 cases the loudness of voice made them be able to communicate within 1 meter distance and the speech could be understood under quiet circumstance. There were no pharyngeal fistula and pulmonary complications. Local infection was found in 2 cases and cured in 7 days. Local recurrence and cervical lymph node metastasis rate were 3.8% (1/26), 3.8% (1/26) respectively. Lost patients were assumed to death and direct method was used to calculate survival rate. In 17 patients postoperative period was above 3 years, 1 died in 3 years and 1 was lost. 3-year survival rate was 88.2% (15/17). In 10 patients postoperative period was above 5 years and 2 died in 5 years. 5-year survival rate was 80.0% (8/10). CONCLUSION: In selected cases with invasion of both vocal cords, unilateral arytenoid cartilage can be reserved and it will be helpful to improve voice quality. The active motion of arytenoid cartilage toward antero-median position and the corresponding motion of epiglottis maybe the reason to improve voice quality.
Adult↗
Cell origin in experimental repair of cricoid cartilage defects treated with recombinant human bone morphogenetic protein-2.
We determined the origin of new cartilage and new bone induced by recombinant human bone morphogenetic protein-2 (rhBMP-2) at the site of cricoid cartilage defects in rabbits randomly divided into eight groups. The cricoid cartilage was split vertically along the anterior midline and a strip was excised from the anterior part of the cricoid cartilage in all rabbits. The perichondrium from the anterior part of the cricoid cartilage was trimmed off in four groups; two groups treated with rhBMP-2 and two control groups. In four other groups, the anterior perichondrium was detached and used as a flap with two groups treated with rhBMP-2 and two groups serving as controls. The rabbits were killed 1 week or 4 weeks after surgery. The larynges were removed, fixed and sectioned, and the sections were stained for light microscopy using various cytochemical and immunological techniques. New cartilage was only present close to the host perichondrium adherent to cricoid cartilage in rabbits treated with rhBMP-2. New bone was present 4 weeks after surgery, although calcified matrix and alkaline phosphatase activity could be detected at the site of cricoid defects as early as 1 week after surgery. The cell proliferation marker Ki-67 was strongly expressed in granulation tissue and bone marrow, and it was moderately expressed in muscles adjacent to the cricoid cartilage in rhBMP-2-treated specimens. BMP receptors were strongly expressed in cartilage and moderately expressed in adjacent muscles. We conclude that new cartilage originates from the mesenchymal progenitor cells of host perichondrium adherent to cricoid cartilage in rabbits treated with rhBMP-2. New bone may originate from local muscle.
Administration, Topical↗
Chondromatous hamartoma of the cricoid cartilage.
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Cartilage↗
Repair of the injured larynx following destruction of the cricoid cartilage.
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Cartilage↗
[A case of papilloma of an aberrant throid gland simulating ostechondroma of the cricoid cartilage].
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Cartilage↗
The cricoid cartilage and the esophagus are not aligned in close to half of adult patients.
PURPOSE: To determine the frequency and degree of lateral displacement of the esophagus relative to the cricoid cartilage ("cricoid") using computed tomography (CT) images of normal necks. METHODS: Fifty-one cervical CT scans of clinically normal patients were reviewed retrospectively. Esophageal diameter, distance between the midline of the cricoid and the midline of the esophagus, and distance between the lateral border of the cricoid and the lateral border of the esophagus were measured. RESULTS: Lateral esophageal displacement was observed in 49% (25/51) of CT images. When present, the mean length of displaced esophagus relative to the midline of the cricoid was 3.3 mm +/- SD 1.3 mm. Of those with lateral displacement, 64% had esophageal displacement beyond the lateral border of the cricoid (mean 3.2 mm +/- SD 1.2 mm). There is a relatively normal distribution of the grouped measures of percentage of esophageal diameter that is displaced. Of those with displacement, 48% had over 15% of the total width of the esophagus displaced laterally and 20% had over 20% of the esophageal width displaced laterally. CONCLUSION: There is a 49% frequency of some degree of lateral displacement of the esophagus relative to the cricoid.
Adult↗
Fracture of the cricoid cartilage after Sellick's manoeuvre.
We report a case of fracture of the cricoid cartilage associated with cricoid pressure during rapid sequence tracheal intubation in a patient with status asthmaticus. This patient had a history of laryngeal trauma 48 yr previously. Fracture of the cricoid cartilage has not been reported previously after cricoid pressure.
Aged↗