[Vocal cord paralysis with stridor caused by interarytenoid fibrosis--a complication of intensive care]

Translaryngeal long-term intubation in intensive-care patients was followed in three cases by immobilisation of the vocal cords and severe stridor, caused by a fibrotic scar between the processus vocales and the posterior commissure. Different surgical approaches are described. Endoscopic incision of the scars is recommended. Most important is a bolting technique for several consecutive days.

A histopathological study of carcinoma of the larynx

Fifty-one laryngectomy specimens were histopathologically studied in serial sections. The incidence of thyroid cartilage invasion was 10% in supraglottic, 48% in glottic, and 67% in subglottic carcinomas. The incidence of cricoid cartilage invasion was 0% in supraglottic, 22% in glottic, and 33% in subglottic carcinomas. The sites of cartilage invasion were the anterior commissure portion and an ossified lower portion of the thyroid cartilage, and an ossified upper portion of the cricoid cartilage. Fixation of the vocal fold in glottic carcinoma was accounted for by carcinomatous invasion into three-fourths or more of the thyroarytenoid muscle. Impairment of the vocal fold movement was accounted for by carcinomatous invasion into three-fourths or less of the thyroarytenoid muscle. Fixation of the vocal fold in supraglottic carcinomas was accounted for by a massive carcinomatous invasion around the upper aspect of the arytenoid cartilage.

Vocal abnormalities. What listening can tell you

"The human voice is the organ of the soul," said Longfellow. It can also serve as a mirror of the physical and mental problems that affect not only the vocal mechanism but the rest of the body. We should strive to become more aware of this--and that our ears can be, at times, as important a diagnostic tool as our eyes. Mastery of the art of listening to vocal abnormalities will enable the clinician to determine which patients he or she can treat at the outset and which require immediate referral to a laryngologist or other specialist. An experienced listener often is able to diagnose vocal problems prior to a laryngeal examination.

Leprosy of the larynx: a clinicopathological study

Ten established cases of lepromatous leprosy with laryngeal involvement are reported, and their clinical and histopathological findings are discussed with a brief review of the literature.

Chronic chondritis of the arytenoid cartilages in a pony mare

The upper respiratory tract of a pony mare with marked exercise intolerance and respiratory stridor was examined with a flexible fibreoptoscope. Both arytenoids were adducted and distorted. A diagnosis of bilateral chondritis of the arytenoids was made and confirmed at autopsy after surgery to enlarge the rima glottidis was unsuccessful. Other space occupying lesions of the rima glottidis are discussed and theories on the aetiology are postulated.

Histological findings in arytenoid cartilages after long-lasting recurrent nerve paralysis

The histological findings in 15 excised arytenoid cartilages are reported. In all the cases there was a long-term recurrent nerve paralysis without additional inflammatory disease. In one of the cases there was fibrous ankylosis of the crico-arytenoid joint. This is the first report made on the histological findings in the arytenoid cartilage in cases of paralysis. It is confirmed that there are differences in joint pathology between cases of immobility due to inflammatory conditions and those due to pure noninflammatory recurrent paralysis. The fixation caused by arthritis of the joint has a relatively poor prognosis after surgery while, if the fixation is due to recurrent nerve paralysis, the chances of recovery are good in long-term cases.

The effects of lignocaine spray on the laryngeal mucosa of the cat

The laryngeal mucosa of cats which had been treated with a lignocaine aerosol spray prior to endotracheal intubation was examined histologically. A degree of oedema and cell damage was apparent. When one side of the larynx was sprayed before intubation and the other side protected in the same cat, cellular damage was greater on the side which received the lignocaine spray. In no cat were the changes considered severe enough to constitute a post-anaesthetic hazard.

Computed tomography vs. histology of laryngeal cancer: their value in predicting laryngeal cartilage invasion

Twenty-seven cancerous larynges were examined preoperatively by computed tomography and postoperatively by transaxial anatomic sections. Data from this correlative study provides a new radiographic classification based upon the relationship of the plane of maximal tumor size to the apex, body, or vocal process of the arytenoid. Unlike those tumors whose maximal size lies at or above the apex of the arytenoid, those below have a very high association with cartilage invasion (8% in former group, 86% in latter group). This is explained by our observation of sites of predilection of tumor invasion of the thyroid, cricoid, and arytenoid cartilages. At these sites collagen fibers have been observed to pass through the perichondrium and attach directly to cartilage. These same fibers may serve as a pathway to direct growth of tumor cells. There was no correlation between six histologic parameters and the presence of cartilage invasion.

[Histological findings of 15 excised arytenoid cartilages after long-lasting recurrent nerve paralysis (author's transl)]

Histological findings of 15 excised arytenoid cartilages are reported. In all cases there was a long-term recurrent nerve paralysis without additional inflammatory disease. In one of the cases there was fibrosed ankylosis of the cricoarytenoid joint. This is the first report made on the histological findings of the arytenoid cartilage in cases of paralysis. It is confirmed that there is a difference in the joint pathology in cases of immobility due to inflammatory conditions and pure non inflammatory recurrent paralysis. The fixation caused by arthritis of the joint has relatively poor prognosis after surgery while if fixation is due to recurrent nerve paralysis the chances of recovery are good in long-term paralysis.

[Relapsing polychondritis. A case report with special reference to otolaryngological manifestations]

Relapsing polychondritis is a rare disease of unknown etiology. The symptomatology is characterised by inflammatory and degenerative changes of multiple cartilaginous structures. --In this peculiar case the nose, the larynx and the cartilages of the ribs and of one hand were involved. Distinct inflammatory changes of the left vocal cord were seen. The diagnosis of the disease was assured by the presented electron microscopic studies. Treatment with high doses of corticosteroids did not prove effective. The disease process could only be controlled by in immunosuppressive combination therapy with prednisone, and cyclophosphamide. --Characteristic clinical features, diagnosis, pathogenesis and therapeutical problems are discussed.

Congenital laryngeal stridor secondary to flaccid epiglottis, anomalous accessory cartilages and redundant aryepiglottic folds

Most laryngeal anomalies are supraglottic and laryngomalacia is the most common. Cysts, bifid epiglottis and absence of the epiglottis are uncommon. An 18-year-old Caucasian man had long-standing stridor caused by anomalous supraglottic structures: a small floppy epiglottis, enlarged accessory cartilages and redundant aryepiglottic folds. These structures were excised and the airway was improved. The ventral portions of the fourth arches become the aryepiglottic folds and lateral segments of the epiglottis. A disturbance in this portion of the fourth arch may explain the anomaly. The cartilaginous contributions to the epiglottis were possibly isolated as accessory cartilages. Epiglottic anomalies may be associated with other anomalies, especially the digits of the hand. This patient had a short lingual frenulum and mild macroglossia.

Chronic chondritis of the equine arytenoid cartilage

Chronic chondritis of the arytenoid cartilage was diagnosed in 7 male Thoroughbred horses examined for obstructive upper airway disorders. The history of the cases was characterized by a 3- to 6-month progression of exercise intolerance and inspiratory dyspnea during exercise. Endoscopy revealed marked asymmetry of the rima glottidis, partial or complete inability to abduct the involved cartilage, and axial displacement of the involved arytenoid cartilage. In less severe cases, the disorder was confused with laryngeal hemiplegia. Focal elevated lesions of the involved cartilage, which were frequently seen, produced contact lesions on the contralateral cartilage. Subtotal arytenoidectomy was performed in 6 cases. Histologic examination of the removed cartilages revealed marked lamination of the cartilage with fibrous connective tissue. Granulating sinus tracts were seen in 3 cases. The surgical intervention resulted in marked improvement of exercise intolerance in 5 cases.