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Yamaguchi T, Itagaki H, Endo T. Post-traumatic Delayed Bilateral Vocal Cord Paralysis Caused by Cervical Osteophytes: A Case Report. Cureus 2024; 16:e64189. [PMID: 39130864 PMCID: PMC11310360 DOI: 10.7759/cureus.64189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 08/13/2024] Open
Abstract
Vocal fold paralysis occurs when the function of the vagus nerve or its distal branch, the recurrent laryngeal nerve, is diminished or absent. Bilateral vocal fold paralysis can present with varying degrees of severity and is sometimes fatal. Cervical osteophytes are a rare cause of bilateral vocal fold paralysis, with only a few cases reported. A 68-year-old man was brought to the emergency department because of a disturbance in consciousness following a fall. A CT scan of the head showed multiple cranium and brain injuries, and the patient was treated conservatively by neurosurgery. The day after the injury, dysphagia and dysarthria appeared. On the third day of admission, both vocal cords were fixed bilaterally in the paramedian position, and the patient was nearly choking on sputum. A CT scan showed that the intracranial lesions gradually improved, but the vocal cord paralysis remained. A cervical CT scan was performed to investigate the cause of the vocal cord paralysis, which revealed that cervical vertebral osteophytes were compressing the tracheoesophageal groove and the glottis. The patient was transferred to the hospital for rehabilitation, although bilateral vocal cord paralysis remained. Although rare, clinicians need to be aware that cervical osteophytes can cause vocal fold paralysis, which may be manifested when combined with further trauma. It is also important to note that traumatic vocal cord paralysis can be delayed.
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Affiliation(s)
- Takuya Yamaguchi
- Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, Miyagi, JPN
| | - Hideya Itagaki
- Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, Miyagi, JPN
| | - Tomoyuki Endo
- Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, Miyagi, JPN
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Ehret J, Thomas A, Penn DL, Kaplan S. Delayed Bilateral Vocal Cord Paralysis Following Cervical Spine Trauma. Cureus 2023; 15:e39891. [PMID: 37404428 PMCID: PMC10315223 DOI: 10.7759/cureus.39891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
Bilateral vocal cord paralysis is a potentially life-threatening condition, depending on the position in which the vocal cords are paralyzed. When the vocal cords are fixed in adduction, patients develop respiratory distress, inspiratory stridor, aspiration, and minimal phonation deficits. This condition can result from acute injuries to the right and left recurrent laryngeal nerves, or from chronic bilateral recurrent laryngeal nerve palsy. The clinical presentation is variable with such nerve injuries. Traumatic injuries to the cervical spine are an uncommon cause of this condition. In this report, we describe a patient who developed progressive respiratory distress, inspiratory stridor, and dysphagia to liquids several weeks after suffering major trauma to the head and neck. Laryngoscopy revealed immobile bilateral vocal cords fixed in the paramedian position, resulting in severe airway obstruction that warranted an emergency tracheostomy.
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Affiliation(s)
- Jane Ehret
- Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, USA
| | - Andrew Thomas
- Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, USA
| | - David L Penn
- Neurosurgery, Vassar Brothers Medical Center, Poughkeepsie, USA
| | - Stanley Kaplan
- Pulmonary and Critical Care, Vassar Brothers Medical Center, Poughkeepsie, USA
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Biehl A, Colmon R, Timofeeva A, Gracioso Martins AM, Dion GR, Peters K, Freytes DO. Scalable and High-Throughput In Vitro Vibratory Platform for Vocal Fold Tissue Engineering Applications. Bioengineering (Basel) 2023; 10:602. [PMID: 37237672 PMCID: PMC10215097 DOI: 10.3390/bioengineering10050602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
The vocal folds (VFs) are constantly exposed to mechanical stimulation leading to changes in biomechanical properties, structure, and composition. The development of long-term strategies for VF treatment depends on the characterization of related cells, biomaterials, or engineered tissues in a controlled mechanical environment. Our aim was to design, develop, and characterize a scalable and high-throughput platform that mimics the mechanical microenvironment of the VFs in vitro. The platform consists of a 24-well plate fitted with a flexible membrane atop a waveguide equipped with piezoelectric speakers which allows for cells to be exposed to various phonatory stimuli. The displacements of the flexible membrane were characterized via Laser Doppler Vibrometry (LDV). Human VF fibroblasts and mesenchymal stem cells were seeded, exposed to various vibratory regimes, and the expression of pro-fibrotic and pro-inflammatory genes was analyzed. Compared to current bioreactor designs, the platform developed in this study can incorporate commercial assay formats ranging from 6- to 96-well plates which represents a significant improvement in scalability. This platform is modular and allows for tunable frequency regimes.
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Affiliation(s)
- Andreea Biehl
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, 4130 Engineering Building III, Campus Box 7115, Raleigh, NC 27695, USA (R.C.); (A.M.G.M.)
- Comparative Medicine Institute, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27606, USA
| | - Ramair Colmon
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, 4130 Engineering Building III, Campus Box 7115, Raleigh, NC 27695, USA (R.C.); (A.M.G.M.)
- Comparative Medicine Institute, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27606, USA
| | - Anastasia Timofeeva
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA; (A.T.); (K.P.)
| | - Ana Maria Gracioso Martins
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, 4130 Engineering Building III, Campus Box 7115, Raleigh, NC 27695, USA (R.C.); (A.M.G.M.)
- Comparative Medicine Institute, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27606, USA
| | - Gregory R. Dion
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH 45267, USA;
| | - Kara Peters
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA; (A.T.); (K.P.)
| | - Donald O. Freytes
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, 4130 Engineering Building III, Campus Box 7115, Raleigh, NC 27695, USA (R.C.); (A.M.G.M.)
- Comparative Medicine Institute, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27606, USA
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Arens C, Müller AH. [Management of blunt and penetrating laryngeal trauma]. HNO 2023; 71:28-34. [PMID: 36264298 DOI: 10.1007/s00106-022-01238-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 01/18/2023]
Abstract
Patients presenting with laryngotracheal trauma can be in a life-threatening situation. Early recognition of the severity of the injury and, if necessary, surgical intervention within the first 24-48 h increases the chance of achieving a good functional late result. Preservation or restoration of voice and swallowing function is the long-term therapeutic goal. Precise assessment of the extent of the injury can be achieved using a combination of computed tomography and flexible laryngotracheoscopy. Symptoms often do not reflect the extent of the injury, which can vary from endolaryngeal hemorrhage to complete laryngotracheal separation. Conservative treatment consists of observation with symptomatic therapy. On the other hand, surgery may include endolaryngeal repair and/or transcervical reconstruction; securing the airways is of utmost importance.
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Affiliation(s)
- Christoph Arens
- Zentrum für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen, Klinikstraße 33, Ebene 1, 35392, Gießen, Deutschland.
| | - Andreas H Müller
- Klinik für HNO-Heilkunde/Plastische Operationen, SRH Wald-Klinikum Gera, Straße des Friedens 122, 07548, Gera, Deutschland.
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Fukumoto W, Mitani H, Kuno Y, Higaki T, Tatsugami F, Nakamura Y, Nagao M, Awai K. Incidence and factor analysis of laryngohyoid fractures in hanging individuals-computed tomography study. Eur Radiol 2021; 31:7827-7833. [PMID: 33864138 DOI: 10.1007/s00330-021-07932-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/12/2021] [Accepted: 03/24/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Although laryngohyoid fracture indicates the applied neck pressure and is an important finding in hanging individuals, the reported rate varies widely and its true incidence remains controversial. We used computed tomography (CT) studies to investigate the incidence of laryngohyoid fracture in hanging individuals and identify factors contributing to such fractures. METHODS Considered for inclusion in this study were 107 attempted or successful hanging individuals subjected to CT studies between 2005 and 2019. After excluding 19 whose images were inadequate for evaluation, 88 subjects were included. Body suspension was complete in 20, partial in 49, and unknown in 19; 54 (61.4%) individuals died. Two radiologists performed image analysis and recorded the presence and site of laryngohyoid fractures. Multiple logistic regression analysis was used for factor analysis of laryngohyoid fractures; it included the gender, the age (< or ≧ 40 years), the type of suspension (complete or incomplete), and the outcome (death or survival). RESULTS Of the 88 subjects, 35 (39.8%) presented with laryngohyoid fractures on CT images; the superior horn of the thyroid cartilage was fractured in 32 (91.4%) of the 35. Age was the only factor significantly related to laryngohyoid fracture (odds ratio = 2.85, 95% confidence interval = 1.08-7.52). CONCLUSIONS In hanging individuals, the incidence of laryngohyoid fracture on CT images was 39.8%. The superior horn of the thyroid cartilage was the most frequent fracture site. KEY POINTS • The incidence of laryngohyoid fracture on CT images of hanging individuals was almost 40%; the superior horn of the thyroid cartilage was the most frequent fracture site. • In older hanging individuals, attention must be paid to laryngohyoid fractures on CT images.
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Affiliation(s)
- Wataru Fukumoto
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
- Center for Cause of Death Investigation Research, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Hidenori Mitani
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Yuka Kuno
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Toru Higaki
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Fuminari Tatsugami
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Yuko Nakamura
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Masataka Nagao
- Center for Cause of Death Investigation Research, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
- Center for Cause of Death Investigation Research, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
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Cricotracheal separation: do not get fooled by what you see. Eur Arch Otorhinolaryngol 2020; 278:471-476. [PMID: 32592012 DOI: 10.1007/s00405-020-06140-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Laryngeal involvement in neck trauma is quite considerable. The presence of a cricotracheal separation type of injury can be easily missed and overlooked, especially if the neck does not show any external signs. Blunt trauma to the neck affects many anatomical structures inside the intact-looking neck that threatens the victim's life. At exploration, the surgeon must be aware of the full impact of the injury on different neck structures. AIM OF WORK Raise the attention on the proper management of laryngeal trauma victims. PATIENTS AND METHOD This is a retrospective study carried out on 23 patients who suffered from cricotracheal separation as a result of laryngeal trauma. RESULTS Cricotracheal separation is a frequent finding in an innocent-looking neck. The mechanism of the trauma itself is an excellent clue to suspect its presence. CONCLUSION This type of laryngeal injury must be kept in mind and must be suspected. Some recommendations and guidelines are presented on the proper handling of such patients.
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Kunii M, Ishida K, Ojima M, Sogabe T, Shimono K, Tanaka T, Ohnishi M. Bilateral vocal cord paralysis in a hanging survivor: a case report. Acute Med Surg 2020; 7:e519. [PMID: 32528709 PMCID: PMC7280028 DOI: 10.1002/ams2.519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/04/2020] [Accepted: 04/28/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Complications in survivors after typical hanging have not been well characterized because of the high mortality rate. CASE PRESENTATION We present a patient with bilateral vocal cord paralysis following typical hanging. A 39-year-old man with depression attempted suicide by hanging. He was in a coma and was transported to our hospital. Emergency endotracheal intubation was carried out. After 10 days of mechanical ventilation, he was extubated. After extubation, his voice was hoarse and stridor was heard. Vocal cord paralysis became apparent by laryngeal fiberscopy, and a tracheotomy was carried out. It resolved gradually 2 months after injury without surgery or drug treatment. CONCLUSION Although vocal cord paralysis after typical hanging is rare, there is a need for adequate assessment of the airways in survivors of typical hanging as a differential diagnosis of airway edema after extubation.
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Affiliation(s)
- Mayuko Kunii
- Department of Acute Medicine and Critical Care Medical CenterOsaka National HospitalOsakaJapan
| | - Kenichiro Ishida
- Department of Acute Medicine and Critical Care Medical CenterOsaka National HospitalOsakaJapan
| | - Masahiro Ojima
- Department of Acute Medicine and Critical Care Medical CenterOsaka National HospitalOsakaJapan
| | - Taku Sogabe
- Department of Acute Medicine and Critical Care Medical CenterOsaka National HospitalOsakaJapan
| | - Keiichiro Shimono
- Department of Acute Medicine and Critical Care Medical CenterOsaka National HospitalOsakaJapan
| | - Tasuke Tanaka
- Department of Acute Medicine and Critical Care Medical CenterOsaka National HospitalOsakaJapan
| | - Mitsuo Ohnishi
- Department of Acute Medicine and Critical Care Medical CenterOsaka National HospitalOsakaJapan
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
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