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Morita K, Maeda K, Kawahara I, Bitoh Y. Experimental validation of laryngotracheal growth and recurrent laryngeal nerve preservation after partial cricotracheal resection in a growing rabbit model. Pediatr Surg Int 2018; 34:1053-1058. [PMID: 30056481 DOI: 10.1007/s00383-018-4314-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of this study was to confirm laryngotracheal growth and recurrent laryngeal nerve (RLN) preservation after partial cricotracheal resection (PCTR) in a growing rabbit model by performing the procedure in pediatric animals. METHODS Six female Japanese white rabbits, 12 weeks of age, underwent PCTR. The course of the RLN was evaluated during surgery (n = 3). Endoscopic and histologic examinations were performed at 22 weeks of age (n = 6). Four non-operated rabbits, 22 weeks of age, underwent endoscopic and histologic examinations as controls. RESULTS The RLN was preserved at the esophageal side and entered the larynx behind the cricothyroid joint after PCTR. Endoscopic examination showed normal vocal cord movements and the large reconstructed subglottis. Histologically, sufficient submucosal vessels and cartilage growth were identified at the reconstructed larynx. The median inside luminal area at the anastomotic site in the PCTR group was 24.8 mm2 (range 21.8-29.0 mm2), and that at the cricoid cartilage and trachea in the control group was 23.4 mm2 (range 20.0-26.6 mm2) and 25.6 mm2 (range 22.9-28.8 mm2), respectively. CONCLUSION No interference with laryngotracheal growth was seen, and RLN preservation was confirmed after PCTR. Use of PCTR in the pediatric age group seems appropriate.
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Affiliation(s)
- Keiichi Morita
- Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. .,Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan.
| | - Kosaku Maeda
- Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.,Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Insu Kawahara
- Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.,Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Yuko Bitoh
- Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Lee SH, Koh KS, Song WC. Oblique thyroarytenoid muscle in humans: An independent muscle or an accessory belly? Laryngoscope 2018; 128:1634-1638. [PMID: 29332305 DOI: 10.1002/lary.27090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 11/27/2017] [Accepted: 12/18/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to determine the prevalence and morphological variations of the oblique thyroarytenoid (TA) muscle in humans. STUDY DESIGN Cadaveric anatomic dissections. METHODS One hundred hemilarynges from 50 formalin-embalmed cadavers were dissected to investigate the morphology of muscle fibers of the TA muscle. RESULTS Thirty-six (36%) hemilarynges were found to have a distinct oblique belly superficial to the TA muscle. In 28 cases, the belly had a relatively constant origin and an insertion that extended straight onto the TA muscle from the anterosuperior area of the internal surface of the thyroid lamina to the base of the muscular process of the arytenoid cartilage. Eight cases were located in a similar area but with some differences in the origin or insertion features. CONCLUSIONS We proposed that the oblique TA muscle has a high prevalence and probably acts to close and relax the vocal cords. It remains to be determined whether the oblique TA muscle is an independent muscle or an accessory belly of the main TA muscle. LEVEL OF EVIDENCE NA. Laryngoscope, 128:1634-1638, 2018.
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Affiliation(s)
- Shin-Hyo Lee
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ki-Seok Koh
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Wu-Chul Song
- Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
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Su WF, Liu SC, Tang WS, Yang MC, Lin YY, Huang TT. Suture Lateralization in Patients With Bilateral Vocal Fold Paralysis. J Voice 2014; 28:644-51. [DOI: 10.1016/j.jvoice.2013.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
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Fishman JM, Ansari T, Sibbons P, De Coppi P, Birchall MA. Decellularized rabbit cricoarytenoid dorsalis muscle for laryngeal regeneration. Ann Otol Rhinol Laryngol 2012; 121:129-38. [PMID: 22397223 DOI: 10.1177/000348941212100210] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Although considerable progress has been made in regenerative medicine, a quantum step would be the replacement and/or regeneration of functional muscle tissue. For example, although patients' airways can now be successfully replaced with stem cell-based techniques, a much greater patient need would be addressed by regeneration of the muscles required for engineering a functional larynx, in which active movement is critical. The rabbit cricoarytenoid dorsalis muscle was chosen for the present study because it is equivalent to the posterior cricoarytenoid muscle, the only significant abductor muscle in human larynges. METHODS Rabbit cricoarytenoid dorsalis muscles were harvested, and different decellularization methods were compared by use of a combination of histologic, immunohistochemical, and molecular techniques. Decellularized scaffolds were implanted into Sprague-Dawley rats as part of a 2-week biocompatibility study to assess immunogenicity. RESULTS Decellularization with a combination of latrunculin B, potassium iodide, potassium chloride, and deoxyribonuclease resulted in total DNA clearance and reduced levels of major histocompatibility complex class II expression, with relative preservation of the scaffold's structural integrity (collagen, elastin, and glycosaminoglycan content). The scaffolds showed minimal signs of rejection at 2 weeks in a cross-species (xenotransplantation) study. CONCLUSIONS Decellularized laryngeal muscles, which are nonimmunogenic, may provide the optimal scaffold source for the generation of a fully functional tissue-engineered larynx.
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Affiliation(s)
- Jonathan M Fishman
- University College London Institute of Child Health, 30 Guilford St, London WC1N 1EH, United Kingdom
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Perkins JD, Raffetto J, Thompson C, Weller R, Piercy RJ, Pfau T. Three-dimensional biomechanics of simulated laryngeal abduction in horses. Am J Vet Res 2010; 71:1003-10. [DOI: 10.2460/ajvr.71.9.1003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mu L, Sanders I. Sihler's whole mount nerve staining technique: a review. Biotech Histochem 2010; 85:19-42. [PMID: 19572223 DOI: 10.3109/10520290903048384] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Sihler's stain is a whole mount nerve staining technique that renders other soft tissue translucent or transparent while staining the nerves. It permits mapping of entire nerve supply patterns of organs, skeletal muscles, mucosa, skin, and other structures after the specimens are fixed in neutralized formalin, macerated in potassium hydroxide, decalcified in acetic acid, stained in Ehrlich's hematoxylin, destained in acetic acid, and cleared in glycerin. The unique advantage of Sihler's stain over other anatomical methods is that all the nerves within the stained specimen can be visualized in their three-dimensional positions. To date, Sihler's stain is the best tool for demonstrating the precise intramuscular branching and distribution patterns of skeletal muscles, which are important not only for anatomists, but also for physiologists and clinicians. Advanced knowledge of the neural structures within mammalian skeletal muscles is critical for understanding muscle functions, performing electrophysiological experiments and developing novel neurosurgical techniques. In this review, Sihler's stain is described in detail and its use in nerve mapping is surveyed. Special emphasis is placed on staining procedures and troubleshooting, strengths and limitations, applications, major contributions to neuroscience, physiological and clinical significance, and areas for further technical improvement that deserve future research.
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Affiliation(s)
- L Mu
- Upper Airway Research Laboratory, Department of Research, Hackensack University Medical Center, Hackensack, NJ 07601, USA.
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Ge PJ, French LC, Ohno T, Zealear DL, Rousseau B. Model of evoked rabbit phonation. Ann Otol Rhinol Laryngol 2009; 118:51-5. [PMID: 19244964 DOI: 10.1177/000348940911800109] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We describe a method for eliciting phonation in an in vivo rabbit preparation using low-frequency, bipolar pulsed stimulation of the cricothyroid muscles with airflow delivered to the glottis. METHODS Ten New Zealand White breeder rabbits weighing 3 to 5 kg were used in this study. The cricothyroid muscles were isolated bilaterally, and separate pairs of anode-cathode hooked-wire electrodes were inserted into each muscle. A Grass S-88 stimulator and 2 constant-current PSIU6 isolation units were used to deliver bipolar square wave pulses to each cricothyroid muscle, with airflow delivered to the glottis through a cuffed endotracheal tube. RESULTS Phonation was evoked with a 50-Hz, 4-mA stimulus train of 1-ms pulses delivered to each cricothyroid muscle. The pulse trains were on for 2 seconds and were repeated every 5 seconds over a period of 180 minutes. Airflow was delivered at 143 cm3/s, producing phonation measuring 71 to 85 dB sound pressure level. CONCLUSIONS Evoked phonation is feasible in rabbits by use of bipolar stimulation of the cricothyroid muscles with airflow delivered to the glottis. The in vivo rabbit preparation described may provide a useful small animal option for studies of evoked phonation. From the level and consistency of the adduction observed, we hypothesize that current spreading to the underlying adductor muscles and nerves resulted in neural pathway involvement beyond discrete activation of the cricothyroid muscle, providing sufficient approximation of the vocal folds for phonation.
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Affiliation(s)
- Ping Jiang Ge
- Department of Otolaryngology, Vanderbilt University Bill Wilkerson Center for Otolaryngology and Communication Sciences, Nashville, Tennessee 37232-4480, USA
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Yoo PB, Woock JP, Grill WM. Somatic innervation of the feline lower urinary tract. Brain Res 2008; 1246:80-7. [PMID: 18848924 DOI: 10.1016/j.brainres.2008.09.053] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 09/08/2008] [Accepted: 09/13/2008] [Indexed: 11/19/2022]
Abstract
Electrical stimulation of pudendal nerve sensory pathways can evoke excitatory bladder reflexes. However, the precise peripheral innervation pattern of these somatic fibers remains unclear. In adult male cats, we investigated pudendal nerve innervation of the lower urinary tract (LUT) by employing anatomical (Sihler's stain) and electrophysiological (selective electrical nerve stimulation) techniques. The stained specimens revealed differential innervation of the proximal and distal urethrae by fibers derived from the sensory branch of the pudendal nerve. Cranial sensory branch fibers penetrated the prostate to terminate along the intraluminal surface of the urethra, whereas the dorsal nerve of the penis primarily innervated the glans penis. Further examination of the proximal urethra showed a separate pathway (deep perineal nerve) that inserted directly into the external urethral sphincter. These observations were confirmed electrophysiologically by the measured urethral sphincter activity evoked in response to selective nerve stimulation. Electrical activation of the sensory pathway evoked only reflex (latency=8.9+/-1.1 ms) contractions of the urethral muscle, whereas stimulation of the perineal pathway elicited direct (latency=1.3+/-0.1 ms) responses. Our findings identify specific pudendal nerve sensory pathways that can be used potentially to restore bladder function in persons with spinal cord injury and also treat LUT symptoms such as urinary retention.
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Affiliation(s)
- Paul B Yoo
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708-0281, USA.
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Hunter EJ, Titze IR. Refinements in modeling the passive properties of laryngeal soft tissue. J Appl Physiol (1985) 2007; 103:206-19. [PMID: 17412782 DOI: 10.1152/japplphysiol.00892.2006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The nonlinear viscoelastic passive properties of three canine intrinsic laryngeal muscles, the lateral cricoarytenoid (LCA), the posterior cricoarytenoid (PCA), and the interarytenoid (IA), were fit to the parameters of a modified Kelvin model. These properties were compared with those of the thyroarytenoid (TA) and cricothyroid (CT) muscles, as well as previously unpublished viscoelastic characteristics of the human vocal ligament. Passive parameters of the modified Kelvin model were summarized for the vocal ligament, mucosa, and all five laryngeal muscles. Results suggest that the LCA, PCA, and IA muscles are functionally different from the TA and CT muscles in their load-bearing capacity. Furthermore, the LCA, PCA, and IA have a much larger stress-strain hysteresis effect than has been previously reported for the TA and CT or the vocal ligament. The variation in this effect suggests that the connective tissue within the TA and CT muscles is somehow similar to the vocal ligament but different from the LCA, PCA, or IA muscles. Further demonstrating the potential significance of grouping tissues in the laryngeal system by functional groups in the laryngeal system was the unique finding that, over their working elongation range, the LCA and PCA were nearly as exponentially stiff as the vocal ligament. This paper was written in conjunction with an online technical report (http://www.ncvs.org/ncvs/library/tech) in which comprehensive muscle data and sensitivity analysis, as well as downloadable data files and computer scripts, are made available.
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Affiliation(s)
- Eric J Hunter
- National Center for Voice and Speech, The Denver Center for the Performing Arts, Denver, CO 80204, USA.
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Calguner E, Erdogan D, Elmas C, Bahcelioglu M, Gozil R, Ayhan MS. Innervation of the rat anterior abdominal wall as shown by modified Sihler's stain. Med Princ Pract 2006; 15:98-101. [PMID: 16484834 DOI: 10.1159/000090911] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The purpose of this study was to use the modified Sihler's staining technique to demonstrate detailed distribution of the rat anterior abdominal wall nerves and test the value of Sihler's technique in demonstrating such a complex muscle-nerve relationship. MATERIALS AND METHODS The anterior abdominal walls of 5 Wistar rats were isolated by making a deep incision from the costal arches on each side down to the inguinal region and processed using a modified Sihler's stain technique. RESULTS This technique was successfully applied to visualize the innervation of the anterior abdominal wall muscles of the rat. The segmental nerves of T6-L1 and their terminal branches were shown and possible motor and sensory fibers identified. CONCLUSIONS This technique is valuable in understanding the complex nature of final branching of the nerve endings, and it may be useful for studying experimental nerve models.
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Affiliation(s)
- Engin Calguner
- Department of Anatomy, School of Medicine, University of Gazi, Ankara, Turkey
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