Assessment of thyroid cartilage ossification pattern in cancer patients: A suggestion of active ossification by tumor progression

BACKGROUND

Ossified cartilage is much more susceptible to cancer infiltration, but the reason remains unknown, and the relationship between the ossification pattern and cancer infiltration has not been studied.

METHODS

The presence of thyroid cartilage ossification, cancer infiltration, ossification pattern (usual: direction from inferior to superior; unusual: other than the usual pattern), and distance between cancer and ossified cartilage were evaluated in laryngectomy specimens.

RESULTS

There were 28 and 27 cases of usual and unusual patterns, respectively. There was no association between ossification pattern and cancer infiltration. However, the distance between the ossified area and cancer cells was greater in the usual pattern than in the unusual pattern (p = 0.006). And the usual pattern was more frequently observed in cases with a distance >1 mm than in cases with cancer infiltration or a distance ≤1 mm (p = 0.004).

CONCLUSION

These results suggest the possibility of an active ossification due to tumor progression.

The clinical value of DCE-MRI for differentiating secondary laryngeal cartilage lesions

To explore the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the assessment of laryngeal cartilage lesions. In this study, 3 groups of cases were selected, including 16 cases benign lesions of the laryngopharynx as the benign group, 17 cases malignant lesions of laryngopharynx as the malignant group and 23 healthy adults as the control group. Conventional magnetic resonance imaging and DCE-MRI were performed with a 3.0 T MR scanner. cutoff, sensitivity, specificity and area under the curve values were calculated via receiver operating characteristic curve analysis based on the pathologic findings of surgically resected specimens. There were significant differences in the values of the volume transfer constant (Ktrans), the rate constant between the extravascular extracellular space and blood plasma (Kep) and The extravascular extracellular space fractional volume (Ve) between the control, benign and malignant groups (P < .005). Among the 3 groups, the malignant group had the highest Ktrans and Ve values (0.8681 ± 0.3034 and 0.6186 ± 0.2405, respectively), and the benign group had the highest Kep value (2.445 ± 0.7346). The cutoff points of the Ktrans, Kep, and Ve values of the control, benign and malignant groups were 0.39, 1.261, and 0.195; 0.471, 0.964, and 0.235; and 0.706, 2.005, and 0.659, respectively. The Ktrans, Kep, and Ve values obtained via DCE-MRI may enable differentiating laryngeal cartilage lesions. DCE-MRI can be used to evaluate laryngeal cartilage lesions accurately and quantitatively.

Laryngeal fracture presentation and management in United States emergency rooms

OBJECTIVES/HYPOTHESIS

There are limited data on laryngeal fracture presentation and management in US emergency departments (EDs). We aimed to characterize patients who are diagnosed with laryngeal fractures in the ED and identify management patterns.

STUDY DESIGN

Retrospective review of the Nationwide Emergency Department Sample (NEDS) from 2009 to 2011.

METHODS

The NEDS was queried for patient visits with a primary diagnosis of open or closed laryngeal fracture (International Classification of Diseases, Ninth Revision codes 807.5 and 807.6). Patient demographics, comorbidities, ED management, and hospital characteristics were extracted.

RESULTS

There were 3,102 ED visits with a diagnosis of laryngeal fracture during the study period. Mean patient age was 40.9 years (range, 3-93 years). The majority of patients were male (85.5%) and sustained a closed (vs. open) fracture (91.4%), with an overall mortality rate of 3.8%. The majority of patients were treated for more than one injury during the same visit (76.2%). Most patients were evaluated at a trauma hospital (53.9%), and most patients were admitted to the hospital (71.9%). Emergent intubation or tracheostomy was rarely reported (2.6% and 0.1% of all cases), and a minority of patients underwent fiberoptic flexible laryngoscopy in the ED (1.9%). Laryngeal fractures occurred more frequently during summer months (28.2%). Mean charge for the entirety of the ED stay was $4,957.34.

CONCLUSIONS

Laryngeal fracture is rare and frequently associated with other injuries. The frequency of emergent airway procedure, imaging, and flexible fiberoptic laryngoscopy is lower than expected, raising concerns about appropriate workup and management or recognition of injury in the ED setting.

LEVEL OF EVIDENCE

NA Laryngoscope, 129:2341-2346, 2019.

Construction of tissue-engineered laryngeal cartilage with a hollow, semi-flared shape using poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) as a scaffold

The aim of the present study was to construct tissue-engineered laryngeal cartilage with a hollow, semi-flared shape using a poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHH) scaffold. Porous PHBHH was prepared and formed into a hollow, semi-flared shape, and the cell-material composites were cultured for one week in vitro prior to implantation in vivo. Cells of the nine rabbits of the experimental group were filled and encapsulated in the myofascial flap-shaping material composite for in situ implantation. The three rabbits in the control group were treated with the shaping material without the chondrocytes. Cartilage regeneration was assessed at six, 12 and 18 weeks after surgery. In the experimental group, the shape and porosity of the material were ideal, the cells exhibited good adhesion with the material and the myofascial flap blood supply was rich. The engineered laryngeal cartilage with the hollow, semi-flared shape was ideally formed, and the cartilage formed at six weeks after the surgery. Further maturation of the cartilage was observed at 12 and 18 weeks after the surgery. PHBHH was a suitable material for the formation of a hollow, semi-flared shape with good cellular compatibility. Myofascial flap filling and wrapping can be used to build tissue-engineered laryngeal cartilage with a hollow, semi-flared shape.