Changes in Rima Glottidis Area and Lack of Laryngeal Epiglottic–Glottic Seal After Unilateral Cricoarytenoid Lateralization <i>Ex Vivo</i>

Guillemot, Alexandre; Rouvre, Gérald; Autefage, A.; Etchepareborde, S.

doi:10.1111/j.1532-950x.2014.12300.x

Cited by 3 publications

(16 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…14,[21][22][23]26,27 Over the years, the literature has shifted practice away from procedures which dramatically increase the RGA to those that provide a moderate increase in order to lessen the risk of aspiration through better preservation of the LEGS. 11,14,20,21,23,27 The Hagen-Poiseuille equation describes the impact of airway radius on the physics of laminar gas flow, principally, that airway resistance is inversely proportional to the airway radius to the fourth power. Based on our results, the average increase in RGA following a TEA would equate to an estimated 84% decrease in airway resistance using this calculation.…”

Section: Discussionmentioning

confidence: 99%

“…Across these UAL techniques, there was an average increase in RGA of 180.07% (173.68–186.45), while the TEA yielded an average 157.00% (Table 1). Many studies evaluating surgical treatment for canine laryngeal paralysis have shown that only a small increase in RGA is required to provide relief of clinical signs 14,21–23,26,27 . Over the years, the literature has shifted practice away from procedures which dramatically increase the RGA to those that provide a moderate increase in order to lessen the risk of aspiration through better preservation of the LEGS 11,14,20,21,23,27 .…”

Section: Discussionmentioning

confidence: 99%

“…Cadaveric airways have been utilized as models for canine laryngeal paralysis in several studies evaluating surgical effects on RGA and airway resistance 20–27 . The lack of muscle tone in the canine cadaver larynges causes passive adduction of both arytenoid cartilages, emulating a state of bilateral laryngeal paralysis.…”

Section: Discussionmentioning

confidence: 99%

“…Cadaveric airways have been utilized as models for canine laryngeal paralysis in several studies evaluating surgical effects on RGA and airway resistance. [20][21][22][23][24][25][26][27] The lack of muscle tone in the canine cadaver larynges causes passive adduction of both arytenoid cartilages, emulating a state of bilateral laryngeal paralysis. The epiglottis can be manually opened or closed to simulate inspiration and protection of the airway during swallowing, respectively.…”

Section: T a B L Ementioning

confidence: 99%

“…Guillemot, et al examined the effects of variable suture placement, tension, and joint disarticulation during UAL on LEGS in the sagittal plane and found that all variants of UAL impacted the LEGS, with more aggressive dissections causing greater disruption. 23 The preservation of LEGS after TEA is likely due to the relatively lower magnitude increase in RGA and lack of laryngeal dissection. Since UAL anchors the arytenoid cartilage in abduction to a relatively fixed cricoid cartilage, the change in the LEGS and its contribution to risk of aspiration are static.…”

Section: T a B L Ementioning

confidence: 99%

See 4 more Smart Citations

Description and evaluation of a novel transoral endoscopic arytenopexy in canine cadavers

2022

View full text Add to dashboard Cite

Objective To describe the transoral endoscopic arytenopexy (TEA) and evaluate its effects on the rima glottis area (RGA) and laryngeal epiglottic‐glottic seal (LEGS). We hypothesize the TEA will be a feasible surgical technique and the TEA will provide a significant increase in RGA with minimal change to the LEGS. Study design Canine cadaveric model. Animals Fifteen medium‐ to large‐breed canine cadavers. Methods Endoscopic photos of the larynx were taken with the epiglottis open for baseline RGA measurement and closed for baseline measurement of exposed RGA and LEGS. A custom endoscopic gag port (EGP) facilitated the TEA, performed by suturing the lateral aspect of the left arytenoid soft tissues to adjacent pharyngeal wall across the piriform recess. Endoscopic photos were repeated to measure changes in RGA and LEGS. A computerized planimetric analysis program was used to calculate baseline RGA and LEGS. The RGA was reported in % change from baseline. The LEGS was reported as intact or altered. A nonparametric Wilcoxon signed‐rank test was used to compare baseline to post‐TEA RGA. Results The mean baseline RGA was 0.52 ± 0.28 cm3 and mean post‐TEA RGA was 0.78 ± 0.37 cm3 (p‐value < .0001). The LEGS remained intact post‐TEA in all cadavers. Conclusions The TEA was technically feasible and resulted in an increase in RGA while maintaining the LEGS. Clinical significance The TEA may provide a minimally invasive addition to the established techniques for reducing airway resistance while minimizing the impact on the LEGS.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: T a B L Ementioning

confidence: 99%

Section: T a B L Ementioning

confidence: 99%

See 3 more Smart Citations

Description and evaluation of a novel transoral endoscopic arytenopexy in canine cadavers

2022

View full text Add to dashboard Cite

show abstract

Evaluation of two unilateral laryngoplasty techniques and their effect on arytenoid cartilage abduction in cats

Bonanno¹,

White

2023

Journal of Feline Medicine and Surgery

View full text Add to dashboard Cite

Objectives The aim of this study was to evaluate two unilateral laryngoplasty (arytenoid lateralisation) techniques for use in the surgical management of laryngeal paralysis in cats. Methods Left cricoarytenoid abduction (lateralisation) was performed in 20 ex vivo cat larynges; 10 following complete cricoarytenoid disarticulation (group LAA-dis) and 10 following no cricoarytenoid disarticulation (group LAA-nodis). For both groups, left arytenoid abduction (LAA) was measured in the resting and postoperative larynges using image analysis software. Measurements were evaluated using the Mann–Whitney U-test. For both groups, dorsal images of the postoperative larynges were assessed visually for evidence of epiglottic coverage of the entrance to the larynx. Results The mean percentage increase in LAA was 311.5% and 199.4% ( P <0.006) for group LAA-dis (complete cricoarytenoid disarticulation) and group LAA-nodis (no cricoarytenoid disarticulation), respectively. In both groups, there was no evidence of a lack of epiglottic coverage of the entrance of the larynx for any of the postoperative larynges. Conclusions and relevance Placement of a single, tensioned suture between the muscular process of the left arytenoid cartilage and the caudolateral aspect of the ipsilateral cricoid cartilage (unilateral cricoarytenoid lateralisation) resulted in abduction of the left arytenoid cartilage and a corresponding increase in the area of the rima glottidis on the operated side. The clinical significance of the difference in outcome between left cricoarytenoid abduction following complete cricoarytenoid disarticulation and abduction following no cricoarytenoid disarticulation remains unclear, and both might be considered appropriate for the surgical management of laryngeal paralysis in the cat.

show abstract

Effects of a novel, 3D printed bilateral arytenoid abductor on canine laryngeal airway resistance ex vivo

MacGillivray

Bellefeuille

Hoffmann³

et al. 2022

BMC Vet Res

View full text Add to dashboard Cite

Background Laryngeal paralysis is a disease process most commonly seen in older, large breed dogs. When both arytenoid cartilages are affected dogs can develop life-threatening respiratory compromise, therefore surgical intervention is recommended. While there are multiple surgical procedures that have been described to treat laryngeal paralysis, there remains a considerable risk for postoperative complications, most commonly aspiration pneumonia. The objective of this ex vivo experimental study was to evaluate the effects of a novel, 3D printed bilateral arytenoid abductor on laryngeal airway resistance in canine cadaver larynges. Laryngeal airway resistance was calculated for each specimen before (control) and after placement of a 3D printed, bilateral arytenoid abductor. The airway resistance was measured at an airflow of 10 L/min with the epiglottis closed and at airflows ranging from 15 L/min to 60 L/min with the epiglottis open. The effects of the bilateral arytenoid abductor on laryngeal airway resistance were evaluated statistically. Results With the epiglottis open, median laryngeal airway resistance in all larynges with a bilateral arytenoid abductor were significantly decreased at airflows of 15 L/min (0.0cmH2O/L/sec), 30 L/min (0.2cmH2O/L/sec), and 45 L/min (0.2cmH2O/L/sec) compared to the controls 15 L/min (0.4cmH2O/L/sec; P = 0.04), 30 L/min (0.9cmH2O/L/sec; P = 0.04), and 45 L/min (1.2cmH2O/L/sec; P = 0.04). When the epiglottis was closed, there was no significant difference in laryngeal resistance between the control (18.8cmH2O/L/sec) and the abducted larynges (18.1cmH2O/L/sec; P = 0.83). Conclusions Placement of a bilateral arytenoid abductor reduced laryngeal resistance in canine cadaver larynges compared to the controls when the epiglottis was open. With the epiglottis closed, there was no loss of laryngeal resistance while the device abducted the arytenoid cartilages. The results of this ex vivo study is encouraging for consideration of further evaluation of the bilateral arytenoid abductor to determine an appropriate material and tolerance of this device in vivo.

show abstract

Changes in Rima Glottidis Area and Lack of Laryngeal Epiglottic–Glottic Seal After Unilateral Cricoarytenoid Lateralization Ex Vivo

Cited by 3 publications

References 18 publications

Description and evaluation of a novel transoral endoscopic arytenopexy in canine cadavers

Description and evaluation of a novel transoral endoscopic arytenopexy in canine cadavers

Evaluation of two unilateral laryngoplasty techniques and their effect on arytenoid cartilage abduction in cats

Effects of a novel, 3D printed bilateral arytenoid abductor on canine laryngeal airway resistance ex vivo

Contact Info

Product

Resources

About