Three‐dimensional arytenoid movement induced by vocal fold injections

Mau, Ted; Weinheimer, Kent T.

doi:10.1002/lary.20973

Cited by 10 publications

(8 citation statements)

References 13 publications

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“…Rather, further medialization of the posterior membranous vocal fold is likely produced by passive movement of the vocal process as the vocal ligament is further medialized by the additional bolus. 5 …”

Section: Discussionmentioning

confidence: 99%

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Three‐Dimensional Conformation of the Injected Bolus in Vocal Fold Injections in a Cadaver Model

Mau

Brewer

Gatzert

et al. 2011

Otolaryngol.--head neck surg.

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Objective To determine the 3-dimensional (3D) conformation of the injected bolus in the larynx in vocal fold injections, to understand how the bolus interacts spatially with elements of the laryngeal framework, and to relate the above to clinical observations in performing vocal fold injections. Study Design Excised cadaveric larynx study. Setting Laboratory. Subjects and Methods Vocal folds of 12 human excised cadaveric larynges were injected with calcium hydroxylapatite. High-resolution computed tomography scans were obtained of the injected larynges. Densities corresponding to the injected bolus and the laryngeal framework were extracted and processed with MATLAB routines to generate selective 3D reconstructions of the injected bolus within the laryngeal framework. Histology analysis was also performed to correlate with observations from the 3D reconstructions. Results Boluses injected into the lateral aspect of the thyro-arytenoid muscle tended to be irregularly shaped, appeared to fill up the paraglottic space, and were associated with significant muscle compression. The vertical thickness of the injected boluses averaged 9.5 mm for lateral boluses and 7.6 mm for medial boluses, which were comparable to the vertical thickness of uninjected vocal folds. Conclusion Laterally injected boluses are shaped by spatial constraints imposed by elements of the laryngeal framework. Compression of vocal fold muscle may be a mechanism accounting for stiffness from overinjection. The irregular shapes of some boluses may affect the outcome of subsequent medialization attempts. Injections may enhance the vocal fold contact height as a favorable effect beyond simple medialization.

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Section: Discussionmentioning

confidence: 99%

“…5 Densities corresponding to the object of interest were extracted using hand-drawn masks and built-in filters in Adobe Photoshop CS2 (version 9.0; Adobe, San Jose, California). The extracted images were imported into MATLAB 7.8.0 (The MathWorks, Natick, Massachusetts) and processed with custom routines to generate 3D surface plots.…”

Section: Methodsmentioning

confidence: 99%

Three‐Dimensional Conformation of the Injected Bolus in Vocal Fold Injections in a Cadaver Model

Mau

Brewer

Gatzert

et al. 2011

Otolaryngol.--head neck surg.

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show abstract

“…7 CT images were imported into Adobe Photoshop CS2 (Version 9.0; Adobe, San Jose, CA). Densities corresponding to the arytenoid and cricoid cartilages were extracted using hand-drawn masks and Photoshop filters.…”

Section: Materials and Methods Clinical Historymentioning

confidence: 99%

“…The mirrored arytenoid was then transformed by the MATLAB hgtransform function to match the subluxed arytenoid with the method described in the study by Mau and Weinheimer. 7 The complex transformation is defined by three translational components and three rotational components, with the origin of rotation at the center of mass of the arytenoid being transformed. Matching was performed interactively on the computer graphics window by manipulating the six parameters individually to obtain the best visual overlap of the two 3D surfaces of the arytenoids.…”

Section: Quantification Of Arytenoid Subluxationmentioning

confidence: 99%

Three-Dimensional Morphometric Analysis of Cricoarytenoid Subluxation

Mau

2012

Journal of Voice

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“…Posterior glottic insufficiency can be challenging to address. Well-known therapeutic options are injection augmentation [20,21] and medialization thyroplasty [22], performed with or without arytenoid adduction [23] or arytenopexy [24]. However, injection augmentation or medialization thyroplasty are better suited to correct more anterior located glottic insufficiencies, rather than the more difficult to correct posterior glottic insufficiencies [13][14][15][16].…”

Section: Therapeutic Options For Posterior Glottic Insufficiencymentioning

confidence: 99%

Superomedial partial arytenoidectomy for voice improvement by correction of posterior glottic insufficiency

Mahieu

Heuveling

Mahieu

2020

Eur Arch Otorhinolaryngol

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Purpose Arytenoid resection is a well-known intervention to improve glottic airway. Superomedial partial arytenoidectomy (SPA) can also be used for voice improvement by correcting posterior glottic insufficiency in patients with an obstructing anteromedially prolapsed arytenoid. Posterior glottic insufficiency can be difficult to address and traditionally involves challenging arytenoid repositioning procedures. This study aimed to compare postoperative functional voice outcomes in patients who underwent SPA to pre-operative voice status. Second, consequences of concomitant injection augmentation in patients who underwent SPA were studied. Additionally, presenting the surgical technique. Methods In this retrospective cohort study, pre-operative and postoperative clinical data of patients who underwent SPA between 2004 and 2018 were analyzed. Both short-and long-term voice outcomes were assessed using Voice Handicap Index (VHI) and maximum phonation time (MPT). Pre-to postoperative assessment changes (delta: δ) were applied to multivariate analyses. Results A total of 105 patients were included, of which 91 had hemilaryngeal immobility, 25 had undergone previous phonosurgical procedures and 45 received concomitant injection augmentation. Patients who underwent SPA had significant improvement of VHI and MPT. In 81% of our population, laryngeal framework surgery was avoided. Multivariate analyses showed significantly improved short-term voice outcomes in patients who received injection augmentation concomitantly to SPA. Finally, δMPT was a significant predicting factor regarding additional procedures in patients who underwent SPA. Conclusion SPA is a safe and efficient procedure for voice improvement in patients with posterior glottic insufficiency due to an obstructing anteromedially prolapsed arytenoid. We recommend performing this procedure combined with injection augmentation.

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Three‐dimensional arytenoid movement induced by vocal fold injections

Cited by 10 publications

References 13 publications

Three‐Dimensional Conformation of the Injected Bolus in Vocal Fold Injections in a Cadaver Model

Three‐Dimensional Conformation of the Injected Bolus in Vocal Fold Injections in a Cadaver Model

Three-Dimensional Morphometric Analysis of Cricoarytenoid Subluxation

Superomedial partial arytenoidectomy for voice improvement by correction of posterior glottic insufficiency

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