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RESUMEN Introducción: La tomografía computarizada es el estudio Gold standard para complementar a la endoscopia en el estudio de patologías laríngeas. Por lo tanto, se debe tener conocimiento de la anatomía normal de la laringe. Metodología: Se realizó un estudio observacional descriptivo, de corte transversal retrospectivo. Se recolecto los datos a través del análisis tomográfico, se analizaron 26 tomografías de pacientes que acudieron al Servicio de Imágenes del Hospital de Clínicas sin patología laríngea. Las variables investigadas fueron características tomográficas como: Calcificación cartílagos laríngeos, Altura cartílago tiroideo, Distancia tiro-aritenoidea, Distancia interaritenoidea, Altura y diámetro del espacio preepiglótico. Resultados: Se lograron identificar cada una de las características anatómicas radiológicas buscadas. Además, se realizaron las mediciones correspondientes, detallando el promedio de cada una de las mediciones y clasificándolo por sexo. La altura de cartílago tiroideo la media en hombres fue 28.05±1.2 mm y en mujeres fue 27.8±0.92 mm, para la distancia Tiro-aritenoidea en hombres fue 12.3±1.3 y en mujeres 10.97±0.95 mm, para el diámetro transversal del cartílago tiroideo en hombres fue 16.63±1.58 mm y en mujeres 17.96±1.11 mm. Conclusión: Los promedios de las mediciones realizadas fueron mayor en hombres excepto en el diámetro transversal del cartílago tiroideo, La prevalencia de calcificación de cartílagos laríngeos fue del 54% de los pacientes estudiados.
ABSTRACT Introduction: Computed tomography is the Gold standard study to complement endoscopy in the study of laryngeal pathologies. Therefore, knowledge of the normal anatomy of the larynx is required. Methodology: A retrospective cross-sectional descriptive observational study was carried out. Data were collected through tomographic analysis, 26 tomographies of patients who attended the Imaging Service of the Hospital de Clínicas without laryngeal pathology were analyzed. The variables investigated were tomographic characteristics such as: laryngeal cartilage calcification, thyroid cartilage height, thyro-arytenoid distance, interarytenoid distance, height and diameter of the pre-epiglottic space. Results: Each of the radiological anatomical characteristics sought were identified. In addition, the corresponding measurements were taken, detailing the average of each of the measurements and classifying them by sex. The average thyroid cartilage height in men was 28.05±1.2 mm and in women was 27.8±0.92 mm, for the thyro-arytenoid distance in men was 12.3±1.3 and in women 10.97±0.95 mm, for the transverse diameter of the thyroid cartilage in men was 16.63±1.58 mm and in women 17.96±1. 11 mm. Conclusions: The averages of the measurements taken were higher in men except for the transverse diameter of the thyroid cartilage. The prevalence of laryngeal cartilage calcification was 54% of the patients studied.
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Introduction: Chondrolaryngoplasty or "tracheal shaving" is cosmetic surgery to reduce the laryngeal prominence in transgender women. Complications may include damage to the vocal folds and epiglottic destabilization or aesthetic dissatisfaction. Objective: To assess and compare acoustic and perceptual voice outcomes and aesthetic satisfaction of transgender women submitted to chondrolaryngoplasty. Methods: Prospective interventional cohort of transgender women submitted to chondrolaryngoplasty between March 2018 and October 2019. Voice analysis included simple-blind application of the GRBAS Hirano scale by speech therapist and measurement of the fundamental frequency, in the preoperative and 1-month postoperative periods. The visual analog scale was used to analyze the aesthetic satisfaction, before and 6-months after chondrolaryngoplasty. Results: Fifteen patients participated, with a mean age of 31.7 ± 8.3 years (range 22-51 years). The mean postoperative follow-up period was 15.3 ± 6.1 months (range 6-25 months). There was a significant improvement in the visual analog scale for aesthetic satisfaction, with a preoperative mean = 0.7 ± 1.0 and a postoperative mean = 9.3 ± 1.1 (95% CI for difference = 7.3 to 9.6; p < 0.001). All patients presented a positive variation. The preoperative mean fundamental frequency was 171.3 ± 41.2 Hz and the postoperative, 177.1 ± 39.5 Hz, with no statistical significance (95% CI for difference = -30.1 to 41.7; p = 0.74). There was no statistically significant difference in the pre- and postoperative comparison of each component of the GRBAS scale. One (7%) patient presented a hyperpigmented scar and 2 (13%) reported hoarseness during the first postoperative week. There were no major complications such as disinsertion of the epiglottis or vocal folds. Conclusion: Chondrolaryngoplasty led to significant aesthetic satisfaction in transgender women. The surgery caused no noticeable vocal change in pitch or perception.
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Abstract Laryngotracheal trauma is rare but potentially life-threatening as it implies a high risk of compromising airway patency. A consensus on damage control management for laryngotracheal trauma is presented in this article. Tracheal injuries require a primary repair. In the setting of massive destruction, the airway patency must be assured, local hemostasis and control measures should be performed, and definitive management must be deferred. On the other hand, management of laryngeal trauma should be conservative, primary repair should be chosen only if minimal disruption, otherwise, management should be delayed. Definitive management must be carried out, if possible, in the first 24 hours by a multidisciplinary team conformed by trauma and emergency surgery, head and neck surgery, otorhinolaryngology, and chest surgery. Conservative management is proposed as the damage control strategy in laryngotracheal trauma.
Resumen El trauma laringotraqueal es poco frecuente, pero con alto riesgo de comprometer la permeabilidad la vía aérea. El presente artículo presenta el consenso de manejo de control de daños del trauma laringotraqueal. En el manejo de las lesiones de tráquea se debe realizar un reparo primario; y en los casos con una destrucción masiva se debe asegurar la vía aérea, realizar hemostasia local, medidas de control y diferir el manejo definitivo. El manejo del trauma laríngeo debe ser conservador y diferir su manejo, a menos que la lesión sea mínima y se puede optar por un reparo primario. El manejo definitivo se debe realizar durante las primeras 24 hora por un equipo multidisciplinario de los servicios de cirugía de trauma y emergencias, cirugía de cabeza y cuello, otorrinolaringología, y cirugía de tórax. Se propone optar por la estrategia de control de daños en el trauma laringotraqueal.
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Humanos , Traqueia/lesões , Laringe/lesões , Ferimentos e Lesões/terapiaRESUMO
Introducción: La laringe de cerdo doméstico tiene similitudes con la laringe humana. La capacidad elástica de las cuerdas vocales del cerdo demuestran tener la mayor similitud con la humana comparado con otros animales por lo que se ha propuesto usar las laringes de cerdo como modelo de entrenamiento quirúrgico. Objetivo: Determinar las diferencias y similitudes anatómicas e histológicas entre la laringe del cerdo y la humana. Material y método: Se realizaron mediciones por 4 observadores en 5 laringes porcinas cuyos resultados se compararon con los descritos en la literatura para las laringes humanas. Además se realizaron cortes histológicos para visualizar fibras elásticas, mucinas neutras y mucinas ácidas. Resultados: El cartílago tiroides porcino mide entre las astas superiores 37,55 ±7,30 mm, entre astas inferiores 31,33 ±3,27 mm, desde la prominencia laríngea al borde posterior 34,32 ±7,30 mm. En el cartílago cricoides, desde el borde superior-inferior en el arco anterior 7,28 ±2,21 mm, altura borde superior-inferior pared posterior 27,47 ±3,40 mm, ancho máximo pared posterior 30,99 ±4,51 mm, diámetro interior anteroposterior (borde cefálico) 30,90 ±2,12 mm, diámetro interior anteroposterior (borde caudal) 21,78 ±2,55 mm, diámetro interior derecha-izquierda (borde cefálico) 18,11 ±2,13 mm, diámetro interior derecha-izquierda (borde caudal) 21,10 ±2,40 mm. Histológicamente, la laringe de cerdo y humana presentan leves diferencias en cuanto al epitelio de cada porción de la laringe, a pesar de que el tipo de cartílago es el mismo en ambas especies. Conclusión: Si bien existen diferencias anatómicas e histológicas entre la laringe de cerdo y el humano, el modelo porcino es una alternativa útil, accesible y de bajo costo para el entrenamiento en cirugía laringotraqueal y microcirugía laríngea.
Introduction: The domestic pig larynx has similarities with the human larynx. The elastic capacity of the vocal folds of the pig has the greater similarity with the human one compared with other animals. It has been proposed to use the porcine larynx as a model for surgical training. Aim: To determine the anatomical and histological differences and similarities between the pig larynx and the human larynx. Material and method: Measurements were made by 4 observers in 5 porcine larynxes whose results were compared with those described in the literature. In addition, histological sections were performed to visualize elastic fibers, neutral mucins and acid mucins. Results: The porcine thyroid cartilage measured 37.55 ±7.30 mm between the upper horns, 31.33 ±3.27 mm between lower horns and 34.32 ±7.30 mm from the laryngeal prominence to the posterior margin. In the cricoid cartilage, from the upper-lower edge in the anterior arch 7.28 ±2.21mm, height upper-lower edge posterior wall 27.47 ±3.40 mm, maximum posterior wall width 30.99 ±4.51 mm, anteroposterior inner diameter (head margin) 30.90 ±2.12 mm, inner diameter anteroposterior (caudal edge) 21.78 ±2.55 mm, inner diameter right-left (head edge) 18.11 ±2.13 mm, inner diameter right-left (caudal edge) 21.10 ±2.40 mm. Histologically, the pig and human larynxes present slight differences in the epithelium of each portion of the larynx, despite the fact that type of cartilage is the same in both species. Conclusions: Although there are anatomical and histological differences between the pig larynx and the human larynx, the porcine model is a useful, accessible and low cost alternative for training in laryngotracheal surgery and laryngeal microsurgery.
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Humanos , Animais , Laringe/anatomia & histologia , Microcirurgia/educação , Cartilagem Aritenoide/anatomia & histologia , Suínos , Cartilagem Tireóidea/anatomia & histologia , Cartilagem Cricoide/anatomia & histologia , Nervos Laríngeos , Laringe/irrigação sanguíneaRESUMO
Laryngotracheal trauma is rare but potentially life-threatening as it implies a high risk of compromising airway patency. A consensus on damage control management for laryngotracheal trauma is presented in this article. Tracheal injuries require a primary repair. In the setting of massive destruction, the airway patency must be assured, local hemostasis and control measures should be performed, and definitive management must be deferred. On the other hand, management of laryngeal trauma should be conservative, primary repair should be chosen only if minimal disruption, otherwise, management should be delayed. Definitive management must be carried out, if possible, in the first 24 hours by a multidisciplinary team conformed by trauma and emergency surgery, head and neck surgery, otorhinolaryngology, and chest surgery. Conservative management is proposed as the damage control strategy in laryngotracheal trauma.
El trauma laringotraqueal es poco frecuente, pero con alto riesgo de comprometer la permeabilidad la vía aérea. El presente artículo presenta el consenso de manejo de control de daños del trauma laringotraqueal. En el manejo de las lesiones de tráquea se debe realizar un reparo primario; y en los casos con una destrucción masiva se debe asegurar la vía aérea, realizar hemostasia local, medidas de control y diferir el manejo definitivo. El manejo del trauma laríngeo debe ser conservador y diferir su manejo, a menos que la lesión sea mínima y se puede optar por un reparo primario. El manejo definitivo se debe realizar durante las primeras 24 hora por un equipo multidisciplinario de los servicios de cirugía de trauma y emergencias, cirugía de cabeza y cuello, otorrinolaringología, y cirugía de tórax. Se propone optar por la estrategia de control de daños en el trauma laringotraqueal.
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Laringe/lesões , Traqueia/lesões , Humanos , Ferimentos e Lesões/terapiaRESUMO
RESUMEN El trauma laríngeo constituye un grupo de lesiones infrecuentes, pero de gran importancia clínica dada su alta morbimortalidad. Requiere un alto nivel de sospecha, puesto que muchas de estas lesiones pueden pasar desapercibidas en la evaluación inicial. Se debe sospechar en todo paciente que se presenta con traumatismo cervical y síntomas que van desde la disfonía y el dolor cervical anterior, a la disnea e incluso el compromiso respiratorio severo por obstrucción de la vía aérea. El abordaje de estos pacientes debe iniciar con la evaluación de la vía aérea y asegurar su estabilidad, para luego enfocarse en el diagnóstico y manejo específico de las lesiones. Presentamos a continuación una revisión bibliográfica en cuanto a los mecanismos de trauma, presentación clínica, diagnóstico, clasificación y manejo.
ABSTRACT The laryngeal trauma constitutes a group of infrequent lesions, but with great clinical importance, given its high morbidity and mortality. It requires a high level of suspicion, since many of these injuries may go unnoticed at the initial evaluation. It should be suspected in every patient presenting with cervical trauma and symptoms ranging from dysphonia and anterior cervical pain, to dyspnea or even severe respiratory distress, due to obstruction of the airway. The approach of these patients should begin with the evaluation of the airway and ensure its stability, to then focus on the diagnosis and specific management of the lesions. We present an updated literature review regarding the mechanisms of trauma, clinical presentation, diagnosis, classification and management.
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Humanos , Cartilagem Tireóidea/lesões , Laringe/lesões , Ferimentos e Lesões , Fraturas Ósseas/mortalidade , Fraturas Ósseas/terapia , Laringe/cirurgia , Laringe/diagnóstico por imagemRESUMO
INTRODUCTION: The anterior commissure is an area of glottic cancer infiltration, even in early stages. OBJECTIVE: To evaluate the invasion by tumors into the anterior commissure cartilage in surgical specimens of frontolateral laryngectomy. METHODS: Forty-eight patients who had undergone frontolateral laryngectomy for T1b/T2 squamous cell carcinoma were included. Epidemiological and clinical aspects as well as morphological histopathological analysis were evaluated. RESULTS: Of the 48 patients, 42 (87.5%) had T1b lesions and 6 (12.5%) had T2. Thirty-four cases (70.8%) showed healthy tissue between the tumor and the thyroid cartilage, 10 cases (20.8%) had a tumor in close proximity to the cartilage, and in 4 cases (8.3%) there was cartilage invasion. There was no major risk of adverse outcome in the groups with infiltration or tumor adjacent to the cartilage. Level of differentiation, mitotic index, nuclear irregularity, and the presence of nucleolus and tumor necrosis were not related to cartilage invasion. CONCLUSION: The infiltration of thyroid cartilage occurred in 8.3% of tumors and did not change the outcome in patients submitted to frontolateral laryngectomy. The morphological characteristics did not present any statistical significance.
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Carcinoma de Células Escamosas/patologia , Glote/patologia , Neoplasias Laríngeas/patologia , Cartilagem Tireóidea/patologia , Adulto , Idoso , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Estudos Prospectivos , Resultado do TratamentoRESUMO
Los tumores condroides de la laringe son poco frecuentes, y generalmente se ubican en el cartílago cricoides. El tratamiento de elección es quirúrgico, con buen pronóstico general. Se presenta el caso de un hombre de 60 años con historia de disfonía. El estudio nasofaringolaringofibroscópico revela una masa laríngea supraglótica. Las imágenes son compatibles con una lesión del cartílago tiroides. La biopsia obtenida por microlaringoscopía directa informa tumor compatible con condroma. Se realiza una resección completa de la masa por abordaje externo, la biopsia corrobora el diagnóstico de tumor condroide de bajo grado. Se describe esta patología mediante revisión bibliográfica.
Chondroid tumors of the larynx are uncommon, and usually located in the cricoid cartilage. Surgery is the treatment of choice, with good prognosis in general. We report the case of a 60-year-old man consulting for dysphonia. The nasopharyngolaryngoscopy showed a supraglottic laryngeal mass. The images were compatible with a thyroid cartilage lesion. The biopsy sample obtained by direct microlaryngoscopy was consistent with a condroma. A complete excision of the lesion was performed by external approach and the biopsy confirmed the diagnosis of a low grade chondroid tumor. We present a review of chondroid tumors of the larynx based on available literature.
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Humanos , Masculino , Pessoa de Meia-Idade , Condroma/diagnóstico , Condroma/cirurgia , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/cirurgia , Cartilagem Tireóidea/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate the acceptability of an educational project using A porcine model of airway for teaching surgical cricothyroidotomy to medical students and medical residents at a university hospital in southern Brazil. METHODS: We developed a teaching project using a porcine model for training in surgical cricothyroidotomy. Medical students and residents received lectures about this surgical technique and then held practical training with the model. After the procedure, all participants filled out a form about the importance of training in airway handling and the model used. RESULTS: There were 63 participants. The overall quality of the porcine model was estimated at 8.8, while the anatomical correlation between the model and the human anatomy received a mean score of 8.5. The model was unanimously approved and considered useful in teaching the procedure. CONCLUSION: The training of surgical cricothyroidotomy with a porcine model showed good acceptance among medical students and residents of this institution.
OBJETIVO: Avaliar a aceitabilidade de um projeto de ensino utilizando modelo porcino de vias aéreas no ensino da cricotiroidotomia cirúrgica para estudantes de Medicina e médicos residentes em um hospital universitário no sul do Brasil. MÉTODOS: Foi desenvolvido um projeto de ensino usando modelo porcino para treinamento em cricotiroidotomia cirúrgica. Estudantes de Medicina e residentes receberam aula teórica sobre esta técnica cirúrgica e, em seguida, realizaram no modelo o treinamento prático. Após o procedimento, todos os participantes preencheram um formulário acerca da importância do treinamento em manuseio de vias aéreas e do modelo utilizado. RESULTADOS: Houve 63 participantes. A qualidade geral do modelo porcino foi estimada em 8,8, enquanto a correlação anatômica entre o modelo e a anatomia humana recebeu o escore médio de 8,5 entre os treinandos. O modelo foi unanimemente aprovado e considerado útil no ensino do procedimento. CONCLUSÃO: O treinamento de cricotiroidotomia cirúrgica em modelo porcino apresentou boa aceitação entre os estudantes de Medicina e os residentes desta Instituição.
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Humanos , Manuseio das Vias Aéreas , Cartilagem Cricoide , Educação , Cirurgia Geral , Ensino , Cartilagem TireóideaRESUMO
OBJECTIVES/HYPOTHESIS: The aim of this study has been to establish an alternative approach in the form of regeneration of the thyroid cartilage. STUDY DESIGN: Four 1-month old pigs (Sus scrofa) were used (divided into 3 groups) and submitted to general anesthetic to perform cervictomy with exposure of the thyroid cartilage in a total of 12 (twelve) samples. METHOD: A resection of 4.0 cm(2) of cartilage was carried out in the right upper region and in the left upper and lower left region of the cartilage, where a scaffold with or without stem cells was implanted. In the left lower region, no biomaterial was implanted and the defect was left open (lesion control [L]). RESULTS: The average extension of the cartilaginous neoformation of L group was 136.3 µm (± 9.6) and 387.7 µm (± 43.2) in the scaffold (SCA) group, presenting a significant statistical difference (P < 0.01). The analysis carried out on the lesion site sections of the cartilage of the larynx of the animals from the SCA group + mesenchymal stem cells (SCA+MSC) showed an average of the extension of neocartilage of 825.4 µm (± 122.1), showing a more extensive area of neocartilage when compared to the other groups. These results demonstrated a high significantly statistical difference (P < 0.001) when compared with the L and SCA groups. CONCLUSION: In 100% of the cases for which SCA+MSCs were used, a significant success in the cartilage growth and closing of the lesion in the thyroid cartilage was obtained compared to the other two groups for which MSCs were not used. LEVEL OF EVIDENCE: N/A.