Учебники / Operative Techniques in Laryngology Rosen 2008
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XVIII |
Contents |
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5 |
Glottic Insufficiency: Vocal Fold Paralysis, |
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Paresis, and Atrophy . . |
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5.1 |
Introduction . . |
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5.2 |
Unilateral Vocal Fold Paralysis . . |
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5.2.1 |
Etiology . . . . . . . |
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5.3 |
Surgical Indications and Contraindications . |
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5.3.1 |
Vocal Quality and Swallowing . . |
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5.4Unilateral Vocal Fold Paralysis:
Physical Examination . . . . . . . . . . . . 31 5.4.1 General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 5.4.2 Laryngeal . . . . . . . . . . . . . . . . . 31 5.5 Unilateral Vocal Fold Paralysis: Workup . . . . 32 5.5.1 Serology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 5.5.2 Imaging Studies . . . . . . . . . . . . . . 32 5.6 Unilateral Vocal Fold Paralysis: Treatment . . . 32 5.7 Unilateral/Bilateral Vocal Fold Paresis . . . . . 33 5.7.1 Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 5.7.2 History . . . . . . . . . . . . . . . . . . 33 5.7.3 Physical Examination . . . . . . . . . . . . 33 5.7.4 Diagnostic Workup . . . . . . . . . . . . 33 5.7.5 Treatment . . . . . . . . . . . . . . . . . 33
5.8Presbylaryngis/Age-Related Changes
in the Larynx . . . . . . . . . . . . . . . 34 5.8.1 General Considerations . . . . . . . . . . . 34 5.8.2 Etiology, History, and Physical Findings . . . . 34 5.8.3 Workup . . . . . . . . . . . . . . . . . . 34 Key Points . . . . . . . . . . . . . . . . . 34 Selected Bibliography . . . . . . . . . . . . 35
6 Glottic and Subglottic Stenosis: Evaluation
and Surgical Planning . . . . . . . . . . . 37 6.1 Fundamental and Related Chapters . . . . . . 37 6.2 Introduction . . . . . . . . . . . . . . . . 37
6.3Etiology of Glottic and Subglottic
(Laryngotracheal) Narrowing . . . . . . . . 37
6.3.1Common Clinical Conditions
and Associated Risk Factors . . . . . . . . . 37 6.4 Glottic and Subglottic Stenosis: History . . . . 38 6.4.1 Symptoms/Time Course . . . . . . . . . . . 38 6.4.2 Medical Comorbidities . . . . . . . . . . . 38
6.5Glottic and Subglottic Stenosis:
Physical Examination . . . . . . . . . . . . 38
6.5.1Local Anesthesia Techniques for
Examination . . . . . . . . . . . . . . . . 38 6.5.2 Documentation of Examination . . . . . . . 38 6.5.2.1 Flexible Laryngoscopy/Tracheoscopy
Protocol . . . . . . . . . . . . . . . . . . 39
6.6Additional Studies for the Evaluation
of Glottic/Subglottic Stenosis . . . . . . . . . 40
6.6.1Voice Evaluation
(VHI-10, Audio Recording) . . . . . . . . . 40 6.6.2 Air-Flow Measures . . . . . . . . . . . . . 40 6.6.3 Radiographic Studies . . . . . . . . . . . . 40 6.6.4 Laboratory Testing . . . . . . . . . . . . . 40
6.7Glottic and Subglottic Stenosis: Surgical
Planning . . . . . . . . . . . . . . . . . 41
6.7.1Corrective Surgical Procedures for Glottic/
Subglottic Stenosis . . . . . . . . . . . . . 41
6.7.2Criteria for Endoscopic Treatment
for Subglottic Stenosis . . . . . . . . . . . . 41
6.7.3Criteria for T-Tube Stenting for Subglottic
Stenosis . . . . . . . . . . . . . . . . . . 42
6.7.4Criteria for External Treatment of Glottic/ Subglottic Stenosis . . . . . . . . . . . . . 42 Key Points . . . . . . . . . . . . . . . . . 42
Selected Bibliography . . . . . . . . . . . . 42
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Nonsurgical Treatment of Voice Disorders . . 43 |
7.1Fundamental and Related Chapters . . . . . . 43
7.2Introduction . . . . . . . . . . . . . . . . 43
7.3Surgical Indications and Contraindications . . 43
7.4Vocal Fold Granuloma . . . . . . . . . . . 43
7.5Infectious and Inflammatory Disorders . . . . 44
7.6Neurologic Disorders . . . . . . . . . . . . 45
7.6.1Spasmodic Dysphonia . . . . . . . . . . . 45
7.6.2Essential Tremor . . . . . . . . . . . . . . 45
7.6.3Parkinson’s Disease . . . . . . . . . . . . . 45
7.6.4Muscle Tension Dysphonia . . . . . . . . . 45
7.6.5Paradoxical Vocal Fold Motion Disorder . . . 46
7.6.6Postviral Vagal Neuropathy . . . . . . . . . 46
7.7Allergy and Voice Disorders . . . . . . . . . 46
7.8Medications and Their Effects on Voice . . . . 46
7.9Vocal Hygiene . . . . . . . . . . . . . . . 47
7.10Role of the Speech–Language Pathologist
in Voice Therapy . . . . . . . . . . . . . . 47 Key Points . . . . . . . . . . . . . . . . . 48
Selected Bibliography . . . . . . . . . . . . 48
8 Timing, Planning, and Decision Making
in Phonosurgery .. . . . . . . . . . . . . . . . . . . . . . . . . . 49
8.1Fundamental and Related Chapters . . . . . . 49
8.2Key Components to Successful Care
of Patients with Voice Disorders . . . . . . . 49
8.3Surgical Indications and Contraindications . . 49
8.3.1Timing of Phonomicrosurgery . . . . . . . . 49
8.3.2Preoperative Considerations for Phonomicrosurgery . . . . . . . . . . . . 49
8.4Decision Making in Phonosurgery . . . . . . 50
8.5Informed Consent Regarding Phonosurgery . . 51 Key Points . . . . . . . . . . . . . . . . . 51
Selected Bibliography . . . . . . . . . . . . 51
9 Anesthesia and Airway Management
for Laryngeal Surgery . . . . . . . . . . . 53
9.1Fundamental and Related Chapters . . . . . . 53
9.2Equipment . . . . . . . . . . . . . . . . 53
9.3Surgical Indications and Contraindications . . 53
9.4Principles of Airway Management:
Subglottic and Tracheal Stenosis . . . . . . . 54
9.5Special Circumstances: Difficult Exposure
of the Larynx . . . . . . . . . . . . . . . 55
9.6Anesthesia for Laryngeal Framework
Surgery . . . . . . . . . . . . . . . . . . 58 Key Points . . . . . . . . . . . . . . . . . 58 Selected Bibliography . . . . . . . . . . . . 58
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Contents |
XIX |
Part B Phonomicrosurgery for Benign
Laryngeal Pathology
I Fundamentals of Phonomicrosurgery
10Principles of Phonomicrosurgery . . . . . . 63
10.1Fundamental and Related Chapters . . . . . . 63
10.2Introduction . . . . . . . . . . . . . . . . 63
10.3Surgical Indications and Contraindications . . 63
10.4Equipment for Phonomicrosurgery . . . . . . 65
10.5Phonomicrosurgery Procedures,
Techniques, and Methods . . . . . . . . . . 67
10.5.1Anesthesia . . . . . . . . . . . . . . . . 67
10.5.2Patient Position . . . . . . . . . . . . . . 68
10.5.3Laryngoscope Placement . . . . . . . . . . 68
10.5.4Suspension Device . . . . . . . . . . . . . 70
10.5.5External Counter-Pressure . . . . . . . . . . 71
10.5.6Telescopic Evaluation of Vocal Fold
Pathology . . . . . . . . . . . . . . . . . 71
10.5.7Operating Microscope and Surgeon
Ergonomics . . . . . . . . . . . . . . . . 72
10.5.8Microflap Approach to Submucosal
Pathology . . . . . . . . . . . . . . . . . 73
10.6Postoperative Care and Complications . . . . 75 Key Points . . . . . . . . . . . . . . . . . 75 Selected Bibliography . . . . . . . . . . . . 75
11 Perioperative Care for Phonomicrosurgery . . 77
11.1Fundamental and Related Chapters . . . . . . 77
11.2Timing of Phonomicrosurgery . . . . . . . . 77
11.3Surgical Indications and Contraindications . . 77
11.4Considerations for the Day of
Phonomicrosurgery . . . . . . . . . . . . 78
11.5Postoperative Voice Rest . . . . . . . . . . 78
11.6Postoperative Voice Care . . . . . . . . . . 78
11.7Intralaryngeal Steroid Injection to Soften Postoperative Scar in the Vocal Fold . . . . . 78 Key Points . . . . . . . . . . . . . . . . . 79 Selected Bibliography . . . . . . . . . . . . 79
12Management and Prevention of Complications Related
to Phonomicrosurgery . . . . . . . . . . . 81
12.1Fundamental and Related Chapters . . . . . . 81
12.2Overview of Management and Prevention of Complications Related to Phonomicrosurgery 81
12.3Surgical Indications and Contraindications . . 81
12.4Postoperative Dysphonia . . . . . . . . . . 81
12.5Medical Complications Associated with Phonomicrosurgery . . . . . . . . . . . . 82 Key Points . . . . . . . . . . . . . . . . . 82 Selected Bibliography . . . . . . . . . . . . 83
13Principles of Laser Microlaryngoscopy . . . . 85
13.1Fundamental and Related Chapters . . . . . . 85
13.2Laser Physics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
13.2.1 Wavelength . . . . . . . . . . . . . . . . 85
13.2.2Tissue Interaction . . . . . . . . . . . . . 85
13.2.3Delivery Systems . . . . . . . . . . . . . 85
13.2.4Types of Laser . . . . . . . . . . . . . . 86
13.3Surgical Indications and Contraindications . . 86
13.4Equipment: Laser Microlaryngoscopy Setup . . 87
13.5CO2 Laser Safety Guidelines . . . . . . . . 87
13.5.1General Guidelines (Fig. 13.1) . . . . . . . . 87
13.5.2CO2 Laser Settings . . . . . . . . . . . . . 88
13.5.3Safety Protocol . . . . . . . . . . . . . . 88
13.6Surgical Principles . . . . . . . . . . . . 88
13.6.1Smoke Evacuation . . . . . . . . . . . . . 88
13.6.2Protecting Surrounding Tissue from Laser Damage . . . . . . . . . . . . . . . . . 88
13.6.3Maintenance of a Clean Surgical Field . . . . 88
13.7Complications and Their Treatments . . . . . 89
13.7.1Laser Fire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
13.7.2Tracheal Perforation . . . . . . . . . . . . 89 Key Points . . . . . . . . . . . . . . . . 89 Selected Bibliography . . . . . . . . . . . 89
14 Principles of Vocal Fold Augmentation . . . 91
14.1Fundamental and Related Chapters . . . . . 91
14.2Vocal Fold Augmentation: Advantages, Disadvantages, and Clinical Utility . . . . . 91
14.3Surgical Indications and Contraindications . . 91
14.4Characteristics of Vocal Fold Augmentation Materials . . . . . . . . . . . . . . . . . 92
14.4.1Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
14.4.2Categories of Vocal Fold Augmentation
Materials . . . . . . . . . . . . . . . . . 92
14.4.3Description of Vocal Fold Augmentation
Materials Characteristics . . . . . . . . . . 92
14.5General Principles of Vocal Fold
Augmentation . . . . . . . . . . . . . . 94
Key Points . . . . . . . . . . . . . . . . 95 Selected Bibliography . . . . . . . . . . . 96
II Phonomicrosurgical Voice Procedures
15Vocal Fold Polyp . . . . . . . . . . . . . 99
15.1Fundamental and Related Chapters . . . . . 99
15.2Disease Characteristics and Differential
Diagnosis . . . . . . . . . . . . . . . . 99
15.3Surgical Indications and Contraindications . . 99
15.4Surgical Equipment . . . . . . . . . . . . 99
15.5Surgical Procedures . . . . . . . . . . . . 100
15.6Postoperative Care/Complications . . . . . . 103 Key Points . . . . . . . . . . . . . . . . 103 Selected Bibliography . . . . . . . . . . . 103
16Vocal Fold Nodules . . . . . . . . . . . . 105
16.1Fundamental and Related Chapters . . . . . 105
16.2Disease Characteristics and Differential
Diagnosis . . . . . . . . . . . . . . . . 105
16.3Surgical Indications and Contraindications . . 105
16.4Surgical Equipment . . . . . . . . . . . . 105
16.5Surgical Procedure . . . . . . . . . . . . 106
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16.6Postoperative Care and Complications . . . . 107 Key Points . . . . . . . . . . . . . . . . 107 Selected Bibliography . . . . . . . . . . . 107
17 Vocal Fold Cyst and Vocal Fold Fibrous
Mass . . . . . . . . . . . . . . . . . . 109
17.1Fundamental and Related Chapters . . . . . 109
17.2Diagnostic Characteristics and Differential Diagnosis . . . . . . . . . . . . . . . . 109
17.3Surgical Indications and Contraindications . . 109
17.4Surgical Equipment . . . . . . . . . . . . 109
17.5Surgical Procedure . . . . . . . . . . . . 109
17.6Postoperative Care and Complications . . . . 111 Key Points . . . . . . . . . . . . . . . . 112 Selected Bibliography . . . . . . . . . . . 112
18Polypoid Corditis . . . . . . . . . . . . . 113
18.1Fundamental and Related Chapters . . . . . 113
18.2Disease Characteristics . . . . . . . . . . . 113
18.3Surgical Indications and Contraindications . . 113
18.4Surgical Equipment . . . . . . . . . . . . 114
18.5Surgical Procedure . . . . . . . . . . . . 114
18.6Postoperative Care and Complications . . . . 116 Key Points . . . . . . . . . . . . . . . . 116 Selected Bibliography . . . . . . . . . . . 117
19Vocal Fold Granuloma . . . . . . . . . . . 119
19.1Fundamental and Related Chapters . . . . . 119
19.2Disease Characteristics and Differential
Diagnosis . . . . . . . . . . . . . . . . 119
19.3Surgical Indications and Contraindications . . 119
19.4Surgical Equipment . . . . . . . . . . . . 119
19.5Surgical Procedure . . . . . . . . . . . . 120
19.6Postoperative Care and Complications . . . . 121 Key Points . . . . . . . . . . . . . . . . 121 Selected Bibliography . . . . . . . . . . . 121
20Vocal Fold Leukoplakia and Hyperkeratosis 123
20.1Fundamental and Related Chapters . . . . . 123
20.2Diagnostic Characteristics and Differential Diagnosis . . . . . . . . . . . . . . . . 123
20.3Surgical Indications and Contraindications . . 123
20.4Surgical Equipment . . . . . . . . . . . . 123
20.5Surgical Procedure . . . . . . . . . . . . 123
20.6Postoperative Care and Complications . . . . 126 Key Points . . . . . . . . . . . . . . . . 126 Selected Bibliography . . . . . . . . . . . 127
21Surgical Treatment of Recurrent
Respiratory Papillomatosis of the Larynx . . 129
21.1Fundamental and Related Chapters . . . . . 129
21.2Disease Characteristics and Differential
Diagnosis . . . . . . . . . . . . . . . . 129
21.3Surgical Indications and Contraindications . . 129
21.4Surgical Equipment . . . . . . . . . . . . 130
21.5Surgical Procedure . . . . . . . . . . . . 130
21.6Postoperative Care and Complications . . . . 133 Key Points . . . . . . . . . . . . . . . . 134 Selected Bibliography . . . . . . . . . . . 134
22 Surgical Management of Vocal Fold
Vascular Lesions . . . . . . . . . . . . . 135
22.1Fundamental and Related Chapters . . . . . 135
22.2Diagnostic Characteristics and Differential Diagnosis of Vocal Fold Varicosities . . . . . 135
22.3Surgical Indications and Contraindications . . 136
22.4Surgical Equipment . . . . . . . . . . . . 136
22.5Surgical Procedure . . . . . . . . . . . . 136
22.6Postoperative Care and Complications . . . . 138 Key Points . . . . . . . . . . . . . . . . 139 Selected Bibliography . . . . . . . . . . . 139
23 Vocal Fold Scar and Sulcus Vocalis . . . . . . . . . 141
23.1Fundamental and Related Chapters . . . . . 141
23.2Disease Characteristics and Differential
Diagnosis . . . . . . . . . . . . . . . . 141
23.3Surgical Indications and Contraindications . . 142
23.4Surgical Equipment . . . . . . . . . . . . 143
23.5Surgical Procedure . . . . . . . . . . . . 143
23.6Postoperative Care and Complications . . . . 150 Key Points . . . . . . . . . . . . . . . . 150 Selected Bibliography . . . . . . . . . . . 150
24 Endoscopic Management of Teflon
Granuloma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
24.1Fundamental and Related Chapters . . . . . 151
24.2Disease Characteristics and Differential
Diagnosis . . . . . . . . . . . . . . . . 151
24.3Surgical Indications and Contraindications . . 151
24.4Surgical Equipment . . . . . . . . . . . . 151
24.5Surgical Procedure . . . . . . . . . . . . 151
24.6Postoperative Care and Complications . . . . 153 Key Points . . . . . . . . . . . . . . . . 153 Selected Bibliography . . . . . . . . . . . 154
25Endoscopic Excision of Saccular Cyst . . . . 155
25.1Fundamental and Related Chapters . . . . . 155
25.2Disease Characteristics and Differential
Diagnosis . . . . . . . . . . . . . . . . 155
25.3Surgical Indications and Contraindications . . 156
25.4Surgical Equipment . . . . . . . . . . . . 156
25.5Surgical Procedure for Saccular Cyst . . . . . 156
25.6Postoperative Care and Complications . . . . 157 Key Points . . . . . . . . . . . . . . . . 158 Selected Bibliography . . . . . . . . . . . 158
26Anterior Glottic Web . . . . . . . . . . . . . . . . . . . 159
26.1Fundamental and Related Chapters . . . . . 159
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XXI |
26.2 |
Disease Characteristics and Differential |
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30.2 |
Disease Characteristics and Differential |
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Diagnosis . . |
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Diagnosis . . |
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26.3 |
Surgical Indications and Contraindications |
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30.3 |
Surgical Indications and Contraindications |
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26.4 |
Surgical Equipment . . |
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30.4 |
Surgical Equipment . . |
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26.5 |
Surgical Procedure . . |
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30.5 |
Surgical Procedure . . |
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26.6 |
Postoperative Care and Complications . |
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30.6 |
Postoperative Care and Complications . . |
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Key Points . . |
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Key Points . . |
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Selected Bibliography . |
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Selected Bibliography |
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III |
Laser Microlaryngeal Surgery |
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IV |
Laryngeal Injection Techniques |
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(Airway/Neoplastic Conditions) |
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Bilateral Vocal Fold Paralysis |
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Vocal Fold Augmentation via Direct |
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Microlaryngoscopy . |
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27.1 |
Fundamental and Related Chapters . . |
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31.1 |
Fundamental and Related Chapters |
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27.2 |
Disease Characteristics and Differential |
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31.2 |
Disease Characteristics |
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Diagnosis . . |
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31.2.1 |
Material Selection . . |
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27.3 |
Surgical Indication and Contraindications . |
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31.3 |
Surgical Indications and Contraindications |
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27.4 |
Surgical Equipment . . |
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31.4 |
Surgical Equipment . . |
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27.5 |
Surgical Procedure . . |
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31.5 |
Surgical Procedure . . |
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27.6 |
Postoperative Care and Complications . |
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31.5.1 |
Principles of Deep Vocal Fold |
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Key Points . . |
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Augmentation |
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Selected Bibliography . |
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31.5.2 |
Vocal Fold Augmentation via |
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Microlaryngoscopy . . |
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31.5.3 |
Endoscopic Vocal Fold Injection . . |
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28 |
Posterior Glottic Stenosis: Endoscopic |
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Lipoinjection of the Vocal Fold . |
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Approach . . |
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31.6 |
Postoperative Care and Complications . . |
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28.1 |
Fundamental and Related Chapters . . |
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Key Points . . |
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28.2 |
Diagnostic Characteristics and Differential |
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Selected Bibliography . |
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Diagnosis . . |
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28.3 |
Surgical Indications and Contraindications |
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Superficial Vocal Fold Injection |
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28.4 |
Surgical Equipment . . |
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28.5 |
Surgical Procedure . . |
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32.1 |
Fundamental and Related Chapters |
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28.6 |
Postoperative Care . . |
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32.2 |
Disease Characteristics |
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Key Points . . |
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and Differential Diagnosis . . |
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Selected Bibliography . |
. . . . . . . . . |
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180 |
32.3 |
Surgical Indications and Contraindications |
. |
. 205 |
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32.4 |
Surgical Equipment . . |
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205 |
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32.5 |
Surgical Procedure . . |
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205 |
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29 |
Subglottic/Tracheal Stenosis: Laser/ |
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181 |
32.6 |
Postoperative Care and Complications . . |
. |
. 206 |
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Endoscopic Management . . . . . |
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Key Points . . |
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207 |
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29.1 |
Fundamental and Related Chapters . . |
. . |
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181 |
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Selected Bibliography . |
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. . . . . . . . . |
. |
207 |
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29.2Disease Characteristics and Differential
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Diagnosis . . |
. . . . . . . . . . . . . |
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181 |
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29.3 |
Surgical Indications and Contraindications |
. |
. 181 |
33 |
Peroral Vocal Fold Augmentation |
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29.4 |
Surgical Equipment . . |
. . . . . . . . . |
. |
182 |
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in the Clinic Setting . . |
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. |
. 209 |
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29.5 |
Surgical Procedure . . |
. . . . . . . . . |
. |
182 |
33.1 |
Fundamental and Related Chapters . . |
. . |
. |
209 |
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29.6 |
Postoperative Care and Complications |
. . . |
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. 185 |
33.2 |
Disease Characteristics and Differential |
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29.7 |
T-Tube Stenting of SGS |
. . . . . . . . . |
. |
185 |
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Diagnosis . . |
. . . . . . . . . . . . . |
. |
209 |
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29.8 |
Surgical Equipment . . |
. . . . . . . . . |
. |
185 |
33.3 |
Surgical Indications and Contraindications |
. |
. 209 |
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29.9 |
Surgical Procedure . . |
. . . . . . . . . |
. |
185 |
33.3.1 |
Suitability for Peroral Vocal Fold |
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29.10 |
Postoperative Care . . |
. . . . . . . . . |
. |
189 |
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Augmentation in the Clinic Setting . . |
. . |
. |
210 |
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29.11 |
Special Considerations in T-Tube Stenting . |
. |
189 |
33.4 |
Surgical Equipment . . |
. . . . . . . . |
. |
. 210 |
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Key Points . . |
. . . . . . . . . . . . . |
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189 |
33.5 |
Surgical Procedure . . |
. . . . . . . . . |
. |
210 |
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Selected Bibliography . |
. . . . . . . . . |
. |
190 |
33.6 |
Postoperative Care and Complications . |
. |
. |
. 213 |
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Key Points . . |
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213 |
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30 |
Carcinoma of the Vocal Fold |
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191 |
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Selected Bibliography . |
. . . . . . . . . |
. |
213 |
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. . . . |
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30.1 |
Fundamental and Related Chapters . . |
. . |
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191 |
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XXII |
Contents |
|
34Percutaneous Vocal Fold Augmentation
in the Clinic Setting . . . . . . . . . . . . 215
34.1Fundamentals and Related Chapters . . . . . 215
34.2Disease Characteristics and Differential
Diagnosis . . . . . . . . . . . . . . . . 215
34.3Surgical Indications and Contraindications . . 215
34.3.1Suitability for Percutaneous Vocal
Fold Augmentation in the Clinic Setting . . . 216
34.4Surgical Equipment . . . . . . . . . . . . 216
34.5Surgical Procedure . . . . . . . . . . . . 216
34.6Postoperative Care and Complications . . . . 219 Key Points . . . . . . . . . . . . . . . . 219 Selected Bibliography . . . . . . . . . . . 220
35 Botulinum Toxin Injection of the Larynx . . . 221
35.1Fundamental and Related Chapters . . . . . 221
35.2Disease Characteristics and Differential
Diagnosis . . . . . . . . . . . . . . . . 221
35.2.1Botulinum Toxin Fundamentals . . . . . . . 221
35.2.2Spasmodic Dysphonia and Essential Tremor 221
35.2.3Different Botulinum Toxin Injection
Approaches . . . . . . . . . . . . . . . . 222
35.3Surgical Indications and Contraindications . . 222
35.4Equipment . . . . . . . . . . . . . . . . 223
35.5Procedure . . . . . . . . . . . . . . . . 223
35.6Postprocedure Care and Complications . . . . 227 Key Points . . . . . . . . . . . . . . . . 227 Selected Bibliography . . . . . . . . . . . 227
Part C Laryngeal Framework Surgery
36 Principles of Laryngeal Framework Surgery 231
36.1Fundamental and Related Chapters . . . . . 231
36.2Introduction . . . . . . . . . . . . . . . 231
36.3Surgical Indications and Contraindications . . 231
36.3.1Medialization Laryngoplasty . . . . . . . . 231
36.3.2Arytenoid Adduction . . . . . . . . . . . 231
36.3.3Cricothyroid Subluxation . . . . . . . . . . 232
36.4Patient Selection for Laryngeal Framework Surgery . . . . . . . . . . . . . . . . . 232
36.5Timing of Medialization Laryngoplasty . . . . 232
36.6Technical Notes and Pertinent Anatomic Landmarks for Medialization Laryngoplasty 232 Key Points . . . . . . . . . . . . . . . . 234 Selected Bibliography . . . . . . . . . . . 234
37 Perioperative Care for Laryngeal
Framework Surgery . . . . . . . . . . . . 235
37.1Fundamental and Related Chapters . . . . . 235
37.2Perioperative Issues in Laryngeal
Framework Surgery . . . . . . . . . . . . 235
37.3Surgical Indications and Contraindications . . 235
37.4Suboptimal Results/Surgical Errors . . . . . 236
37.4.1 Revision Surgery . . . . . . . . . . . . . 237
37.5Long-Term Surgical Issues . . . . . . . . . 239 Key Points . . . . . . . . . . . . . . . . 239 Selected Bibliography . . . . . . . . . . . 239
38 Silastic Medialization Laryngoplasty
for Unilateral Vocal Fold Paralysis . . . . . . 241
38.1Fundamental and Related Chapters . . . . . 241
38.2Disease Characteristics and Differential
Diagnosis . . . . . . . . . . . . . . . . 241
38.3Surgery Indications and Contraindications . . 241
38.4Surgical Equipment . . . . . . . . . . . . 241
38.5Surgical Procedure . . . . . . . . . . . . 242
38.6Postoperative Care and Complications . . . . 250 Key Points . . . . . . . . . . . . . . . . 251 Selected Bibliography . . . . . . . . . . . 251
39 GORE-TEX® Medialization Laryngoplasty . . . 253
39.1Fundamental and Related Chapters . . . . . 253
39.2Disease Characteristics and Differential
Diagnosis . . . . . . . . . . . . . . . . 253
39.3Surgical Indications and Contraindications . . 253
39.4Surgical Equipment . . . . . . . . . . . . 253
39.5Surgical Procedure . . . . . . . . . . . . 254
39.6Postoperative Care and Complications . . . . 255 Key Points . . . . . . . . . . . . . . . . 256 Selected Bibliography . . . . . . . . . . . 256
40Arytenoid Adduction . . . . . . . . . . . 257
40.1Fundamental and Related Chapters . . . . . 257
40.2Fundamentals of Arytenoid Adduction . . . . 257
40.3Surgical Indications and Contraindications . . 257
40.4Surgical Equipment . . . . . . . . . . . . 257
40.5Surgical Procedure . . . . . . . . . . . . 257
40.6Postoperative Care and Complications . . . . 262 Key Points . . . . . . . . . . . . . . . . 262 Selected Bibliography . . . . . . . . . . . 262
41Cricothyroid Subluxation . . . . . . . . . 263
41.1Fundamental and Related Chapters . . . . . 263
41.2Disease Characteristics and Differential
Diagnosis . . . . . . . . . . . . . . . . 263
41.3Surgical Indications and Contraindications . . 263
41.4Surgical Equipment . . . . . . . . . . . . 263
41.5Surgical Procedure . . . . . . . . . . . . 263
41.6Postoperative Care and Complications . . . . 264 Key Points . . . . . . . . . . . . . . . . 265 Bibliography . . . . . . . . . . . . . . . 265
42Translaryngeal Removal of Teflon
Granuloma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
42.1Fundamental and Related Chapters . . . . . 267
42.2Disease Characteristics and Differential
Diagnosis . . . . . . . . . . . . . . . . 267
|
Contents |
XXIII |
42.3Surgical Indications and Contraindications . . 267
42.4Surgical Equipment . . . . . . . . . . . . 268
42.5Surgical Procedure . . . . . . . . . . . . 268
42.6Postoperative Care and Complications . . . . 271 Key Points . . . . . . . . . . . . . . . . 271 Selected Bibliography . . . . . . . . . . . 271
43Excision of Combined Laryngocele . . . . . 273
43.1Fundamental and Related Chapters . . . . . 273
43.2Disease Characteristics and Differential
Diagnosis . . . . . . . . . . . . . . . . 273
43.2.1Anatomy and Classification . . . . . . . . . 273
43.2.2Clinical Presentation and Differential
Diagnosis . . . . . . . . . . . . . . . . 274
43.3Surgical Indications and Contraindications . . 274
43.4Surgical Equipment . . . . . . . . . . . . 275
43.5Surgical Procedure . . . . . . . . . . . . 275
43.6Postoperative Care and Complications . . . . 277 Key Points . . . . . . . . . . . . . . . . 277 Selected Bibliography . . . . . . . . . . . 277
44Repair of Laryngeal Fracture . . . . . . . . 279
44.1Fundamental and Related Chapters . . . . . 279
44.2Disease Characteristics . . . . . . . . . . 279
44.3Surgical Indications and Contraindications . . 279
44.4Surgical Equipment . . . . . . . . . . . . 280
44.5Surgical Procedure . . . . . . . . . . . . 280
44.6Postoperative Care and Complications . . . . 282 Key Points . . . . . . . . . . . . . . . . 282 Selected Bibliography . . . . . . . . . . . 282
45Glottic and Subglottic Stenosis: Laryngotracheal Reconstruction
with Grafting .. . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
45.1Fundamental and Related Chapters . . . . . 283
45.2Disease Characteristics and Differential
Diagnosis . . . . . . . . . . . . . . . . 283
45.3Surgical Indications and Contraindications . . 283
45.4Surgical Equipment . . . . . . . . . . . . 283
45.5Surgical Procedure . . . . . . . . . . . . 284
45.6Postoperative Care and Complications . . . . 287 Key Points . . . . . . . . . . . . . . . . 287 Selected Bibliography . . . . . . . . . . . 288
46 Glottic and Subglottic Stenosis: Cricotracheal Resection with Primary
Anastomosis . . . . . . . . . . . . . . . 289
46.1Fundamental and Related Chapters . . . . . 289
46.2Diagnostic Characteristics for Open
Treatment of Subglottic Stenosis . . . . . . . 289
46.3Surgical Indications and Contraindications . . 289
46.4Surgical Equipment . . . . . . . . . . . . 289
46.5Surgical Procedure . . . . . . . . . . . . 289
46.6Postoperative Management . . . . . . . . . 292 Key Points . . . . . . . . . . . . . . . . 292 Selected Bibliography . . . . . . . . . . . 293
47Tracheal Stenosis: Tracheal Resection
with Primary Anastomosis . . . . . . . . . 295
47.1Fundamental and Related Chapters . . . . . 295
47.2Background Information and Diagnosis
of Tracheal Stenosis . . . . . . . . . . . . 295
47.3Surgical Indications and Contraindications . . 295
47.4Surgical Equipment . . . . . . . . . . . . 295
47.5Surgical Procedure . . . . . . . . . . . . 295
47.6Postoperative Care and Complications . . . . 298 Key Points . . . . . . . . . . . . . . . . 298 Selected Bibliography . . . . . . . . . . . 298
48The Gray Minithyrotomy for Vocal Fold Scar/Sulcus Vocalis . . . . . . . . . . . . 299
48.1Fundamental and Related Chapters . . . . . 299
48.2General Considerations . . . . . . . . . . 299
48.3Surgical Indications and Contraindications . . 299
48.4Surgical Equipment . . . . . . . . . . . . 299
48.5Surgical Procedure . . . . . . . . . . . . 299
48.6Postoperative Care and Complications . . . . 303 Key Points . . . . . . . . . . . . . . . . 304 Selected Bibliography . . . . . . . . . . . 304
Subject Index . . . . . . . . . . . . . . . . . . 305
Contributing Authors
Milan Amin, M.D.
Chief, Division of Laryngology
Department of Otolaryngology
New York University School of Medicine
550 First Avenue, NBV 5E5
New York, NY 10016
USA
Chapter 2: Principles of Clinical Evaluation
for Voice Disorders
Chapter 45: Subglottis Stenosis: Laryngotracheal
Reconstruction with Grafting
Michiel J. Bové, M.D.
Searle Building
Room 12-561
320 Superior
Chicago, IL 60611
USA
Chapter 2: Principles of Clinical Evaluation
for Voice Disorders
Mark Courey, M.D.
UCSF Voice & Swallowing Center 2330 Post Street, 5th Floor
San Francisco, CA 94115 USA
Chapter 28: Posterior Glottis Stenosis—Endoscopic Approach (Laser Division with MMC)
Jonathan R. Grant, M.D.
Dept. of Otolaryngology and Communication Sciences
Medical College of Wisconsin
Milwaukee, IL
USA
Chapter 34: Percutaneous VF Augmentation
in a Clinical Setting
Patrick J. Gullane, M.D.
7-242 Eaton Wing N
Toronto General
200 Elizabeth Street, Room 3S438
Toronto, Ontario M5G 2CH
Canada
Chapter 46: Glottic and Subglottic Stenosic: Cricotracheal
resection with primary anastamosis
Rene Gupta, MD
Department of Otolaryngology
New York University School of Medicine
550 First Avenue, NBV 5E5
New York, NY 10016
USA
Chapter 29: Subglottis Stenosis: Laryngotracheal
Reconstruction with Grafting
Michael Johns, M.D.
Emory Health Care
Dept. of Otolaryngology
550 Peachtree Street, Suite 9-4400
Atlanta, GA 30308
USA
Chapter 1: Anatomy and Physiology of the Larynx
Priya Krishna, M.D.
University of Pittsburg
Voice Center
Department of Otolaryngology
200 Lothrop Street, Suite 500
Pittsburgh, PA 15213
USA
Chapter 7: Medical Treatment of Voice Disorders
XXVI |
Invited Authors |
Albert Merati, M.D.
University of Washington Department of Otolaryngology Box 356515
Health Sciences Building Suite BB1165
Seattle, WA 98195
Chapter 34: Percutaneous VF Augmentation
in a Clinical Setting
Chapter 47: Tracheal Resection with Primary Anastomosis
Christine Novak PT
7-242 Eaton Wing N
Toronto General
200 Elizabeth Street, Room 3S438
Toronto, Ontario M5G 2CH
Canada
Chapter 46: Glottic and Subglottic Stenosic: Cricotracheal
resection with primary anastamosis
Gregory Postma, M.D.
Department of Otolaryngology
Medical College of Georgia
1120 15th Street
Augusta, GA 30912
USA
Chapter 39: Goretex Medialization Laryngoplasty
Anthony Rider, MD
Department of Otolaryngology and Communication Sciences Medical College of Wisconsin
Milwaukee, WI USA
Chapter 47: Tracheal Resection with Primary Anastomosis
Robert T. Sataloff, M.D.
1721 Pine Street
Philadelphia, PA 19103
USA
Chapter 22: Vocal Fold Varix
Lucian Sulica, M.D.
10 Union Square East, Suite 4J New York, NY 10003
USA
Chapter 35: Botox Toxin Injection
Chapter 37: Peri-Operative Care for Laryngeal Framework Surgery
Chapter 38: Principles of Laryngeal Framework Surgery Chapter 48: Mini-Thyrotomy for Vocal Fold Scar
Part A Clinical Evaluation
of Laryngeal Disorders
Chapter 1 |
|
Anatomy and Physiology |
1 |
of the Larynx |
1.1Anatomy
1.1.1 Laryngeal Cartilages
1.1.1.1 Thyroid
The laryngeal skeleton consists of several cartilaginous structures (Fig. 1.1), the largest of which is the thyroid cartilage. The thyroid cartilage is composed of two rectangular laminae that are fused anteriorly in the midline. The incomplete fusion of the two laminae superiorly forms the thyroid notch. Attached to each lamina posteriorly are the superior and inferior cornua. The superior cornua articulate with the greater horns of the hyoid bone, while the inferior cornua form a synovial joint with the cricoid cartilage (the cricothyroid joint). At the junction of each superior cornu with its respective thyroid ala is a cartilaginous prominence, the superior tubercle. The superior tubercle is of significance because it marks the point 1 cm below which the superior laryngeal artery and nerve cross over the lamina from laterally to pierce the thyrohyoid membrane. The sternothyroid and the thyrohyoid strap muscles attach to
Fig. 1.1 Cartilaginous and fibroelastic structures of the larynx
the anterior surface of the thyroid laminae at the oblique line. The inferior pharyngeal constrictor muscles insert on the posterior edge of each thyroid lamina.
The relationship of the internal laryngeal structures to the surface anatomy of the thyroid cartilage is important in surgical planning, particularly in planning the placement of the window for thyroplasty. The level of the vocal fold lies closer to the lower border of the thyroid cartilage lamina than to the upper, and not at its midpoint, as is frequently (and erroneously) stated. Correct placement of the window is necessary to avoid medialization of the false vocal folds or ventricular mucosa.
1.1.1.2 Cricoid
This signet ring-shaped cartilage is the only laryngeal cartilage to encircle completely the airway. The cricoid cartilage articulates with the thyroid cartilage’s inferior cornua on the cricothyroid joint facets. It joins the first tracheal ring inferiorly via membranous attachments. The face of the cricoid cartilage has a vertical height of only about 3–4 mm, while the lamina posteriorly stands about 20–30 mm high. There is a steep incline from anterior to posterior of the superior margin of the cricoid cartilage. This incline leaves an anterior window where the cricothyroid membrane lies.
1.1.1.3 Arytenoid
The arytenoid cartilages are paired, pyramidal cartilages that articulate with the posterior lamina of the cricoid cartilage at the cricoarytenoid joint. Each arytenoid has both a vocal process medially and a muscular process laterally. These processes act as the attachment sites for the vocal ligament and the major intrinsic muscles of vocal fold movement respectively.
1.1.1.4Accessory Cartilages: Cuneiform and Corniculate
The cuneiform cartilages are crico-arytenoid joint paired elastic cartilages that sit on top of, and move with, the corresponding arytenoid. The soft tissue of the aryepiglottic folds covers these cartilages. The corniculates are small, paired, fibroelastic cartilages that sit laterally to each of the arytenoids, and are completely embedded within the aryepiglottic folds. These