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Prostate cancer metastases to the thyroid cartilage is an extremely rare phenomenon. We report three cases of advanced prostate carcinoma with metastases to the thyroid cartilage identified on 18F prostate-specific membrane antigen-1007 (PSMA-1007) positron emission tomography (PET)/computed tomography (CT). The pathophysiology and possibility for under-reporting are also discussed. Prostate cancer metastases to the larynx should be considered in the differential diagnosis of thyroid cartilage lesions in patients with advanced prostate cancer and is associated with poor prognosis. [ABSTRACT FROM AUTHOR]

Abstract Background The computed tomography (CT) details of the dimensions of the trachea and the subglottic area are not fully covered in the literature, so it is important to build up a database for the CT measurements of that area. Preoperative details of the trachea are crucial prior to any approach or procedure involving the trachea. So, the aim of this study was to determine the different dimensions of the trachea and subglottic area by computed tomography (CT). Methods From 100 CTs of the trachea acquiring the axial images via the multiplanar reformates for all subjects to get the delicate details measuring the transverse diameter (width) and the anteroposterior diameter (depth) of the trachea and subglottic area. Results The mean tracheal width was 15.5 ± 2.1 mm (range = 11.5–21.7), and its mean anteroposterior diameter was 16.56 ± 2.77 mm (range = 11.8–25.1), while the mean width of the subglottic area was 15.1 ± 1.86 mm (range = 12.3–21.1), and its mean anteroposterior diameter was 17.75 + 2.76 (range = 12.9–25.2). All the dimensions of the trachea and the subglottic area were found significantly smaller in female than males. There was positive correlation between anteroposterior and transverse diameters of the trachea with the subglottic area with more tendency for more subglottic area dimension with increase tracheal dimensions and vice versa. Conclusion The current work updates the CT knowledge about the tracheal and subglottic area dimensions enhancing the surgeons, anesthetist, and radiologists data and orientation of the tracheal dimensions and could aid effective and safe tracheolaryngeal surgery.

Background: The ventral enclosure of the thyroid cartilage by a collapsed hyoid bone (CHB) is poorly encountered in previous research. It was aimed to observe whether or not these malformations could be found and detailed anatomically in a consistent lot of computed tomography (CT) files. Methods: Two hundred archived CT angiograms were explicitly observed for the CHB anatomical variant. Results: Different possibilities of CHB were found in 6/200 cases, five males and one female. The symmetrical overlap of the thyroid cartilage by the hyoid body was found in one male case. In three cases, two males and one female, there was asymmetrical overlapping due to tilted hyoid bones. In one male case with such asymmetrical CHD, an ossified anterior longitudinal ligament was noted: the tips of the superior horns of the thyroid cartilage reached lateral to it, thus being retropharyngeal. A different male case had a lowered hyoid with a greater horn fused to the superior horn of the thyroid cartilage, with an interposed ossified triticeal cartilage. In the last male case, the right greater horn collapsed laterally to an ossified triticeal cartilage fused with the thyroid cartilage's superior horn. Conclusions: The CHB is an undeniable anatomical possibility of an atavism that alters conventional anatomical and surgical landmarks. Different anatomical components of the hyoid bone can descend uni- or bilaterally. [ABSTRACT FROM AUTHOR]

Subtotal or total glossectomy for advanced tongue cancer has an adverse impact on swallowing. The purpose of this retrospective study was to analyse postoperative swallowing outcomes and to determine the ideal reconstruction method in these patients. The clinical and swallowing data of patients with tongue cancer who underwent subtotal glossectomy at the study institution between 2005 and 2019 were reviewed retrospectively. Data were available for 101 patients. The most common reconstruction method was a free rectus abdominis musculocutaneous flap (69 cases). The postoperative feeding tube dependency rate was 11.1% at discharge and 9.4% at 1 year. During the study period, laryngeal suspension and/or a cricopharyngeal myotomy was performed in 39 patients (38.6%), with 25 of these operations performed after 2017. Patients treated in 2017–2019 were significantly more able to take thin liquid (P < 0.001) and lost less weight (P = 0.015) compared to those treated in 2005–2016. Multivariate analysis of 61 patients who did not undergo laryngeal suspension and/or cricopharyngeal myotomy showed significant feeding tube dependency in those aged 65 years and older (P = 0.004). Thin liquid intake was significantly improved after subtotal glossectomy with laryngeal suspension, which led to better postoperative swallowing and improved quality of life. [ABSTRACT FROM AUTHOR]

Background: The prominence of the Adam's apple can cause dissatisfaction with physical appearance among transgender people. However, there seems to be no difference of the particular organ between Thai males and females. Objective: To analyze variations between the genders in the interlaminar angle (IA) and the convex distance (CD) of the thyroid cartilage. Additionally, measurements from the thyroid cartilage's most prominent point to the thyroepiglottic ligament's attachment point as the Notchto-Epiglottis (NTE) were compared. Materials and Methods: The present study was a retrospective cross-sectional study. Data were collected from patients that attended Rajavithi Hospital for neck computed tomography (CT) in the two-year period between 2019 and 2020. These patients were divided into two groups, one consisted of 100 males and the other of 100 females, all of whom were aged 18 to 60 years. The IA, CD, and the NTE of the two genders were analyzed. Results: The IA was measured at 65.3±9.4° for males and 88.9°±11.3° for females. The CD was measured at 9.9±2.1 mm and 7.8±1.5 mm for males and females, respectively, while the NTE was measured at 7.4±1.2 mm and 6.1±1.1 mm, respectively. All of these differences between the genders were statistically significant (p<0.001). Previous neck radiation and thyroid disease did not affect differences in the IA, CD, or NTE. Conclusion: Based on the population samples, it was observed that, in comparison to females, males exhibited a more acute IA, a notably larger CD, and a greater NTE measurement. Developing a comprehensive understanding of the thyroid notch can help to reduce the occurrence of complications in chondrolaryngoplasty. [ABSTRACT FROM AUTHOR]

Background: The computed tomography (CT) details of the dimensions of the trachea and the subglottic area are not fully covered in the literature, so it is important to build up a database for the CT measurements of that area. Preoperative details of the trachea are crucial prior to any approach or procedure involving the trachea. So, the aim of this study was to determine the different dimensions of the trachea and subglottic area by computed tomography (CT). Methods: From 100 CTs of the trachea acquiring the axial images via the multiplanar reformates for all subjects to get the delicate details measuring the transverse diameter (width) and the anteroposterior diameter (depth) of the trachea and subglottic area. Results: The mean tracheal width was 15.5 ± 2.1 mm (range = 11.5–21.7), and its mean anteroposterior diameter was 16.56 ± 2.77 mm (range = 11.8–25.1), while the mean width of the subglottic area was 15.1 ± 1.86 mm (range = 12.3–21.1), and its mean anteroposterior diameter was 17.75 + 2.76 (range = 12.9–25.2). All the dimensions of the trachea and the subglottic area were found significantly smaller in female than males. There was positive correlation between anteroposterior and transverse diameters of the trachea with the subglottic area with more tendency for more subglottic area dimension with increase tracheal dimensions and vice versa. Conclusion: The current work updates the CT knowledge about the tracheal and subglottic area dimensions enhancing the surgeons, anesthetist, and radiologists data and orientation of the tracheal dimensions and could aid effective and safe tracheolaryngeal surgery. [ABSTRACT FROM AUTHOR]

The attachment of the palatopharyngeus extended from the posterior end of the thyroid cartilage to the posterior margin of the inferior constrictor attachment that might contribute to successive swallowing movements. Laryngeal elevation is essential for proper swallowing and breathing. Recently, clinical research has demonstrated that the palatopharyngeus, a longitudinal muscle of the pharynx, is involved in the elevation of the larynx. However, the morphological relationship between the larynx and palatopharyngeus remains unclear. In the present study, we analyzed the attachment site and characteristics of the palatopharyngeus in the thyroid cartilage. We evaluated 14 halves of seven heads from Japanese cadavers (average age: 76.4 years); 12 halves, anatomically and two halves histologically. A part of the palatopharyngeus, which originated from the inferior aspect of the palatine aponeurosis, was attached to the inner and outer surfaces of the thyroid cartilage through collagen fibers. The attachment area extends from the posterior end of the thyroid cartilage to the posterior margin of the attachment site of the inferior constrictor. The palatopharyngeus may elevate the larynx with the suprahyoid muscles and contribute to successive movements of swallowing with surrounding muscles. Based on our findings and previous studies, palatopharyngeus with various muscle bundle directions may be essential for the coordination of continuous swallowing events. [ABSTRACT FROM AUTHOR]

Osteomas are benign and generally slow-growing, consisting of densely sclerotic and well-defined bones that are typically located in the skull and facial bones. We present a 19-year-old female patient with a painless lump on one side of the neck. Computed tomography was performed with a report of tumor growth in the thyroid cartilage. The patient underwent an external neck approach for excision of the tumor and the histopathological diagnosis confirmed the diagnosis of osteoma. Thyroid cartilage osteomas should be taken into consideration when dealing with a patient presenting with a neck mass. [ABSTRACT FROM AUTHOR]

Abstract Background Accurate identification of the cricothyroid membrane is crucial for successful cricothyrotomy; however, a manoeuvre that helps identify it both accurately and quickly remains unclear. The effectiveness of the so-called ‘bottom-up manoeuvre’ has never been investigated. This study aimed to examine whether the bottom-up manoeuvre is as rapid and accurate as the conventional ‘top-down manoeuvre’ at identifying the cricothyroid membrane. Methods This study was a prospective randomised cross-over trial conducted at an academic medical centre between 2018 and 2019. Fifth-year medical students participated. The students were trained in the use of either the top-down manoeuvre or the bottom-up manoeuvre first. Each student subsequently performed the technique once on a volunteer. The students were then taught and practiced the other manoeuvre as well. The accuracy of cricothyroid membrane identification and the time taken by successful participants only were measured and compared between the manoeuvres using equivalence tests with two one-sided tests. Results A total of 102 medical students participated in this study and there was no missing data. The accuracy of identification and time required for success were similar between the top-down manoeuvre and the bottom-up manoeuvre (65.7% vs. 70.6%, taking 13.8 s [interquartile range (IQR): 9.4–17.5] vs. 15.5 s [IQR: 11.5–19.9], respectively). The success rate was statistically equivalent (rate difference, 4.9%; 90% confidence interval [CI], -5.8 to 15.6; equivalence margin, -20.0 to 20.0). The time required for success was also statistically equivalent (median difference, 1.7 s; 90% CI, -0.2 to 3.3; equivalence margin, -4.0 to 4.0). Conclusion Among students first trained in both manoeuvres for identifying the cricothyroid membrane, the speed and accuracy of identification were similar between those using the bottom-up manoeuvre and those using the top-down manoeuvre.

Patients with cartilage invasion in hypopharyngeal squamous cell carcinoma (HPSCC) would benefit from partial laryngopharyngectomy (PLP). The purpose of this study was to examine the treatment outcomes of PLP for HPSCC with cartilage invasion, with a focus on the oncological safety and the function preservation. We performed a retrospective review of 28 patients with HPSCC with thyroid or cricoid cartilage invasion who had undergone upfront surgery and were followed for more than one year between 1993 and 2019. Twelve patients treated with PLP (42.9%) and 16 patients treated with total laryngopharyngectomy (TLP) for cartilage invasion in HPSCC were identified. There was no significant difference in recurrence between the PLP group (7/12, 58.3%) and the TLP group (8/16, 50.0%) (p =.718). PLP was not associated with decreased five-year disease free survival (p =.662) or disease specific survival (p =.883) rates compared to TLP. Nine patients receiving PLP could be decannulated and retained intelligible speech (9/12, 75%). Gastrostomy tubes were placed in the PLP group (5/12, 42.9%) and TLP group (1/16, 6.2%) (p =.057). PLP appears to be a feasible option for the treatment of thyroid or cricoid cartilage invasion in HPSCC. [ABSTRACT FROM AUTHOR]

The frequency and distribution of fractures are commonly utilized to assist in interpreting the manner of death. In cases of alleged suicide by hanging, however, the evidence base for the frequency and patterning of laryngohyoid and cervical vertebrae fractures resulting from such blunt force traumatic events is limited and so fractures cannot be reliably used to assist in interpreting the manner. Using meta‐analytic techniques, this study aimed to estimate frequency and distribution of fractures in the context of relevant intrinsic and extrinsic variables. A systematic review of the literature identified 20 studies with relevant data (8523 cases of suicide by hanging). Meta‐analyses identified the frequency and distribution of fractures present and how fracture frequency was affected by the subgroups of age, sex, completeness of suspension, ligature knot position and study design. Results indicated that fracture frequency was variable, there was no unique patterning, and high levels of heterogeneity were present in all variable sub‐groups. Age was the only subgroup to show differences. Findings suggest that neck fracture frequency is inconsistent and cannot be predicted by the chosen variables. Subsequently, neck fractures in isolation should not be given weight in medico‐legal interpretations of a hanging death as suicidal. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Myeloma of the thyroid cartilage is a rare but important differential diagnosis of a laryngeal mass. Although hoarseness as the initial presenting symptom in multiple myeloma is extremely rare, a clinician should always consider it. Multiple myeloma (MM) is a malignant plasma cell disorder characterized by an uncontrolled proliferation of monoclonal plasma cells. Although the clinical presentation at diagnosis can be quite variable, thyroid cartilage infiltration in MM is rare. Here we discuss a 65‐year‐old Caucasian male presenting to the ENT doctor with continuous hoarseness for 3 months. The initial clinical examination showed a tangible mass at the left lymph node level II–III. Further examination with fiber‐optic laryngoscopy showed a bulging of the aryepiglottic and ventricular fold. Neck and chest CT scan revealed multiple osteolytic bone lesions in addition to the large lesion in the left thyroid cartilage. Laboratory work‐up, PET‐CT scan and biopsy of the thyroid cartilage were performed and eventually all confirmed the presence of a new diagnosis of IgA kappa MM. The patient was referred to the department of hematology to start with chemotherapy. [ABSTRACT FROM AUTHOR]

Background: This retrospective case report describes a rare presentation of VBI in a young male patient. Aims: Share a rare cause of VBI in a young patient. Materials & Methods: The patient presented with recurrent episodes of dizziness and a history of several cerebellar infarcts. Imaging revealed the right vertebral artery was being mechanically compressed by the right superior cornu of the thyroid cartilage during mouth opening. Surgical resection of the right superior cornu of the thyroid cartilage was performed. Results: Intraoperative angiography revealed a right vertebral artery without compression during mouth opening. Discussion: Clinicians should consider the thyroid cartilage as a potential source of recurrent VBI due to mechanical compression of the VA. Conclusion: Resection of the causative portion of the thyroid cartilage resolved the compression in this case, and should be employed in similar cases. Laryngoscope, 133:1214–1217, 2023 [ABSTRACT FROM AUTHOR]

Background:Hanging is a form of asphyxia caused by external pressure on upper airwaysderived from a band tightened by the gravitational weight of the body. It could by suicidal or homicidal. Method: 50 dead bodies (35 males and 15 females) aged between 20-70 years old who died due to hanging were studied. The autopsies were carried out to rule out gender differences, pattern of ligature marks on neck, ligature material used, fractures of hyoid bone or thyroid cartilage in the neck, significant findings in dissection of neck caused by death due to hanging, differences between antemortemand postmortem hanging, associated injuries in hanging etc. Results: 35 (70%) males, 15 (30%) females dead bodies due to hanging 19 (38%) were summer, 20 (40%) in rainy, 11 (22%) in winter season, 14 (28%) outdoor, 36 (72%) were outdoor hanging deaths, 36 (72%) ligatures were above the thyroid cartilage, 9 (18%) at the level of cartilage, 5 (10%) below the level of thyroid cartilage. The significant findings of neck dissection were 30 (60%) in the present study. Conclusion: The present study of deaths due to hanging will certainly help the medico-legal experts to differentiate betweensuicidalandhomicidal hanging. [ABSTRACT FROM AUTHOR]

Hanging, a method of deliberate & intentional self-harm amounts for a major proportion of autopsies which medicolegal experts encounter in their clinical tenure at various hospitals pan India. A retrospective study was conducted in the Department of Forensic Medicine and Toxicology, Kanachur Institute of Medical Sciences, Mangalore from Jan 2016 to June 2022, with an objective to study the post mortem findings in autopsy cases of hanging. Out of 306 autopsies, 14.38 % cases were that of hanging with a female to male ratio being 3:1. Most cases were atypical (81.81%,36) and partial hanging (72.72%, 32) with the ligature mark situated above the thyroid cartilage. 86.36 % of cases (38) had dried salivary stain at the angle of mouth and one case showed involuntary discharge. The incidence of fracture of hyoid bone and thyroid cartilage not observed in any cases. [ABSTRACT FROM AUTHOR]

Background: Accurate identification of the cricothyroid membrane is crucial for successful cricothyrotomy; however, a manoeuvre that helps identify it both accurately and quickly remains unclear. The effectiveness of the so-called 'bottom-up manoeuvre' has never been investigated. This study aimed to examine whether the bottom-up manoeuvre is as rapid and accurate as the conventional 'top-down manoeuvre' at identifying the cricothyroid membrane. Methods: This study was a prospective randomised cross-over trial conducted at an academic medical centre between 2018 and 2019. Fifth-year medical students participated. The students were trained in the use of either the top-down manoeuvre or the bottom-up manoeuvre first. Each student subsequently performed the technique once on a volunteer. The students were then taught and practiced the other manoeuvre as well. The accuracy of cricothyroid membrane identification and the time taken by successful participants only were measured and compared between the manoeuvres using equivalence tests with two one-sided tests. Results: A total of 102 medical students participated in this study and there was no missing data. The accuracy of identification and time required for success were similar between the top-down manoeuvre and the bottom-up manoeuvre (65.7% vs. 70.6%, taking 13.8 s [interquartile range (IQR): 9.4–17.5] vs. 15.5 s [IQR: 11.5–19.9], respectively). The success rate was statistically equivalent (rate difference, 4.9%; 90% confidence interval [CI], -5.8 to 15.6; equivalence margin, -20.0 to 20.0). The time required for success was also statistically equivalent (median difference, 1.7 s; 90% CI, -0.2 to 3.3; equivalence margin, -4.0 to 4.0). Conclusion: Among students first trained in both manoeuvres for identifying the cricothyroid membrane, the speed and accuracy of identification were similar between those using the bottom-up manoeuvre and those using the top-down manoeuvre. [ABSTRACT FROM AUTHOR]

Objectives and Methods: We report a unique case of Bow Hunter's syndrome with a dominant aberrantly coursing right vertebral artery (VA), presenting with persistent dizziness and syncope despite previous decompressive surgery at vertebral levels C5-C6. Results: Re-evaluation with computed tomography-scan during provocation of dizziness by neck rotation revealed compression of the right VA at level C6 from against the ipsilateral posterior border and superior cornu of the thyroid cartilage. Laryngoplasty resulted in complete resolution of symptoms. Conclusion: This extremely rare cause of Bow's Hunter's syndrome should be considered, especially in refractory cases after neurosurgical decompression, and surgical management is straightforward and successful. [ABSTRACT FROM AUTHOR]

Previous studies transplanted human-induced pluripotent stem cells (hiPSCs)-derived mesenchymal stem cells (iMSCs) into thyroid cartilage defect of X-liked severe combined immunodeficiency (X-SCID) rats and confirmed transplanted cell survival and cartilage regeneration. Thus, this study aimed to investigate the contribution of iMSC transplantation to thyroid cartilage regeneration of nude rats. iMSCs were induced from hiPSCs via a neural crest cell lineage. Then, clumps formed from an iMSC/extracellular matrix complex were transplanted into thyroid cartilage defects in nude rats. The larynx was removed and histological and immunohistochemical analyses were performed 4 or 8 weeks after the transplantation. Human nuclear antigen (HNA)-positive cells were observed in 11 of 12 (91.7%) rats, which indicated that transplanted iMSCs survived in thyroid cartilage defects in nude rats. HNA-positive cells co-expressed SOX9, and type II collagen was identified around HNA-positive cells in 8 of 12 rats (66.7%), which indicated cartilage-like regeneration. Cartilage-like regeneration in nude rats in this study was comparable to the previous report on X-SCID rats (HNA-positive cells were observed in all 14 rats and cartilage-like regeneration was observed in 10 of 14 rats). This result suggests that nude rats could be an alternative to X-SCID rats in thyroid cartilage regeneration experiments using iMSCs, and this nude rat cartilage transplantation model may develop cartilage regeneration research concerning fewer problems such as infection due to immunosuppression. [ABSTRACT FROM AUTHOR]

Key Clinical Message Myeloma of the thyroid cartilage is a rare but important differential diagnosis of a laryngeal mass. Although hoarseness as the initial presenting symptom in multiple myeloma is extremely rare, a clinician should always consider it. Abstract Multiple myeloma (MM) is a malignant plasma cell disorder characterized by an uncontrolled proliferation of monoclonal plasma cells. Although the clinical presentation at diagnosis can be quite variable, thyroid cartilage infiltration in MM is rare. Here we discuss a 65‐year‐old Caucasian male presenting to the ENT doctor with continuous hoarseness for 3 months. The initial clinical examination showed a tangible mass at the left lymph node level II–III. Further examination with fiber‐optic laryngoscopy showed a bulging of the aryepiglottic and ventricular fold. Neck and chest CT scan revealed multiple osteolytic bone lesions in addition to the large lesion in the left thyroid cartilage. Laboratory work‐up, PET‐CT scan and biopsy of the thyroid cartilage were performed and eventually all confirmed the presence of a new diagnosis of IgA kappa MM. The patient was referred to the department of hematology to start with chemotherapy.

Introduction: Common carotid artery is a gateway to the blood supply to the head and neck region, including the brain. Previous cadaveric and few radiological studies have shown variation in the level of division and varying patterns of branches of the common carotid artery. Aim: The aim of the study is to investigate the prevalence of the commonest level of division of CCA in vivo through the use of CT angiography and the distance of STA (superior thyroid artery) from the level of bifurcation. Material and method: A total of 88 angiograms evaluated for study purpose, both right & left-sided views of the neck of all the 44 patients, have been taken into consideration during three years. Patients with intraparenchymal bleed and stroke, who had undergone CT angiography of the head and neck region, were selected and evaluated for study. Result: In the present study, the most frequent site of bifurcation of CCA was found to be type-II, which was at the level above the greater cornua of the hyoid bone (43.18%), and the least common site was type-V, which was at the level below the superior border of thyroid cartilage (1.13%). Conclusion: Variation in the bifurcation level of CCA results in variation in the origin and other parameters of other vessels (especially STA in this case) originating from the carotid arterial trunk. It leads to the possibility of misleading information to the clinicians during surgical and radiological procedures.

During neck surgery; Zuckerkandl's tubercle, Berry's ligament, the inferior horn of thyroid cartilages have become crucial anatomical landmarks in order to protect the integrity of the recurrent laryngeal nerve. Forty-two male postmortem human cadavers were used. The proximal part of the recurrent laryngeal nerve, before the inferior thyroid artery arises from its source has been observed in 87% inside the tracheoesophageal groove and in 13% running laterally to the trachea. The recurrent laryngeal nerve was encountered passing behind and through the branches of the inferior thyroid artery in 92% and 8% respectively. At all sides; the nerve was piercing the larynx 0.6 ± 0.1 mm below the inferior horn of thyroid cartilage, passing next to the inner-lower side of Berry's ligament and running under the lower middle part of Zuckerkandl's tubercle. These landmarks and their upper mentioned distances to the laryngeal nerve can be taken into consideration as important surgical guides. [ABSTRACT FROM AUTHOR]

The most commonly reported superior thyroid cornu (STC) anatomical variation is in STC syndrome, where the cornu is enlarged or medially displaced. STC agenesis is a rare laryngeal variation that can be unilateral or bilateral. Previous studies have reported STC agenesis in cadaveric or forensic studies in patients with an otherwise normal larynx. We report a case of unilateral STC agenesis in the context of a stage III glottic laryngeal squamous cell carcinoma. The variation was discovered intra-operatively during a total laryngectomy and was clinically unknown beforehand. There were no clinical or histological signs of bony erosion by the tumor. To our knowledge, this is the first report of unilateral STC agenesis in a patient with laryngeal malignancy. This article draws attention to a rare anatomical variant of the larynx and highlights the surgical implications including potential diagnostic challenges and operative considerations.

Background: Treatment for carcinoma larynx is dependent on the T-category, with T4a disease (major thyroid cartilage involvement and extra-laryngeal extension) requiring radical surgery while lesser stages are treated with voice conserving treatments including radiation or chemoradiation. Pre-treatment computerized tomography (CT) scan is routinely used to categorize the T-category; however, studies have reported variable accuracy. Objective: We aimed to ascertain the accuracy of the preoperative CT scan in determining major thyroid cartilage involvement and T-category of the tumor when compared to the postoperative histopathology report. Materials and Methods: This retrospective observational study was conducted between January 01, 2017, and May 31, 2021, in the Department of Radiodiagnosis at the Homi Bhabha Cancer Hospital, Sangrur, Punjab (India). We analyzed the data of 30 patients with histologically proven squamous cell carcinoma of the larynx, who had undergone preoperative CT scans followed by total laryngectomy. The diagnostic accuracy of the T-category based on the preoperative CT, including major thyroid cartilage involvement, extra-laryngeal extension along with other laryngeal subsites was compared to the postoperative histopathology report. Results: CT scan was highly precise in determining the preoperative T-category with an accuracy of 90%. Detection of erosion of the outer cortex of the thyroid cartilage had a sensitivity of 94.4% (95% CI, 74.2-99) for major thyroid cartilage involvement. When erosion of the outer cortex of the thyroid cartilage was combined with the soft tissue on both sides of the thyroid cartilage, the CT scan yielded an accuracy of 100% (95% CI, 88.65-100). CT showed a sensitivity of 92.9% (95% CI, 68.5-98.7) and a specificity of 87.5% (95% CI, 63.9-96.5) for extra-laryngeal extension. Conclusion: CT scan is an accurate and reliable preoperative investigation for diagnosing major thyroid cartilage involvement and T-category staging in patients with carcinoma larynx.

We present the first case of buckled thyroid cartilage identified in a human cadaver. This rare anatomical variant, in patients, often produces dysphonia and is a potential source for diagnostic confusion. In the cadaveric case described, the laryngeal prominence is deviated to the left without deviation of the internal structures of the larynx, such as vocal folds and vocalis muscles. The medical history of the patient is not known. Finally, a review of current literature on the buckled thyroid cartilage is presented. Such a case represents a rare opportunity to visualize this deformity via anatomical dissection. [ABSTRACT FROM AUTHOR]

We present the case of a patient with a recent history of ischemic stroke who presented with clicking larynx syndrome, a condition in which clicking noises in the larynx can be provoked by movement of the head and neck. Diagnostic imaging revealed unusual development and posterior angulation of the superior horn of the thyroid cartilage that potentially was causing trauma to the left common carotid artery. We deduced that symptomatic impingement of the carotid artery by the thyroid cartilage was not only the cause of the patient's clicking larynx syndrome, but also suspected to be the cause of her prior strokes due to repetitive trauma resulting in thrombus. The patient was managed surgically with thyroplasty and transcervical resection of the left greater cornu of the thyroid cartilage with resolution of her symptoms. Anatomical displacement of the thyroid cartilage can manifest as clicking larynx syndrome as well as cause mechanical injury to the carotid artery, resulting in turbulent flow, possible thrombosis, and stroke. Laryngoscope, 132:1410–1413, 2022 [ABSTRACT FROM AUTHOR]

When an ischemic stroke occurs due to bone or cartilage dynamically affecting vessels supplying the brain, it is called bony stroke. We herein report a patient with recurrent cryptogenic stroke that was thought to be a bony stroke. Dynamic three-dimensional computed tomography angiography revealed mechanical compression of the vertebral artery by the hyoid bone and thyroid cartilage. The patient had a recurrent stroke during antiplatelet therapy. Surgical removal of bone tissue prevents stroke recurrence.

Difficult endotracheal intubation has been associated with a number of anatomic factors. According to our experience, the range of movement of thyroid cartilage can be used as a useful test to determine the difficulty in endotracheal intubation. The aim of this study was to evaluate the association between the range of movement of thyroid cartilage and difficulty in intubation. Cross-sectional study. This study was carried out on 400 patients at (Shohada Ashayer Hospital, Khorramabad). After obtaining consent letters from the patients who were between 18 and 60 years of age, the patients underwent general anesthesia. The participants were evaluated by Mallampati and other evaluating tests. The range of movement of thyroid cartilage from the midline was measured and recorded. There were significant correlation between the range of movement of thyroid cartilage and thyromental distance. In addition, in patients with Cormack-Lehane class 1, the mean range of movement of thyroid cartilage was significantly more than the patients with Cormack-Lehane class 3 and 4. The outcomes of our study indicate that the range of movement of thyroid cartilage can be used for predication of difficult intubation. However, further randomized trials should be conducted in this regard. [ABSTRACT FROM AUTHOR]

Laryngeal chondrosarcoma is rare and accounts for 0.2% of all larynx malignancies. Although chondrosarcoma is the most common sarcoma seen in the larynx, laryngeal involvement by cartilage tumors is rare. In this article, we aimed to present the differential diagnosis of chondrosarcoma located in the thyroid cartilage, which is a rare site, in a 75-year-old male patient. The patient underwent total laryngectomy by the otolaryngology department. The macroscopy of the laryngectomy material sent to the pathology laboratory revealed a 3x2 cm tumor with a polypoid extension to the lumen from the bottom of the right vocal cord. Although clinical and radiological findings are important in the diagnosis, the definite diagnosis is based on the pathological examination. It is especially important to differentiate the lesion from chondromas.

Non-traumatic laryngeal fractures are an extremely uncommon presentation, and the diagnosis can be missed. Recognizing these fractures is important to appropriately direct management because most have a good prognosis and result in complete recovery. This article aimed to review the characteristics of all documented cases of non-traumatic fractures of the larynx. We sought to address questions related to the etiology, clinical presentation, and diagnostic assessment of this condition and provide recommendations about the management of these fractures. Electronic databases, mainly PubMed and Google Scholar, were searched for relevant literature with no language or time restrictions. Since 1950, 15 cases of non-traumatic laryngeal fractures have been documented in the medical literature. Out of these, thyroid cartilage fractures have been described in 14 patients, while only one instance demonstrated a fracture in the cricoid cartilage. Patients were managed conservatively using voice rest and observation with complete recovery in all cases. All patients who present with odynophagia, hoarseness, and tenderness over the thyroid cartilage after an episode of severe coughing or sneezing, should be evaluated for a thyroid cartilage fracture using laryngoscopy and computed tomography scan. Management of the airway should be the primary priority in any laryngeal injury, and further management performed after the airway is stable.

Abstract Background The morphometric analysis of the individual bones of the human skeleton can be used to estimate the sex of unidentified corpses. Our aims were as follows: to test whether thyroid cartilage can be used for forensic purposes as a predictor of biological sex; to establish the level of sexual dimorphism of the thyroid cartilage in a sample of adult subjects from a population of European Russia; and to test the accuracy of the morphometric parameters obtained from the thyroid cartilage. Results The thyroid cartilage from 100 adults of known age (50 males and 50 females) was obtained during forensic examination; morphometric tests were conducted using Vernier Digital ROKTOOLS ABS DIN 862 0-200/6 inch with measurement accuracy ± 0.01 mm. The measured parameters were N = 31 for each subject. Intra- and inter-observer reproducibility was tested. Multivariate statistical analysis was applied to the measurements. To check the data set for normal distribution, the Kolmogorov-Smirnov test was used. Finally, to estimate the sex of the observed individuals, a stepwise discriminant analysis was conducted, using the Wilks’ lambda selection method. The most significant parameters were the outer distance between bases of inferior horn; the inner distance between distal ends of inferior horns; distance between distal ends of left superior and inferior horns; left superior horn length (distance between left superior horn distal end and base); distance between superior and inferior notches; thyroid angle; left lamina height (vertical line along left lamina middle); horizontal distance between anterior intermedium line and the right lamina posterior edge; distance between inferior thyroid notch and line connecting left and right thyroid laminae; and left superior horn thickness at mid-line. The stepwise discriminant analysis resulted in an equation with ten parameters. Conclusions The results of the current study indicated that in the European Russian population, the equation obtained in the stepwise discriminant analysis makes it possible to predict sex with a probability of 100% on the validation set. On the test set, the resultant accuracy was 100% for females and 100% for males. Our findings confirm the scientific evidence that the thyroid cartilage has a pronounced sexual dimorphism.

Abstract Background Laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC) with thyroid cartilage invasion are considered T4 and need total laryngectomy. However, the accuracy of preoperative diagnosis of thyroid cartilage invasion remains lower. Therefore, the purpose of this study was to assess the potential of computed tomography (CT)-based radiomics features in the prediction of thyroid cartilage invasion from LHSCC. Methods A total of 265 patients with pathologically proven LHSCC were enrolled in this retrospective study (86 with thyroid cartilage invasion and 179 without invasion). Two head and neck radiologists evaluated the thyroid cartilage invasion on CT images. Radiomics features were extracted from venous phase contrast-enhanced CT images. The least absolute shrinkage and selection operator (LASSO) and logistic regression (LR) method were used for dimension reduction and model construction. In addition, the support vector machine-based synthetic minority oversampling (SVMSMOTE) algorithm was adopted to balance the dataset and a new LR-SVMSMOTE model was constructed. The performance of the radiologist and the two models were evaluated with receiver operating characteristic (ROC) curves and compared using the DeLong test. Results The areas under the ROC curves (AUCs) in the prediction of thyroid cartilage invasion from LHSCC for the LR-SVMSMOTE model, LR model, and radiologist were 0.905 [95% confidence interval (CI): 0.863 to 0.937)], 0.876 (95%CI: 0.830 to 0.913), and 0.721 (95%CI: 0.663–0.774), respectively. The AUCs of both models were higher than that of the radiologist assessment (all P

ObjectiveInternal jugular vein puncture or cannulation is far more difficult in children compared with adults. Anthropometric measures of the internal jugular vein acquired by two-dimensional ultrasound are useful in the practice of puncture and catheterization. The aim of this study is to measure anthropometric parameters of bilateral internal jugular veins in children and to determine the best puncture site based on these parameters.MaterialsA total of 107 pediatric patients undergoing elective operation were included. Ultrasound-visible evaluation of bilateral internal jugular veins was used to obtain the depth from skin, maximum antero-posterior diameter, and cross-sectional area at the levels of the superior border of thyroid cartilage and cricoid cartilage. Statistical analysis was performed using these anthropometric data and demographic variables of all studied pediatric patients, such as age, height, and weight.ResultsA very weak correlation was noted between the depth, maximal antero-posterior diameter, and cross-sectional area of both internal jugular veins and the age, height, weight, and body surface index of all included children. All Pearson's R correlation coefficients were

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. [ABSTRACT FROM AUTHOR]

Objectives: Although laryngohyoid fracture indicates the applied neck pressure and is an important finding in hanging individuals, the reported rate varies widely and its true incidence remains controversial. We used computed tomography (CT) studies to investigate the incidence of laryngohyoid fracture in hanging individuals and identify factors contributing to such fractures. Methods: Considered for inclusion in this study were 107 attempted or successful hanging individuals subjected to CT studies between 2005 and 2019. After excluding 19 whose images were inadequate for evaluation, 88 subjects were included. Body suspension was complete in 20, partial in 49, and unknown in 19; 54 (61.4%) individuals died. Two radiologists performed image analysis and recorded the presence and site of laryngohyoid fractures. Multiple logistic regression analysis was used for factor analysis of laryngohyoid fractures; it included the gender, the age (< or ≧ 40 years), the type of suspension (complete or incomplete), and the outcome (death or survival). Results: Of the 88 subjects, 35 (39.8%) presented with laryngohyoid fractures on CT images; the superior horn of the thyroid cartilage was fractured in 32 (91.4%) of the 35. Age was the only factor significantly related to laryngohyoid fracture (odds ratio = 2.85, 95% confidence interval = 1.08–7.52). Conclusions: In hanging individuals, the incidence of laryngohyoid fracture on CT images was 39.8%. The superior horn of the thyroid cartilage was the most frequent fracture site. Key Points: • The incidence of laryngohyoid fracture on CT images of hanging individuals was almost 40%; the superior horn of the thyroid cartilage was the most frequent fracture site. • In older hanging individuals, attention must be paid to laryngohyoid fractures on CT images. [ABSTRACT FROM AUTHOR]

ABSTRACT: A 76-year-old man was admitted because of visual loss in his right eye, and was diagnosed with central retinal artery occlusion. Brain MRI revealed asymptomatic acute infarctions in the right middle cerebral artery territory. The proximal right internal carotid artery had migrated into a retropharyngeal location, presenting a 50% stenosis with calcified plaques, and was compressed by the hyoid bone and thyroid cartilage during swallowing on dynamic 3D-CT angiography. Partial resection of the hyoid bone and thyroid cartilage was performed and the postoperative course was uneventful. This case supports the utility of dynamic 3D-CT angiography during swallowing for diagnosing hyoid bone or thyroid cartilage compression-induced thromboembolism.

Background: Early dysphagia is a frequent complication of anterior cervical (AC) spine surgery. However, there are no reports that have discussed the correlation between early dysphagia and the positional relationship between thyroid cartilage and the surgical level. Methods: We retrospectively enrolled 82 patients in our hospital who underwent single-level AC discectomy performed by the same surgeon using the same internal fixation apparatus from 2015 to 2017. Swallowing difficulty was rated during the first five postoperative days using a 10-point scoring system. The positional relationship between the thyroid cartilage and the surgical level was defined as discectomy within the thyroid cartilage (IN group) or outside the thyroid cartilage (OUT group) using preoperative computed tomography (CT) images. The confounding factors such as gender, age, body mass index (BMI), hypertension, diabetes mellitus, drinking, smoking, operative level, operative time, and blood loss were analyzed by a binomial logistic regression. Results: The thyroid cartilage was most commonly located above the C5 level (65.1%). Early dysphagia developed in 47.6% of the patients during the first five postoperative days. The IN and OUT groups each contained 41 cases. The difference in the cumulative postoperative early dysphagia score between the IN and OUT groups was statistically significant (p

Objective: Detection of laryngeal cartilage invasion is of great importance in staging of laryngeal squamous cell carcinoma (LSCC). The role of prognosticators in locally advanced laryngeal cancer are still widely debated. This study aimed to assess the impact of volume of thyroid cartilage infiltration, as well as other histopathologic variables, on patient survival., Materials and Methods: We retrospectively analysed 74 patients affected by pT4 LSCC and treated with total laryngectomy between 2005 and 2021 at the Department of Otorhinolaryngology - Head and Neck Surgery of the University of Brescia, Italy. We considered as potential prognosticators histological grade, perineural (PNI) and lympho-vascular invasion (LVI), thyroid cartilage infiltration, and pTN staging. Pre-operative CT or MRI were analysed to quantify the volume of cartilage infiltration using 3D Slicer software., Results: The 1-, 3-, and 5-year disease free survivals (DFS) were 76%, 66%, and 64%, respectively. Using machine learning models, we found that the volume of thyroid cartilage infiltration had high correlation with DFS. Patients with a higher volume (>670 mm 3 ) of infiltration had a worse prognosis compared to those with a lower volume., Conclusions: Our study confirms the essential role of LVI as prognosticator in advanced LSCC and, more innovatively, highlights the volume of thyroid cartilage infiltration as another promising prognostic factor., (Copyright © 2024 Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale, Rome, Italy.)

Objectives: To evaluate one-stage thyroid cartilage laryngotracheal reconstruction in children less than one year of age with congenital subglottic stenosis., Methods: Congenital subglottic stenosis children less than one year old who underwent one-stage thyroid cartilage laryngotracheal reconstruction between 2016 and 2020 in our department were retrospectively reviewed. Their clinical characteristics, treatments and prognoses were assessed., Results: Eleven congenital subglottic stenosis children (6-11 months) were included: seven with Myer-Cotton grade II, and four with Myer-Cotton grade III. Their tracheal diameters were corrected to normal size using thyroid cartilage, and they were intubated under sedation for two weeks after surgery. Moreover, all of them received anti-infection and anti-reflux therapies during hospitalisation. No breathing difficulty, aspiration, hoarseness or laryngitis was observed during the follow-up period (10-30 months), and their growth and development were age appropriate., Conclusion: The one-stage thyroid cartilage laryngotracheal reconstruction is a good treatment option for congenital subglottic stenosis children less than one year old with Myer-Cotton grade II-III.

Objectives: External laryngotracheal trauma (ELT), blunt or penetrating, is a rare but potentially life-threatening injury. Immediate care in the emergency department can be challenging because it requires managing a potentially unstable airway and may have associated vascular injuries with massive bleeding. Here, we look at the details of injury, treatment measures, and outcomes in patients following ELT., Methods: We retrospectively analyzed 22 patients treated at our center for ELT from January 2005 up to December 2021 with varying grades of injury. We looked at their status at presentation, management strategy and functional status., Results: In our report, we include 18 men and 4 women having varying Schaefer injury grades. Eight patients had tracheostomy at presentation and eight had vocal fold immobility. Two patients were treated endoscopically, 12 had open surgery and 8 received no treatment. Of the patients undergoing open surgery, thyroid cartilage fracture was seen in 9 patients, thyroid plus cricoid fracture and cricotracheal separation were seen in 3 patients each. All patients were safely decannulated and spontaneous recovery of vocal cord palsy was seen in some patients., Conclusion: The success of managing ELT relies on fast decision-making, correct patient evaluation, securing the airway and maintaining the hemodynamic stability. Early surgical intervention must be aimed at optimally treating the larygotracheal injuries to prevent long-term disastrous consequences., (© 2024. The Author(s).)

The most commonly reported superior thyroid cornu (STC) anatomical variation is in STC syndrome, where the cornu is enlarged or medially displaced. STC agenesis is a rare laryngeal variation that can be unilateral or bilateral. Previous studies have reported STC agenesis in cadaveric or forensic studies in patients with an otherwise normal larynx. We report a case of unilateral STC agenesis in the context of a stage III glottic laryngeal squamous cell carcinoma. The variation was discovered intra-operatively during a total laryngectomy and was clinically unknown beforehand. There were no clinical or histological signs of bony erosion by the tumor. To our knowledge, this is the first report of unilateral STC agenesis in a patient with laryngeal malignancy. This article draws attention to a rare anatomical variant of the larynx and highlights the surgical implications including potential diagnostic challenges and operative considerations. [ABSTRACT FROM AUTHOR]

Laryngeal chondrosarcoma is rare and accounts for 0.2% of all larynx malignancies. Although chondrosarcoma is the most common sarcoma seen in the larynx, laryngeal involvement by cartilage tumors is rare. In this article, we aimed to present the differential diagnosis of chondrosarcoma located in the thyroid cartilage, which is a rare site, in a 75-year-old male patient. The patient underwent total laryngectomy by the otolaryngology department. The macroscopy of the laryngectomy material sent to the pathology laboratory revealed a 3x2 cm tumor with a polypoid extension to the lumen from the bottom of the right vocal cord. Although clinical and radiological findings are important in the diagnosis, the definite diagnosis is based on the pathological examination. It is especially important to differentiate the lesion from chondromas. [ABSTRACT FROM AUTHOR]

Background: To explore the 131I-SPECT/CT characteristics of remnant thyroid tissue (RTT) in differentiated thyroid cancer (DTC), further assess the risk factors and clinical significance. Methods: 52 DTC patients after total thyroidectomy had undergone neck 131I-SPECT/CT before 131I ablation. The diagnosis of RTT was based on SPECT/CT and follow-up at least 3 months. The anatomic locations and features of SPECT/CT of RTT were assessed by reviewers. The risk factors of RTT with CT positive were analyzed by the chi-square test. Results: A total of 80 lesions of RTT were diagnosed in this study, most of them were mainly located in the regions adjacent to trachea cartilage (37/80) or lamina of thyroid cartilage (17/80). On SPECT/CT of RTT, low, moderate and high uptake were respectively noted in 10, 24 and 46 lesions, definite positive, suspected positive and negative CT findings were respectively noted in 10, 21 and 49. The RTT lesions with definite positive CT findings were mainly located adjacent to lamina of thyroid cartilage (5/10). Primary thyroid tumor (P = 0.029) and T stage (P = 0.000) were the effective risk factors of CT positive RTT. Conclusions: RTT has certain characteristic distribution and appearances on SPECT/CT. Most of RTT with definite CT abnormalities located adjacent to lamina of thyroid cartilage, which suggest surgeons should strengthen the careful removal in this region, especially primary thyroid tumor involving bilateral and T4 stage. This study can provide a certain value for the improvement of thyroidectomy quality in DTC patients. [ABSTRACT FROM AUTHOR]