The larynx ruler to measure height and profile of vocal folds: a proof of concept

Gauthier Desuter,1,2 Benjamin Mertens,3 Alain Delchambre,3 Julie van Lith-Bijl,1,4 Peter Paul van Benthem,2 Elisabeth Sjögren2 1Otolaryngology, Head & Neck Surgery Department, Voice & Swallowing Clinic, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; 2Otolaryngology, Head & Neck Surgery Department, LUMC, University of Leiden, Leiden, the Netherlands; 3BEAMS Department, Ecole Polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium; 4Otolaryngology Department, Flevoziekenhuis, Almere, the Netherlands Introduction: Glottic leakage during phonation is a direct consequence of unilateral vocal fold (VF) paralysis. This air leakage can be in the horizontal plane and in the vertical plane. Presently, there is no easily applicable medical device allowing noninvasive, office-based measurement of the relative vertical position of the VFs. The larynx ruler (LR) is a laser-based measuring device that could meet the previously stated need, using a flexible endoscope. This study represents a proof of concept regarding the use of the LR in assessing VF relative positions in the vertical plane. Materials and methods: One fresh male human cadaver larynx, free of neurologic and anatomic disease, was explored with the LR system through the operative channel of a flexible gastroenterology video-endoscope. The tip of the video-endoscope was located in the laryngeal vestibule. The right crico-arytenoid joint was posteriorly disarticulated. Tilting of the VF was obtained by pulling or pushing the arytenoid cartilage with a mosquito forceps fixed to the stump of the previously sectioned superior tip of the posterior crico-arytenoid muscle allowing anterior and posterior tilting of the arytenoid cartilage in order to induce an elevation or a depression of the VF process. Ten “push” and ten “pull” sessions were performed. The distance from the tip of the video-endoscope to each illuminated pixel of the laser beam was recorded. The level difference between the left and right VFs was measured for each recording. Results: Data provided by the LR were consistently in accordance with the movements applied on the VFs. The accuracy of 0.2 mm of the LR is compatible with the envisioned applications for the human larynx. Conclusion: The LR system represents a feasible technique to evaluate respective vertical position of VFs in the human larynx. Technical limitations were identified that will require improvements before experimental use on human beings. Keywords: laryngoscopy, laser, measurement device, unilateral vocal fold paralysis