声门偏斜与环甲关节驱动装置相互关系的实验研究

驱使环甲关节运动的动力装置是环甲肌和甲杓肌。通过对８只犬的活体实验，证实在该动力装置牵拉下，环状软骨借助于环甲关节可以发生位移，而甲状软骨则相对固定；在单侧环甲肌的作用下，环状软骨可以发生偏转而引起声门偏斜，但不会引起喉扭转；只有在单侧咽下缩肌的作用下才会出现喉扭转现象     

人喉返神经分支的应用解剖研究

目的：了解喉返神经在喉内的分支及分布,为施行选择性喉返神经吻合术提供解剖学依据。方法：５０例正常人新鲜喉标本进行系统的显微神经解剖研究。结果：９５％喉返神经在距同侧环甲关节下方１．０－２．５ｃｍ处形成喉返神经喉外分叉点,根据分支情况可将分为三型。喉内肌除环甲状外,均由喉返神经前支支配,其中８８％的环杓后肌为喉返神经前支发出单支支配;１２％为双支支配,结论：在甲状软骨板后下部处开窗,可显露同侧喉返神     

喉科学

982056环甲肌的解剖形态和生理功能的再认识/尹保国…//中国临床解剖学杂志一19 98,16(l)一57一59 目的:为了重新认识环甲肌的形态和功能。方法:用60个经福尔马林固定的成人尸体喉,在手术显微镜下对环甲肌进行解剖观测;用8条中国犬在手术麻醉下对环甲肌进行电生理实验。结果:电刺激单侧或双侧环甲肌,甲状软骨都固定不动,环状软骨运动;切断一侧喉上神经喉外支.使该侧环甲肌瘫痪,用直接喉镜观察声门,可见声门后端向患侧偏斜。结论环甲肌属于二头肌,起于甲状软骨.止于环状软骨;环甲肌收缩时,甲状软骨固定,环状软骨活动;一侧环甲肌瘫痪时,环状软…     

喉发声功能检查（续6）

４．１．５．３ 检查方法： ①被检者取平卧位，用碘酒、酒精行颈前部消毒。 ②麻醉：向环甲间隙浅面皮内注射 ０．２ ｍｌ１％普鲁卡因，再向喉腔内注射 １％地卡因 １～２ ｍｌ。 ③插入电极方法：自环状软骨弓上方将双极同心针电极垂直刺入环状软骨弓之软骨膜表面，然后将电极向后、上、外的方向进针约５ｍｍ，即达环甲肌。向环杓后肌插针时，自环甲间隙中央刺入声门下腔，将电极尖端偏向检侧，抵至及穿过该侧之环状软骨板即达此肌。 １４例喉疾患者健侧于术中检测的肌电图，多数是直接暴露喉内肌后检测的。其结果是ＣＦ：①平静呼吸时为…     

声门偏斜与环甲关节驱动装置相互关系的实验研究

驱使环甲关节运动的动力装置是环甲肌和甲杓肌。通过对８只犬的活体实验，证实在该动力装置牵拉下，环状软骨借助于环甲关节可以发生位移，而甲次软骨则相对固定；在单侧环甲肌的作用下，环状软骨可以发生偏 则引起声门偏斜，但不会引起喉志扭转；只有在单侧咽下缩肌的作用下会出现现喉扭转现象。     

喉癌喉前淋巴结转移

回顾性调查１８６５例行全喉切除的喉癌病例，发现１２０例喉癌有喉前淋巴结，其中２４例发生喉前淋巴结转移。非转移性喉前淋巴结最大直径从０．２ｃｍ大小到１ｃｍ左右不等，转移性喉前淋巴结从０．２ｃｍ到最大直径１．９ｃｍ。喉前淋巴结转移率为１．３％，其中声门上癌，声门癌，声门下癌和跨声门癌的喉前淋巴结转移率分别为０．３９％，０．７３％，５．０２％和２．５５％。喉前淋巴结转移与细胞分化无关，与喉癌原发部位及肿     

肩胛舌骨肌上腹肌骨瓣修复声带的应用解剖研究

目的：为喉部分切除术后采用肩胛舌骨肌上腹修复声带术式的可行性提供解剖学依据。方法：对２６具（５２侧）头颈部标本的肩胛舌骨肌上腹的形态学特征，血管神经支配进行观测。结果：该肌平均长度为７４．８ｍｍ，起始部宽８．４ｍｍ，中间部宽９．６ｍｍ，肌腱部宽４．４ｍｍ；供应动脉主要来自环甲肌支（５１．９％）和喉上动脉分支（２５．０％），起始部直径平均为０．７ｍｍ，血管干长９．６ｍｍ；末端静脉直径为１．１ｍｍ，干     

全喉切除和部分咽切除术后残咽-期缝合:残咽粘膜保留多宽才够?

对全喉切除术（ＴＬ）和部分咽切除术（ＰＰ）５２例，术后残咽保留粘膜宽度，在松弛状态（ＬＳ）和紧张状态（ＳＳ）下分别进行测量。患者经随访平均３６月中，依据有否咽下困难、体重变化、饮食状况和需否扩张处理，判定吻合新咽功能及需具有保留残咽粘膜最低限度的宽度。本组５２例中，男４９例，女３例，平均年龄６３．２岁。随访３～１０６月，平均３６月。原发癌在喉５０例，梨状窝２例。ＴＬ和ＰＰ术后残咽粘膜宽度范围：ＬＳ为１．５～５．ｏｃｍ，平均３．２４ｃｍ；ＳＳ为２．５～８．ｏｃｍ，平均４．８３ｃｍ。两者之差为工．５…     

经颌下径路治疗茎突综合征

报告３０例（３５侧）茎突综合征经颌下径路茎突截短术。其中茎突舌骨韧带骨化２例，茎突骨折１例。术前被误诊为牙痛而我次拔牙１例，Ｘ线照片 诊１便。经颌下矩路术前茎突长３－７．５ｃｍ，平均右４．１３ｃｍ，左４．３８ｃｍ；手术截除猎庆右２．１３ｃｍ左２．２６ｃｍ；术后存留工庆右２．０ｃｍ，左２．１２ｃｍ。要后经２月至６年随访，显效６５．７％，好转２８．６％，无效５．７。经咽径路茎突截短３例，其中１例术后发     

声门上型喉癌的颈显微转移与迟发转移

对１４７例双侧或对侧无临床淋巴结转移（ｃＮ０）的声门型喉癌作了颈显微转移和迟发转移观察。结果显示Ｔ１～Ｔ４双侧ｃＮ０的同侧显微转移率分别为０／１、２２．５％、３１．６％和３７，５％，平均２６．３％；同侧迟发转移率分别为１／３、２／１１、２／６和２／３，平均３０．４％；对侧迟发转移率分别为０／４、６．１％、８．０％和１８．２％，平均７．９％。Ｔ２～Ｔ４对侧ｃＮ０的对侧迟发转移率分别为９．５％、２６．１％和２８．６％，平均１９．６％。此数据对于决定ｃＮ０者是否行预防性颈廓清术有重要参考意义。     

Central-part laryngectomy is a useful and less invasive surgical procedure for resolution of intractable aspiration

A novel narrow-field laryngectomy procedure known as central-part laryngectomy (CPL) for less invasive laryngeal diversion in patients with intractable aspiration is introduced. We conducted retrospective case reviews of 15 patients who underwent CPL. In this procedure, an area of the glottis including the mid-part of the thyroid cartilage and cricoid cartilage is removed to separate the digestive tract from the air way. The lateral part of the thyroid cartilage, the entire hypopharyngeal mucosa and epiglottis are preserved. The superior laryngeal vessels and nerve are not invaded. All fifteen patients were relieved of aspiration without major complications. In good accordance with cutting of the cricopharyngeal muscles and removal of the cricoid cartilage, postoperative videofluoroscopy demonstrated smooth passages of barium. Ten of 12 patients who had hoped to resume oral food intake became able to do so after CPL and two others also achieved partial oral deglutition. CPL is a useful procedure for treatment of intractable aspiration and offers considerable advantages over other laryngotracheal diversion procedures from the view point of oral food intake.     

The effect of the configuration of the thyroid cartilage on the asymmetry of the dorsal glottis and its significance for vocal function

We investigated the effect of thyroid cartilage asymmetry on the posterior glottis. 1. Patients with vocal disorders showing "crossing" of the arytenoid cartilages underwent phoniatric and logopedic investigation as well as CT scan of the larynx in the horizontal plane. The shape of the thyroid cartilage and its relation to the other laryngeal structures were measured and analysed quantitatively. 2. Laryngeal serial sections in the horizontal plane were made and analysed in the same way. 3. Experiments were done in which the configuration of the thyroid cartilage was varied and the muscular influences were stimulated to produce typical anomalies of the posterior glottis. These investigations showed that there is a correlation between the configuration of the supraglottic thyroid cartilage and anomalies of the posterior glottis. Irregular growth of the thyroid cartilage causes different positions of the aryepiglottic folds with different positions of the corniculate cartilage during phonation. The shape of the anomaly described by us correlated in all cases with reduced vocal ability. It can now be assessed by CT.     

Nerve-muscle transplantation to the paraglottic space after resection of recurrent laryngeal nerve

OBJECTIVE: To evaluate a new method of nerve-muscle transplantation (NMT) to the paraglottic space after resection of the recurrent laryngeal nerve (RLN) during surgery for thyroid cancer. DESIGN: Review of nine consecutive patients with RLN paralysis caused by the thyroid cancer before surgery. METHOD: After the usual extirpation of the thyroid cancer with concomitant removal of the RLN, the lower part of the sternohyoid muscle approximately 1 cm in width and 2 cm in length with the ansa cervicalis nerve connected was inserted into the paraglottic space by way of anterior retraction of the thyroid ala with the inferior horn cut off. When the muscle or the nerve was adhesive to the cancer, the nerve-muscle on the opposite side was used with transfer through the space under the thyrohyoid muscles and the superior horn of thyroid ala. RESULTS: The voice quality was good or fair after surgery. In most patients, the maximum phonation time was 10 seconds or longer, and the mean flow rate was lower than 200 mL/s. The vocal functions were good immediately after surgery and maintained good values for 2 years or more after surgery. Vocal fold atrophy was not found in any patient. CONCLUSION: When the RLN is resected during surgery for thyroid cancer end-to-end anastomosis of the nerve is impossible, NMT to the paraglottic space is a useful method for preserving good voice and preventing atrophy of the vocal fold.     

会厌动脉的显微解剖研究及临床意义

目的通过对中国汉族成人尸体会厌滋养血管的显微解剖观察,为喉移植、修复、重建以及会厌相关疾病的研究提供相关的数据和形态学资料。方法采用10%甲醛常规防腐固定的头颈部正常、身体无明显畸形和外伤的成年尸体30具(男27具,女3具),常规颈部解剖下从舌骨至气管2~4环取下喉。在体式解剖显微镜下进行显微解剖,观察喉上动脉及其分支的分布、走行及形态,并将喉上动脉在甲状软骨上缘附近分出的一支分布、走行于会厌的动脉命名为“会厌动脉”。结果30具(60侧)尸体中会厌动脉均起源于喉上动脉。喉上动脉分支处外径平均(x-±s,以下同)为(1·06±0·16)mm,会厌动脉起始处外径平均为(0·79±0·13)mm。男性喉上动脉分支处外径平均为(1·09±0·12)mm,男性会厌动脉起始处外径平均为(0·81±0·11)mm。会厌动脉起始处到甲状软骨上角的垂直距离(27·16±3·85)mm。会厌动脉向上行于会厌前间隙的黏膜下疏松结缔组织和脂肪组织内,于会厌谷或杓会厌皱襞附近形成会厌动脉袢,再发出2~5个分支。动脉袢位于甲状舌骨膜处或会厌谷黏膜下疏松结缔组织和脂肪组织中,呈“M”、“N”、“Ω”“U”等形状。60侧中仅1侧在甲状舌骨膜外侧发出会厌动脉袢。结论会厌动脉袢是手术中会厌动脉最容易损伤的部位,在使用会厌瓣作为喉功能重建时应注意避免损伤。     

甲状腺手术中常规解剖喉返神经的临床意义

目的:探讨甲状腺手术中常规解剖喉返神经的方法,以避免喉返神经的损伤。方法:247例患者全部以气管食管沟或者甲状软骨下角为解剖标志显露喉返神经,于喉返神经前面沿着其走向向上解剖显露至甲状软骨下角环甲膜入喉处,或向下解剖显露至甲状腺下极下动静脉处,不必刻意寻找喉返神经的分支,共解剖喉返神经258条。结果:全部患者喉返神经损伤2条,损伤率为0.8%,均为喉返神经不全性损伤,1个月左右恢复正常,与前期不进行常规解剖喉返神经276例比较,二者之间差异有统计学意义(P<0.05)。结论:常规解剖喉返神经进行甲状腺手术的方法可以有效降低喉返神经的损伤率。     

Surgical approach to submucosal lesions of the supraglottic larynx: the supero-lateral thyrotomy.

The surgical approach to the hypopharynx by lateral pharyngotomy as described by Trotter has found widespread use in management of supraglottic carcinoma. A similar but more conservative approach may be employed for removal of cysts and benign or well-encapsulated neoplasms of the epiglottis and supraglottic space. We call this approach a supero-lateral thyrotomy, to differentiate it from the classic lateral pharyngotomy. Surgery consists of subperichondrial resection of the superior half of the ipsilateral thyroid cartilage with preservation of internal lining and superior laryngeal nerve. The lesion may then be enucleated or resected, and the defect, if any exists, closed with overlying mucosa and the flap of preserved perichondrium. The technique has been employed in cases of paraganglioma, haemangiopericytoma and saccular cysts.     

Sympathetic innervation in the larynx of cats

The site of origins, peripheral courses and intramucosal distribution of the sympathetic post-ganglionic nerve fibers supplying to the larynx were investigated by means of wheat germ agglutinin-horseradish peroxidase (WGA-HRP) and Falck-Hillarp method in 51 cats. The cervical sympathetic ganglia which send the postganglionic fibers to the larynx were the superior cervical ganglion (SCG), middle cervical ganglion (MCG), and stellate ganglion (SG). Location of MCG was at the bifurcation of the cervical sympathetic trunk, rostrally to the point of its crossing with the subclavian artery. After WGA-HRP injection, labeled sympathetic nerve fibers were observed mainly in the wall of the blood vessels and around the laryngeal glands of the posterior and caudal parts of the larynx. Labeled fibers originated from SCG were seen in the mucosa of the arytenoid region and posterior glottis ipsilaterally. Both the internal and external branches of the superior and inferior laryngeal nerves contained the postganglionic fibers from SCG. Labeled nerve fibers from MCG were recognized in the ipsilateral mucosa of the glottis and subglottis and were also contained in the internal and external branches of the superior and the inferior laryngeal nerves. Labeled sympathetic nerve fibers from SG appeared in the mucosa caudal to the first tracheal ring. The pattern of distribution of labeled sympathetic nerve fibers revealed by WGA-HRP technique coincided with that of the noradrenergic fibers stained by Falck-Hillarp method.     

The incidence of thyroid cartilage invasion through the anterior commissure in clinically early-staged laryngeal cancer

In this study, the incidence of thyroid cartilage invasion in early-stage laryngeal tumors involving anterior commissure was assessed. Medical charts and pathology reports of 62 patients who underwent supracricoid partial laryngectomy as the primary treatment of early-staged laryngeal squamous cell carcinoma were retrospectively reviewed. Patients were divided into two groups according to the macroscopic examination of the surgical specimen: tumors limited to the glottis with the involvement of anterior commissure (TLG); tumors invading both supraglottis and glottis with the involvement of anterior commissure (TISG). Thirty-seven of the cases were classified as TLG group (59.7 %) and the remaining 25 of them were classified as TISG group (40.3 %). Thyroid cartilage invasion was observed totally in ten patients (16.1 %), as macroscopic invasion in two cases and microinvasion in eight patients. Only two were in the TLG group (cartilage invasion rate of 5.4 %), the remaining eight were in the TISG group (cartilage invasion rate of 32 %). Thyroid cartilage invasion rate of TISG group was significantly higher than that of TLG group (p = 0.011, p < 0.05). Tumors limited to the glottis with AC involvement may be more suitable for endoscopic resection; on the contrary, tumors with vertical extension invading both AC and supraglottis should be evaluated more suspiciously due to high rate of thyroid cartilage invasion, which may still necessitate external laryngectomy techniques.     

Useful landmarks in arytenoid adduction and laryngeal reinnervation surgery

OBJECTIVE: Knowledge of the location of the muscular process of the arytenoid cartilage and the recurrent laryngeal nerve is essential to performing a successful arytenoid adduction and laryngeal reinnervation surgery. We describe external landmarks useful in locating these structures. STUDY DESIGN: Cadaveric laryngeal dissection. METHODS: Posterior laryngeal dissection was performed in 16 human larynges. The position of the muscular process of the arytenoid was measured bilaterally relative to the inferior and superior borders of the thyroid lamina. The recurrent laryngeal nerve was followed distally from slightly below the level of the cricothyroid joint to its genu where its vertical course changes to an oblique intralaryngeal course. RESULTS: The muscular process of the arytenoid was usually found halfway between the roots of the superior and inferior cornu of the thyroid lamina. The recurrent laryngeal nerve was found just deep to the cricothyroid joint and lateral to the posterior cricoarytenoid muscle. There were no other nerves in this area. CONCLUSIONS: This study finds that the superior and inferior borders of the thyroid lamina are useful intraoperative landmarks to locate the muscular process of the arytenoid. The cricothyroid joint provides a good starting point to locate the recurrent laryngeal nerve, which can be identified slightly deeper between it and the posterior cricoarytenoid muscle.     

Predictors of thyroid gland invasion in glottic squamous cell carcinoma

OBJECTIVE: This study examines preoperative clinical and intraoperative histopathologic characteristics that can be used to predict thyroid gland invasion in the setting of squamous cell carcinoma (SCC) of the glottis. STUDY DESIGN: The study was retrospectively performed using 30 serially sectioned whole-organ total laryngectomy with thyroidectomy specimens with associated preoperative clinical data. METHODS: Histopathologic and clinical variables including true vocal cord (TVC) fixation, cricoarytenoid joint invasion, subglottic extension (SGE) of tumor, patterns of laryngeal spread, and prior radiation were examined as univariate and multivariate correlates of thyroid gland invasion. RESULTS: Twenty-three percent of thyroid gland specimens demonstrated SCC invasion. Five were T4 stage, two were T3 stage, and all demonstrated direct extension to the thyroid gland. Of these, all had a fixed ipsilateral TVC (P = .003) and SGE of tumor greater than 15 mm (P = .003). Using multivariate analysis, SGE of tumor and TVC fixation contribute independently as correlates of thyroid gland invasion. Prior radiation of the larynx did not correlate with thyroid gland invasion and did not significantly influence the predictive capacity of these variables. Tumors invading the thyroid gland also invaded the cricothyroid membrane (100%), anterior commissure (100%), laryngeal ventricle (100%), and thyroid cartilage (86%). CONCLUSION: Preoperative assessment of TVC mobility and extent of SGE are significant correlates of thyroid gland invasion by SCC of the glottis. Distinct patterns of laryngeal spread are associated with thyroid gland invasion. Prophylactic hemithyroidectomy with isthmusectomy is indicated for glottic SCC in the preoperative setting of a fixed TVC and SGE greater than 15 mm. Additional study correlating patterns of laryngeal spread with thyroid gland invasion will add to these data in determining when to selectively perform thyroidectomy in this setting.