[Functional anatomy of the larynx from clinical viewpoints. Part I: development, laryngeal skeleton, joints, insertion structures, musculature] (original) (raw)
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HNO, 2007
Diseases of the larynx are of concern not only for ear, nose, and throat physicians and phoniatricians but also for other clinicians who treat the larynx either conservatively or surgically, including speech therapists, pediatricians, anesthetists, oncologists, pulmonologists, radiologists, and general practitioners. Based on today's state of knowledge and taking into account our own research results of the last years as well as clinical points of view, the present contribution gives a short overview of the anatomy and physiology of the larynx. Part 2 discusses the functional anatomy of the laryngeal mucous membrane (glycoconjugates, mucins, trefoil factor family peptides, antimicrobial substances, larynx-associated lymphoid tissue), the vascular supply, innervation, and lymphatic drainage, as well as age-related laryngeal changes and their effects on swallowing, breathing, and phonation.
[Diagnostic imaging of the larynx. Normal anatomy of the regional spread of pathologic changes]
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The primary goal of diagnostic imaging of the larynx is analysis of submucosal structures that are not visible by clinical or endoscopic means. Therefore, image analysis of the larynx should only be performed under knowledge of the results of clinical diagnosis. The anatomic relationships of the laryngeal skeleton, the intrinsic structures, and the surrounding soft tissue are presented synoptically.
[Reinnervation and neurostimulation of the larynx.]
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Dynamic rehabilitation of vocal fold paralysis (VFP) should receive more emphasis in the future. In unilateral immobility with signs of atrophy and wide glottal gap, non-selective reinnervation with ansa cervicalis may become an alternative to augmentation and thyroplasty. For bilateral VFP progress has been made in the concepts of selective reinnervation and neurostimulation (pacing). These new therapies have the potential to restore near normal respiration-without compromising the voice quality-and may contribute to the development of larynx transplantation surgery.
Pretherapeutic and posttherapeutic laryngeal imaging
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Cross-sectional imaging with CT, MRI and more recently PET CT plays an indispensable complementary role to endoscopy in the pretherapeutic diagnostic and staging of laryngeal neoplasms and in the evaluation of the operated or irradiated larynx. Adequate interpretation of the CT, PET CT and MR images requires a thorough knowledge of the patterns of submucosal spread and familiarity with the diagnostic signs of neoplastic invasion as seen with each modality. In addition, one should be aware of the implications of imaging for staging and treatment. Both CT and MR imaging are highly sensitive for the detection of neoplastic invasion of the preepiglottic and paraglottic spaces, subglottic region and cartilage. The high negative predictive value of both CT and MRI allows a relatively reliable exclusion of neoplasm cartilage invasion. The specificity of both CT and MRI is, however, moderately high and both methods may, therefore, overestimate the extent of tumor spread. However, recent inv...
[Advanced indications of the laryngeal mask - Limitations of use]
Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS, 2014
The use of extraglottic airway devices (EGA) is well accepted for airway management for certain classic indications such as general anaesthesia during limb surgery in the supine position. Furthermore, EGA have been deemed a useful tool during the management of an unrecognized difficult airway. On the other hand, the use of EGA has been controversially discussed for advanced indications such as during general anaesthesia during laparoscopic surgery and in coexisting morbid obesity. This article provides an evidence based review of the role of EGA during a variety of indications and is designed to assist with the decision making process of whether an EGA may or may not be appropriate for a particular indication. Moreover, recommendations are given for advanced indications.
Analyse der Biomechanik des Kiefergelenks
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Forscher aus unterschiedlichsten Disziplinen befassen sich mit der Kinematik und Biomechanik des Kiefergelenks i. A., um die Pathophysiologie des Kausystems besser zu verstehen. Mit den Fortschritten der bildgebenden Verfahren und der Messtechnik kann die Biomechanik mit hoher Präzision statisch und dynamisch in 3 Dimensionen erfasst werden. Neben rein kinematischer Forschung über die Entwicklung virtueller Artikulatoren, die Funktion von Kiefergelenkprothesen und die Wirkungsweise okklusaler Schienen lassen sich anspruchsvollere Projekte bezüglich der Kiefergelenkbelastung realisieren. Dabei wird nicht nur die biomechanische Umgebung des Gelenkspalts und dadurch die des Diskus untersucht, sondern auch die Häufigkeit der Kiefergelenkbelastung in der natürlichen Umgebung bestimmt. Die Resultate lassen sich dann entsprechend den diagnostischen Gruppen analysieren.