Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A.
Laryngoscope. 2021 Nov;131(11):2540-2544. doi: 10.1002/lary.29578. Epub 2021 Apr 17.
The purpose of this study was to better understand the effects of stitch placement on arytenoid medialization by measuring normative cricoarytenoid joint anatomy and changes in arytenoid position when varying arytenopexy stitch configuration.
This adult human larynx study was done in two parts. First, measurements of the cricoid and arytenoid cartilage anatomy relevant to cricoarytenoid joint function were made in 45 preserved larynges (26 male (M), 19 female (F)) using digital calipers. Second, the arytenoids of six fresh larynges ( three M, three F) were sutured to the cricoid using various arytenopexy-stitch placements ranging from inferior-lateral to superior-medial, and the resulting arytenoid positions were compared by measuring medial displacement of the arytenoid body and change in glottal configuration from macro still images using Image J. Paired t-tests were used to compare the results.
Cartilage and joint facet dimensions showed differences between males (M) and females (F). Cricoid facet lengths averaged 9.3 mm (M) and 7.1 mm (F), and widths averaged 4.9 mm (M) and 4.0 mm (F). The arytenoid facet widths averaged 10.5 mm (M) and 9.7 mm (F). Average distances between cricoid facets were 11.8 mm for both males and females. Securing the arytenoid superior-medially on the cricoid facet produced more medialization (2.2 mm vs 1.0 mm, P < .001) and better glottic aperture configuration (9.5° vs 2.7°, P < .001) than securing the arytenoid inferior-laterally on the facet.
Anatomic consistency in cricoarytenoid anatomy provides reliable surgical landmarks for ideal placement of an arytenopexy suture to optimally reposition the arytenoid cartilage. Optimal arytenoid medialization can be accurately reproduced with an arytenopexy-suture that is placed superior-medially on the cricoid facet.
NA Laryngoscope, 131:2540-2544, 2021.
本研究旨在通过测量正常环杓关节解剖结构，并在改变杓状软骨杓间固定缝线的配置时观察杓状软骨位置的变化，更好地了解缝线位置对杓状软骨内移的影响。
本成人喉研究分两部分进行。首先，使用数字卡尺测量 45 个保存的喉（26 名男性（M），19 名女性（F））的环杓关节功能相关的环状软骨和杓状软骨解剖结构的测量值。其次，用各种杓状软骨杓间固定缝线（从下外侧到上内侧）将 6 个新鲜喉（3 名男性（M），3 名女性（F））的杓状软骨缝合到环状软骨上，并使用 Image J 测量宏观静态图像中杓状软骨体的内侧移位和声门配置的变化来比较由此产生的杓状软骨位置。使用配对 t 检验比较结果。
软骨和关节面尺寸在男性（M）和女性（F）之间存在差异。环状软骨面长度平均为 9.3mm（M）和 7.1mm（F），宽度平均为 4.9mm（M）和 4.0mm（F）。杓状软骨面宽度平均为 10.5mm（M）和 9.7mm（F）。男性和女性的环状软骨面之间的平均距离为 11.8mm。将杓状软骨固定在环状软骨面的上内侧可产生更大的内移（2.2mm 比 1.0mm，P<0.001）和更好的声门开度配置（9.5°比 2.7°，P<0.001），而将杓状软骨固定在关节面的下外侧产生的效果则较差。
环杓关节解剖结构的一致性为理想放置杓状软骨杓间固定缝线提供了可靠的手术标志，以最佳位置重新定位杓状软骨。通过将杓状软骨杓间固定缝线放置在环状软骨面的上内侧，可以准确复制最佳的杓状软骨内移。
无喉镜，131：2540-2544，2021。
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