OBJECTIVE: This study aimed to compare the pharyngocutaneous fistula (PCF) between patients who underwent reconstruction using cervical fascia after total laryngectomy and those who did not and to investigate the factors affecting PCF rates.
METHODS: We retrospectively compared 22 patients operated between February 2021 and March 2023 who received cervical fascia flap as the study group and 21 patients operated between January 2018 and March 2023 who did not receive fascia flap as the control group. The study included patients who underwent total laryngectomy for Stage 3 and 4 squamous cell laryngeal cancer.
RESULTS: We included 43 patients, with 22 (51.2%) and 21 patients (48.8%) in the study and control groups, respectively. The age and sex were not different between the two groups (p = 0.471, p = 0.176, respectively). The distribution of patients as per sex, smoking, alcohol use, chronic obstructive pulmonary disease, diabetes mellitus, coronary artery disease, and multiple comorbidities was similar in both groups (p > 0.05). PCF was observed in one patient (4.5%) and seven patients (33.3%) in the study and control groups, respectively. The PCF rate was significantly lower in the study group (p = 0.021). When the relationship between flap use and risk factors was compared by correlation analysis, a moderate negative relationship was found between flap use and PCF (p = 0.015, r = -0.370).
CONCLUSIONS: The use of a cervical fascia flap is effective in reducing fistula rates after total laryngectomy. Its main advantages include being technically simpler than alternative techniques, locally available, cost-effective.
METHODS: Level 3 Laryngoscope, 2024.

BACKGROUND: Spindle cell lipomas (SL) and pleomorphic lipomas (PL) are rare variants of lipomas, occurring predominantly in the head and neck region. Laryngeal SL/PL is very uncommon and causes obstructive symptoms needing immediate intervention. These tumors are often challenging in radiology due to the admixture of elements and the presence of adipose tissue may help in diagnosis. From a surgeon\'s perspective, understanding the nuances of SL/PL is paramount. Histology is the gold standard for diagnosis; however, it often causes diagnostic challenges in biopsy.  Method: A retrospective review of the clinical and pathologic features of archival cases of SL/PL was performed.
RESULTS: A total of six cases of head and neck region SL/PL were identified. The age of patients ranged from 21 to 58 years and the male-to-female ratio was 5:1. The tumors were distributed in the nape of the neck (n=3), laryngeal region (n=2), and orbit (n=1). Histology in all the cases showed a low-grade neoplasm composed of a variable amount of spindle cells and adipose tissue. The stroma was myxoid in most cases. CD34 was diffusely positive in all the cases.
CONCLUSIONS: SLs are a rare and uncommon variant of lipoma with a predilection in the head and neck region. They are low-grade neoplasms with a propensity to recur after years. Having knowledge of this tumor can improve surgical outcomes and better patient care.

The inaugural total laryngectomy in history was conducted by Billroth in 1873. Nevertheless, significant enhancements to the technique were achieved through the contributions of Gluck, Sorensen, and various other surgeons. Throughout the twentieth century, advancements in anesthesia, infectious disease, hospital hygiene, antibiotic therapy, resuscitation, and the expertise of numerous laryngologists elevated total laryngectomy to a pivotal surgical intervention in head and neck surgery. The latter half of the twentieth century witnessed a paradigm shift with the emergence of organ preservation protocols. Total laryngectomy became the preferred choice for patients experiencing radiotherapy failure. However, the widespread use of laryngeal conservative treatments appears to be correlated with a decline in overall survival rates in the United States and Europe. The evolution of new minimally invasive surgical approaches in the twenty-first century may usher in a revolutionary era in the management of laryngeal carcinoma, offering the potential for improved survival and functional outcomes.

Human papillomavirus (HPV) infection has emerged as an etiologic factor of squamous papilloma (SP). The oropharynx and larynx are common sites of SP, but studies on the prevalence of HPV infection in these sites are lacking. This study aimed to evaluate and compare the prevalence and characteristics of HPV infection in oropharyngeal SP (OPSP) and laryngeal SP (LSP). HPV detection and genotyping data of patients with pathologically confirmed OPSP and LSP were retrospectively analyzed. A total of 119 patients were enrolled, consisting of 93 patients with OPSP and 26 patients with LSP. Of those patients, 13 patients with OPSP and 14 patients with LSP were positive for HPV infection, accounting for a prevalence of 14.0% and 53.8%, respectively (p < 0.001). The most prevalent genotype was HPV16 in OPSP and HPV6 in LSP. Over two-thirds (69.2%) of HPV(+)-OPSP infections were high-risk types compared with 14.3% of HPV(+)-LSP infections (p = 0.004). The prevalence of HPV infection in patients with OPSP and LSP demonstrated no differences in terms of age, sex, and smoking status. These results could provide a better understanding of HPV infection in OPSP and LSP and serve as a background for the epidemiology of HPV-related tumorigenesis of the oropharynx and larynx.

BACKGROUND: Gossypiboma, a retained surgical sponge with a foreign body reaction, is an unusual but serious complication seen in open abdominal surgeries. It is exceptionally rare following head and neck surgeries. Here, we present a case of Gossypiboma of the upper airway following tracheostomy.
METHODS: A 32-year-old male presented with stridor and difficulty breathing one-month post-tracheostomy after a severe head injury following a road traffic accident. A neck radiograph was unremarkable, and a computed tomography (CT) scan of the neck showed a well-defined homogenous curvilinear membrane extending from the hypopharynx to the upper trachea. Bronchoscopic evaluation of the larynx and upper trachea revealed a retained surgical sponge, which was retrieved. The patient\'s breathing improved drastically post intervention.
CONCLUSIONS: Gossypiboma may go undetected in radiographs and may also present atypically as a homogenous membrane on a CT scan of the neck. Though rare, retained surgical items can have profound medicolegal and professional consequences on physicians. Hence, a strong clinical suspicion and vigilance for gossypiboma is necessary for patients presenting with respiratory distress post-tracheostomy.

OBJECTIVE: The public perception relating to the welfare of horses involved with equestrian sports is associated with training methods used and the presentation of horses at events. In this context, very tight nosebands, which are intended to prevent the horse from opening its mouth, also attract a lot of attention. Various studies have evaluated the impact of tight nosebands on stress parameters, whereas the effect of tight nosebands on upper airway function is unknown. Therefore, the aim of the study was to use overground endoscopy to evaluate changes in pharyngeal and laryngeal function when a tight noseband is fitted. Moreover, the ridden horse pain ethogram (RHpE) was applied to investigate signs of discomfort (Dyson et al., 2018).
METHODS: A randomized, blinded, and prospective study was performed.
METHODS: Sixteen warmblood horses consisting of twelve mares and four geldings with a mean age of 11.63 ± 3.53 years were ridden on 2 consecutive days with either loose or tight nosebands (two fingers or no space between bridge of the nose and noseband, respectively) and inserted endoscope in a random order. Videos were taken in a riding arena during a standardized exercise protocol involving beginner level tasks for 30 min in all gaits. For video analysis, freeze frames were prepared and analyzed at the beginning of the expiration phase. Pharyngeal diameter was measured using the pharynx-epiglottis ratio. Other findings (swallowing, pharyngeal collapse, soft palate movements, and secretion) were also evaluated. Moreover, the RHpE was applied. Descriptive statistics and generalized linear mixed effects models were used. Results with a p-value < 0.05 were considered statistically significant.
RESULTS: While the pharynx-epiglottis ratio did not change significantly in horses ridden with loose versus tight nosebands, there was an increase in mean grade and total counts of parameters assessed in the pharyngeal region, for example, grade of secretion (1.5 [±SD 0.89] vs. 3.13 [±SD 0.96]; p = 0.0001), axial deviation of the aryepiglottic folds (0.29 [±SD 0.73] vs. 1.33 [±SD 1.44]; p = 0.01), and pharyngeal collapse (0.69 [±SD 0.87] vs. 1.88 [±SD 1.54]; p = 0.005) in horses ridden with tight nosebands. There was no RHpE score above 8 indicating musculoskeletal pain, but the RHpE scores were significantly higher in horses ridden with tight nosebands (p < 0.001).
CONCLUSIONS: Video quality was limited when horses showed large amounts of secretion. Another limitation was the small number of horses.
CONCLUSIONS: Results add to the evidence obtained in other studies that tight nosebands do not only cause adverse reactions based on the RHpE score such as head behind the vertical or intense staring but also contribute to changes in the pharyngeal region, such as increased secretion and collapse of pharyngeal structures. This may provide further support for future decisions regarding regulations on nosebands.

UNASSIGNED: The growth and development of the epiglottis and preepiglottic space (PES) of the human larynx as it acquires the vocal tract were investigated.
UNASSIGNED: Three newborns, one infant, four children (2, 7, 8, and 12 years old), and two adult normal larynges were investigated and compared using the whole organ serial section technique.
UNASSIGNED: The newborn PES occupied a small area just anterior to the epiglottis. It was composed of immature adipose tissue and areolar tissue. The epiglottis lay on a somewhat horizontal axis and is partially obscured behind the hyoid bone. The hyoid bone overlapped the thyroid cartilage, partially obscuring the superior thyroid notch. The newborn epiglottic cartilage was immature elastic cartilage, and the elastic fiber component was sparse. In the first 8 years of life, as the PES grew, the PES was located not only anterior to but also posterolateral and inferolateral to the epiglottic cartilage and thyroepiglottic ligament. Meanwhile, the epiglottic cartilage matured.
UNASSIGNED: In order to develop the vocal tract for speech production, it is reported that the human larynx descends as the child grows in the first 9 years of life. This study showed that the PES, occupying a small area just anterior to the epiglottis, grew and existed astride the epiglottis as the larynx descended and the vocal tract developed. Consequently, its distribution allows the epiglottis to more effectively play the role of retroflection during swallowing in order to prevent aspiration. The human speech faculty likely develops in conjunction with swallowing physiology.

UNASSIGNED: Physiotherapy has the potential to benefit people with voice and throat problems in conjunction with existing services.
UNASSIGNED: This study aims to explore the impact and role of physiotherapy in voice and throat care, from the perspective of people who have accessed such care. Gaining a better understanding of how physiotherapy contributes to care has the potential to improve services.
UNASSIGNED: An interpretive description design was used to explore participants perspectives of the impact and role of physiotherapy through individual semi-structured interviews with people who had accessed physiotherapy for voice or throat care through a single private practice. Transcripts were analyzed with a general inductive approach suitable for qualitative evaluation data. Data were analyzed from six interviews and four main themes emerged, with each theme further characterized by categories.
UNASSIGNED: Two themes related to the impact of physiotherapy in voice and throat care: Offers a deeper understanding of issues affecting their voice/throat; facilitates individualized specific management. Two themes related to the role of physiotherapy in voice and throat care: Complements existing services; Valuable service. Each theme is further illustrated by categories.
UNASSIGNED: This study indicates that physiotherapy for voice and throat problems can complement existing services while adding value, providing people with a deeper understanding of their problem and facilitating specific management. There is great potential for physiotherapy to benefit voice users. Future research should further evaluate the potential to include physiotherapy in the voice care team and consider how best to capture the broad impacts illustrated.

OBJECTIVE: This scoping review aims to comprehensively assess current surgical interventions for bilateral vocal fold paralysis (BVFP), addressing the heterogeneity in treatment outcomes. Additionally, it explores the potential role of soft robotics as an innovative approach to improve outcomes in BVFP management.
METHODS: This scoping review systematically examines literature from MEDLINE, Embase, and Scopus databases. Inclusion criteria encompass studies related to BVFP management with measurable subjective or objective outcomes. Studies with populations solely under the age of 18 were excluded. Four reviewers independently screened 2263 studies, resulting in the selection of 125 papers for data extraction. Information included study characteristics, interventions, and outcomes. Data synthesis involved both quantitative and qualitative analyses.
RESULTS: The review identified 145 surgical interventions grouped into seven types: tracheostomy, cordectomy, arytenoidectomy, lateralization, combined procedures and others. Outcome measures fit into the following categories: \"objective voice,\" \"subjective voice,\" \"aerodynamics,\" \"dyspnea,\" \"decannulation,\" \"swallow,\" and \"quality of life.\" Positive outcomes were predominant across all interventions, with arytenoidectomy and cordectomy showing relatively lower rates of successful objective and subjective voice outcomes. This could be the result of prioritizing improved airway status. Soft robotics is hypothesized as a potential solution to the limitation of current interventions sacrificing voice for breathing.
CONCLUSIONS: The main aim of current surgical interventions for BVFP is expanding glottic aperture. Yet achieving optimal outcomes remains elusive due to complex airflow dynamics and potential impacts on phonatory function and swallowing. The current review underscores the need for a more nuanced, personalized approach, considering individual anatomical and physiological variations. Soft robotics emerges as a promising avenue to address this variability. However, challenges such as implantation procedures, long-term care, and patient education require careful consideration. Collaboration between medical professionals, engineers, and robotics specialists is essential for translating these principles into practical solutions.

BACKGROUND: Yearling laryngeal function (YLF) is frequently assessed at the time of sale and the outcomes of these assessments can have significant economic implications. The YLF of horses that subsequently underwent a prosthetic laryngoplasty (PL) is unknown.
OBJECTIVE: We hypothesised horses with YLF ≥grade II.2 would be at increased risk of requiring PL, compared with YLF METHODS: Case-control.
METHODS: There were 150 PL cases from 2019 to 2021 with an available yearling post-sale videoendoscopic examination and 600 controls. Two observers unaware of the outcome graded YLF using the Havemeyer system. The risk of PL for each YLF grade was calculated using multivariable conditional logistic regression.
RESULTS: The proportions of each YLF grade in the control group and PL group, respectively, were grade I: 25.8% and 13.3%, grade II.1: 54.3% and 35.3%, grade II.2: 16.7% and 26%, grade III.1: 3% and 20.7%, grade III.2: 0.2% and 3.3%, grade III.3: 0% and 0.7%, grade IV: 0% and 0.7%. The odds ratio (OR, 95% confidence interval) of requiring PL compared with the referent grade I were: grade II.1: 1.2 (0.7, 2.2, p = 0.5), grade II.2: 3.4 (1.8, 6.1, p < 0.001), grade III.1: 13.8 (6.0, 31.6, p < 0.001), grade III.2: 55.5 (10.3, 299.2, p < 0.001), grade III.3: 2930,000 (398173.7, 21 600,000, p < 0.001), grade IV: 26300,000 (3 420 000, 202 000 000, p < 0.001). Yearling LF ≥grade II.2 had an OR of 4.61 (3.0, 7.1, p < 0.001) compared with CONCLUSIONS: Lack of performance data to compare the PL and control groups. The control group was not \'disease-free\' and may have developed disease and been retired or undergone surgery elsewhere.
CONCLUSIONS: Three-quarters of the PL group had ≤grade II.2 YLF, demonstrating deterioration in LF post-sale was common. The risk of requiring PL increased from YLF grade II.2 upwards.
背景: 一岁马驹喉功能(YLF)经常在出售时进行评估，这些评估的结果可能具有重要的经济意义。接受喉修补成形术的马驹的YLF以往是未知的。. 目的: 我们假设:一岁马驹喉功能YLF≥II.2级的马驹，需要喉修补成形术PL的风险增加。. 研究设计: 1:4病例对照研究. 方法: 对2019‐2021年的150例PL病例的周岁拍卖内窥镜检查结果，和600例对照。双盲法Havemeyer系统对YLF进行评分。使用多变量条件逻辑回归计算每个YLF等级的PL风险。. 结果: 对照组和PL组各YLF分级所占比例分别为:I级:25.8%和13.3%； II.1级:54.3%和35.3%； II.2级:16.7%和26%；III.1级:1.3%和20.7%；III.2级:0.2%和3.3%；III.3级:0%和0.7%；IV级:0%和0.7%。. 与I级参考相比，需要PL的比值(OR, 95%置信区间)为: II.1级:1.2 (0.7，2.2，p = 0.5)； ii.2级:3.4 (1.8，6.1，p < 0.001)， iii.1级:13.8 (6.0，31.6，p < 0.001)， iii.2级:55.5 (10.3，299.2，p < 0.001)； iii.3级:2930000 (398173.7，21 600 000，p < 0.001)， IV级:26300000 (3 420 000,202 000 000，p < 0.001)。与LF小于II.2级的马驹相比，LF≥II.2级的OR为4.61 (3.0，7.1，p < 0.001)；与 < III.1级相比，YLF≥III.1级的OR为10.7 (5.6，20.4，p < 0.001)。. 主要限制: 缺乏其他性能数据来比较试验组和对照组。对照组并非“无病”，可能也患病，退役或有其他位置手术。. 结论: PL组3 / 4患者的YLF≤II.2级，表明马驹拍卖后喉功能恶化较为常见。需要PL的风险从YLF II.2级上升。.