Three-dimensional conformation of the injected bolus in vocal fold injections in a cadaver model

Ted Mau, Jacquelyn M. Brewer, Samuel T. Gatzert, Mark S. Courey

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective. To determine the 3-dimensional (3D) conformation of the injected bolus in the larynx in vocal fold injections, to understand how the bolus interacts spatially with elements of the laryngeal framework, and to relate the above to clinical observations in performing vocal fold injections. Study Design. Excised cadaveric larynx study. Setting. Laboratory. Subjects and Methods. Vocal folds of 12 human excised cadaveric larynges were injected with calcium hydroxylapatite. High-resolution computed tomography scans were obtained of the injected larynges. Densities corresponding to the injected bolus and the laryngeal framework were extracted and processed with MATLAB routines to generate selective 3D reconstructions of the injected bolus within the laryngeal framework. Histology analysis was also performed to correlate with observations from the 3D reconstructions. Results. Boluses injected into the lateral aspect of the thyroarytenoid muscle tended to be irregularly shaped, appeared to fill up the paraglottic space, and were associated with significant muscle compression. The vertical thickness of the injected boluses averaged 9.5 mm for lateral boluses and 7.6 mm for medial boluses, which were comparable to the vertical thickness of uninjected vocal folds. Conclusion. Laterally injected boluses are shaped by spatial constraints imposed by elements of the laryngeal framework. Compression of vocal fold muscle may be a mechanism accounting for stiffness from overinjection. The irregular shapes of some boluses may affect the outcome of subsequent medialization attempts. Injections may enhance the vocal fold contact height as a favorable effect beyond simple medialization.

Original languageEnglish (US)
Pages (from-to)552-557
Number of pages6
JournalOtolaryngology - Head and Neck Surgery
Volume144
Issue number4
DOIs
StatePublished - Apr 2011

Fingerprint

Vocal Cords
Cadaver
Larynx
Injections
Laryngeal Muscles
Durapatite
Histology
Tomography
Calcium
Muscles

Keywords

  • 3D analysis
  • Excised larynx
  • Injection augmentation
  • Laryngoplasty
  • Vocal fold injection
  • Vocal fold medialization

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Surgery
  • Medicine(all)

Cite this

Three-dimensional conformation of the injected bolus in vocal fold injections in a cadaver model. / Mau, Ted; Brewer, Jacquelyn M.; Gatzert, Samuel T.; Courey, Mark S.

In: Otolaryngology - Head and Neck Surgery, Vol. 144, No. 4, 04.2011, p. 552-557.

Research output: Contribution to journalArticle

Mau, Ted ; Brewer, Jacquelyn M. ; Gatzert, Samuel T. ; Courey, Mark S. / Three-dimensional conformation of the injected bolus in vocal fold injections in a cadaver model. In: Otolaryngology - Head and Neck Surgery. 2011 ; Vol. 144, No. 4. pp. 552-557.
@article{2de6993830e74504bd93fe16a2eed8b8,
title = "Three-dimensional conformation of the injected bolus in vocal fold injections in a cadaver model",
abstract = "Objective. To determine the 3-dimensional (3D) conformation of the injected bolus in the larynx in vocal fold injections, to understand how the bolus interacts spatially with elements of the laryngeal framework, and to relate the above to clinical observations in performing vocal fold injections. Study Design. Excised cadaveric larynx study. Setting. Laboratory. Subjects and Methods. Vocal folds of 12 human excised cadaveric larynges were injected with calcium hydroxylapatite. High-resolution computed tomography scans were obtained of the injected larynges. Densities corresponding to the injected bolus and the laryngeal framework were extracted and processed with MATLAB routines to generate selective 3D reconstructions of the injected bolus within the laryngeal framework. Histology analysis was also performed to correlate with observations from the 3D reconstructions. Results. Boluses injected into the lateral aspect of the thyroarytenoid muscle tended to be irregularly shaped, appeared to fill up the paraglottic space, and were associated with significant muscle compression. The vertical thickness of the injected boluses averaged 9.5 mm for lateral boluses and 7.6 mm for medial boluses, which were comparable to the vertical thickness of uninjected vocal folds. Conclusion. Laterally injected boluses are shaped by spatial constraints imposed by elements of the laryngeal framework. Compression of vocal fold muscle may be a mechanism accounting for stiffness from overinjection. The irregular shapes of some boluses may affect the outcome of subsequent medialization attempts. Injections may enhance the vocal fold contact height as a favorable effect beyond simple medialization.",
keywords = "3D analysis, Excised larynx, Injection augmentation, Laryngoplasty, Vocal fold injection, Vocal fold medialization",
author = "Ted Mau and Brewer, {Jacquelyn M.} and Gatzert, {Samuel T.} and Courey, {Mark S.}",
year = "2011",
month = "4",
doi = "10.1177/0194599810395107",
language = "English (US)",
volume = "144",
pages = "552--557",
journal = "Otolaryngology - Head and Neck Surgery (United States)",
issn = "0194-5998",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Three-dimensional conformation of the injected bolus in vocal fold injections in a cadaver model

AU - Mau, Ted

AU - Brewer, Jacquelyn M.

AU - Gatzert, Samuel T.

AU - Courey, Mark S.

PY - 2011/4

Y1 - 2011/4

N2 - Objective. To determine the 3-dimensional (3D) conformation of the injected bolus in the larynx in vocal fold injections, to understand how the bolus interacts spatially with elements of the laryngeal framework, and to relate the above to clinical observations in performing vocal fold injections. Study Design. Excised cadaveric larynx study. Setting. Laboratory. Subjects and Methods. Vocal folds of 12 human excised cadaveric larynges were injected with calcium hydroxylapatite. High-resolution computed tomography scans were obtained of the injected larynges. Densities corresponding to the injected bolus and the laryngeal framework were extracted and processed with MATLAB routines to generate selective 3D reconstructions of the injected bolus within the laryngeal framework. Histology analysis was also performed to correlate with observations from the 3D reconstructions. Results. Boluses injected into the lateral aspect of the thyroarytenoid muscle tended to be irregularly shaped, appeared to fill up the paraglottic space, and were associated with significant muscle compression. The vertical thickness of the injected boluses averaged 9.5 mm for lateral boluses and 7.6 mm for medial boluses, which were comparable to the vertical thickness of uninjected vocal folds. Conclusion. Laterally injected boluses are shaped by spatial constraints imposed by elements of the laryngeal framework. Compression of vocal fold muscle may be a mechanism accounting for stiffness from overinjection. The irregular shapes of some boluses may affect the outcome of subsequent medialization attempts. Injections may enhance the vocal fold contact height as a favorable effect beyond simple medialization.

AB - Objective. To determine the 3-dimensional (3D) conformation of the injected bolus in the larynx in vocal fold injections, to understand how the bolus interacts spatially with elements of the laryngeal framework, and to relate the above to clinical observations in performing vocal fold injections. Study Design. Excised cadaveric larynx study. Setting. Laboratory. Subjects and Methods. Vocal folds of 12 human excised cadaveric larynges were injected with calcium hydroxylapatite. High-resolution computed tomography scans were obtained of the injected larynges. Densities corresponding to the injected bolus and the laryngeal framework were extracted and processed with MATLAB routines to generate selective 3D reconstructions of the injected bolus within the laryngeal framework. Histology analysis was also performed to correlate with observations from the 3D reconstructions. Results. Boluses injected into the lateral aspect of the thyroarytenoid muscle tended to be irregularly shaped, appeared to fill up the paraglottic space, and were associated with significant muscle compression. The vertical thickness of the injected boluses averaged 9.5 mm for lateral boluses and 7.6 mm for medial boluses, which were comparable to the vertical thickness of uninjected vocal folds. Conclusion. Laterally injected boluses are shaped by spatial constraints imposed by elements of the laryngeal framework. Compression of vocal fold muscle may be a mechanism accounting for stiffness from overinjection. The irregular shapes of some boluses may affect the outcome of subsequent medialization attempts. Injections may enhance the vocal fold contact height as a favorable effect beyond simple medialization.

KW - 3D analysis

KW - Excised larynx

KW - Injection augmentation

KW - Laryngoplasty

KW - Vocal fold injection

KW - Vocal fold medialization

UR - http://www.scopus.com/inward/record.url?scp=84855548894&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84855548894&partnerID=8YFLogxK

U2 - 10.1177/0194599810395107

DO - 10.1177/0194599810395107

M3 - Article

C2 - 21493234

AN - SCOPUS:84855548894

VL - 144

SP - 552

EP - 557

JO - Otolaryngology - Head and Neck Surgery (United States)

JF - Otolaryngology - Head and Neck Surgery (United States)

SN - 0194-5998

IS - 4

ER -