Authors: Sung Min Jin Chi Yeol Park Jong Kyu Lee Jae Ho Ban Sang Hyuk Lee Kyung Chul Lee
Publish Date: 2007/09/25
Volume: 265, Issue: 3, Pages: 313-319
Abstract
A variety of approaches have been introduced to perform injection laryngoplasty under local anesthesia Among these reported methods transcutaneous injection through the cricothyroid space offers many advantages but it possesses some technical difficulties during access to the vocal fold The aim of this study was to assess the anatomic references related to transcutaneous injection laryngoplasty through cricothyroid space using 3dimensionally reconstructed computed tomography to provide guidelines and to achieve higher efficacy during the procedure The study group consisted of 14 patients 7 male 7 female with unilateral vocal fold paralysis and who had undergone multidetector array computed tomography MDCT between January 2004 and December 2005 Assumption was made that transcutaneous injection is approached from the surface at lower margin of the thyroid cartilage and 7 mm lateral to the midline through the cricothyroid membrane and spot at the posterior 1/3 of true vocal cord is the target for injection laryngoplasty From the surface of the injection point to the target a line was drawn Its length and the angle formed between it and the approach direction of needle was measured Based on these measurements 15 patients 8 male 7 female with unilateral vocal fold paralysis received 15 trials of transcutaneous injection laryngoplasty through the cricothyroid space The average length from the surface of the injection point 7 mm lateral to the midline to the posterior 1/3 of the true vocal cord target of the injection was 1575 mm in men and 1391 mm in women The average of the angle in medial direction at the surface needed to reach the target of the injection was 1057° in men and 1271° in women and in superior direction was 4757° in men and 4743° in women Injection laryngoplasty performed under acquired reference measurements were successful in 14 trials 933 out of 15 trials in 15 patients We suggest that knowledge of the anatomic references regarding the transcutaneous injection laryngoplasty through cricothyroid space will provide guidelines for beginners and improve the understanding of the procedure eventually leading to easier and more precise access to the vocal cord
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