PMC7229273_01
(A) Pre-operative video-endoscopic evaluation showing salivary penetration into the larynx and a wide pharyngeal space. (B) Postoperative video-endoscopic evaluation showing absence of saliva residue and a decrease in vallecula residue due to a shortened distance between the epiglottis and the base of the tongue, as well as a narrowing of the space of the vallecula.
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Video-endoscopic swallowing assessment showed saliva pooling in the pharynx, widening of the pharyngeal space, vallecular and pyriform sinus residue, and aspiration (Fig. 1A). Video-endoscopic examination confirmed his ability to eat a rice cracker and noodles without aspiration and no evidence of pharyngeal residue on POD 11 (Fig. 1B).
Pre-operative video-fluorography showing enlargement of the esophageal orifice, with a weak anterior movement of the larynx. The contraction of the pharyngeal constrictor muscle is decreased, with evident residue in the vallecula and pyriform sinus after swallowing and mixed aspiration. In (A)-(C), circles indicate the location of the hyoid bone. Asterisks indicate the location of the superior border of the thyroid cartilage.
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Video-fluorography revealed a decrease in the forward movement of the larynx, a widened pharyngeal space, weakened pharyngeal constriction, vallecular and pyriform sinus residue, and aspiration (Fig. 2A-C).
(A) Placement of the two skin incisions used for the minimally invasive laryngeal suspension, a 2-cm incision at the revel of the mandible and a second 3-cm incision between the hyoid bone and the superior border of the thyroid cartilage. A 1-cm skin incision is also performed for tracheostomy. (B) Three holes, each separated by 1 cm, are created in the mandible and 6, each separated by less than 1 cm, in the thyroid cartilage. The mandibular and the thyroid cartilage were closely fixed using No.2 nylon thread, passed through the subcutaneous tunnel on the hyoid bone.
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Laryngeal suspension was performed via a minimally invasive thyromadibulopexy, using two skin incisions: one (2-cm) incision at the level of the mandible and the other (3-cm) between the hyoid bone and the superior border of the thyroid cartilage (Fig. 3A). The larynx was suspended about one vertebral body by totally using five No. 2 nylons (Fig. 3B), confirmed by X-ray fluoroscopy.
Postoperative video-fluorography showing the anterosuperior suspension of the larynx after surgery, with absence of pharyngeal residue of contrast agent and aspiration. In (A)-(C), circles indicate the location of the hyoid bone. Asterisks indicate the location of the superior border of the thyroid cartilage.
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Video-fluorography revealed contrast agent residue in the vallecular but with a decrease in residue in the pyriform sinus compared to pre-operative measures, with no evidence of aspiration on POD 6 (Fig. 4A-C).