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Transcutaneous Laryngeal Ultrasonography: Clinical Variables

  • Brian H. LangEmail author
Chapter

Abstract

Transcutaneous laryngeal ultrasound (TLUSG) is a noninvasive and convenient method of assessing the function of both vocal cords (VCs) before and after thyroidectomy. It works by essentially relying on the propagation of ultrasound waves travelling from the anterior neck skin to the VCs and the arytenoids via the ventral window of the thyroid cartilage. As a result, the presence of ossification (i.e., turning from cartilaginous tissue to bone) in the thyroid cartilage is the major determinant of obtaining clear VC visualization by TLUSG. It is now clear that the process of ossification is an inevitable, age-related phenomenon and slowly begins from the posterior part of the thyroid cartilage toward an anteromedial direction. Numerous clinical studies have shown that male patients with advanced age are particularly prone to have a complete ossification of the cartilage rendering VC visualization by TLUSG almost impossible. However, despite this process, one should also realize that since the majority of patients undergoing thyroidectomy are young females, TLUSG should be highly applicable to many thyroid surgeons. With appropriate training, the skills of TLUSG could be quickly learned by surgeons who may or may not routinely perform ultrasound in their practice.

Keywords

Ultrasonography Larynx Vocal cord Vocal cord paresis Surgical outcome Recurrent laryngeal nerve injury Thyroidectomy Parathyroid surgery Laryngoscopy 

Notes

Acknowledgments

I would like to take this opportunity to thank Dr. KP Wong and Dr. JW Woo for providing some of the wonderful images and videos used in this chapter.

Competing Interests 

The author declares that he has no competing interests.

Author Contributions 

BHH Lang was involved in the review of literature, acquisition of data, and drafting and completing the chapter. BHH Lang was also involved in the review of literature and drafting the chapter. BHH Lang conceived the study, participated in the coordination and the acquisition of data and helped to draft the chapter. He read and approved the chapter.

Supplementary material

Video 31.1

Normal (grade I) movement in both vocal cords (MP4 10,363 kb)

Video 31.2

Impaired (grade II) movement in left vocal cord with good compensation (MP4 14,174 kb)

Video 31.3

Absent (grade III) movement in left vocal cord (MP4 14,038 kb)

References

  1. 1.
    Lang BH, Wong CK, Tsang RK, Wong KP, Wong BY. Evaluating the cost-effectiveness of laryngeal examination after elective total thyroidectomy. Ann Surg Oncol. 2014;21(11):3548–56.CrossRefPubMedGoogle Scholar
  2. 2.
    Lang BH, Chu KK, Tsang RK, Wong KP, Wong BY. Evaluating the incidence, clinical significance and predictors for vocal cord palsy and incidental laryngopharyngeal conditions before elective thyroidectomy: is there a case for routine laryngoscopic examination? World J Surg. 2014;38(2):385–91.CrossRefPubMedGoogle Scholar
  3. 3.
    Parangi S. Translaryngeal vocal cord ultrasound: ready for prime time. Surgery. 2016;159:67. doi: 10.1016/j.surg.2015.10.014. pii: S0039-6060(15)00841-7.CrossRefPubMedGoogle Scholar
  4. 4.
    Paul BC, Rafii B, Achlatis S, Amin MR, Branski RC. Morbidity and patient perception of flexible laryngoscopy. Ann Otol Rhinol Laryngol. 2012;121(11):708–13.CrossRefPubMedGoogle Scholar
  5. 5.
    Carneiro-Pla D, Solorzano CC, Wilhelm SM. Impact of vocal cord ultrasonography on endocrine surgery practices. Surgery. 2016;159:58. doi: 10.1016/j.surg.2015.06.067. pii: S0039-6060(15)00743-6.CrossRefPubMedGoogle Scholar
  6. 6.
    Wong KP, Lang BH, Lam S, Au KP, Chan DT, Kotewall NC. Determining the learning curve of transcutaneous laryngeal ultrasound in vocal cord assessment by CUSUM analysis of eight surgical residents: when to abandon laryngoscopy. World J Surg. 2016;40:659.CrossRefPubMedGoogle Scholar
  7. 7.
    Wong KP, Lang BH, Ng SH, Cheung CY, Chan CT, Lo CY. A prospective, assessor-blind evaluation of surgeon-performed transcutaneous laryngeal ultrasonography in vocal cord examination before and after thyroidectomy. Surgery. 2013;154(6):1158–64. discussion 1164-5.CrossRefPubMedGoogle Scholar
  8. 8.
    Woo JW, Suh H, Song RY, Lee JH, Yu HW, Kim SJ, Chai YJ, Choi JY, Lee KE. A novel lateral-approach laryngeal ultrasonography for vocal cord evaluation. Surgery. 2016;159:52. doi: 10.1016/j.surg.2015.07.043. pii: S0039-6060(15)00705-9.CrossRefPubMedGoogle Scholar
  9. 9.
    Raghavendra BN, Horii SC, Reede DL, Rumancik WM, Persky M, Bergeron T. Sonographic anatomy of the larynx, with particular reference to the vocal cords. J Ultrasound Med. 1987;6(5):225–30.CrossRefPubMedGoogle Scholar
  10. 10.
    Garel C, Legrand I, Elmaleh M, Contencin P, Hassan M. Laryngeal ultrasonography in infants and children: anatomical correlation with fetal preparations. Pediatr Radiol. 1990;20(4):241–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Sidhu S, Stanton R, Shahidi S, Chu J, Chew S, Campbell P. Initial experience of vocal cord evaluation using grey-scale, real-time. B-mode ultrasound. ANZ J Surg. 2001;71(12):737–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Cheng SP, Lee JJ, Liu TP, Lee KS, Liu CL. Preoperative ultrasonography assessment of vocal cord movement during thyroid and parathyroid surgery. World J Surg. 2012;36(10):2509–15.CrossRefPubMedGoogle Scholar
  13. 13.
    Wang CP, Chen TC, Yang TL, Chen CN, Lin CF, Lou PJ, Hu YL, Shieh MJ, Hsieh FJ, Hsiao TY, Ko JY. Transcutaneous ultrasound for evaluation of vocal fold movement in patients with thyroid disease. Eur J Radiol. 2012;81(3):e288–91.CrossRefPubMedGoogle Scholar
  14. 14.
    Dedecjus M, Adamczewski Z, Brzeziński J, Lewiński A. Real-time, high-resolution ultrasonography of the vocal folds--a prospective pilot study in patients before and after thyroidectomy. Langenbecks Arch Surg. 2010;395(7):859–64.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Wong KP, Woo JW, Youn YK, Chow FC, Lee KE, Lang BH. The importance of sonographic landmarks by transcutaneous laryngeal ultrasonography in post-thyroidectomy vocal cord assessment. Surgery. 2014;156(6):1590–6. discussion 1596.CrossRefPubMedGoogle Scholar
  16. 16.
    Wong KP, Lang BH, Chang YK, Wong KC, Chow FC. Assessing the validity of transcutaneous laryngeal ultrasonography (TLUSG) after thyroidectomy: what factors matter? Ann Surg Oncol. 2015;22(6):1774–80.CrossRefPubMedGoogle Scholar
  17. 17.
    Carneiro-Pla D, Miller BS, Wilhelm SM, Milas M, Gauger PG, Cohen MS, Hughes DT, Solorzano CC. Feasibility of surgeon-performed transcutaneous vocal cord ultrasonography in identifying vocal cord mobility: a multi-institutional experience. Surgery. 2014;156(6):1597–602. doi: 10.1016/j.surg.2014.08.071. discussion 1602-4.CrossRefPubMedGoogle Scholar
  18. 18.
    Wenaas AE, Tran B, Ongkasuwan J. The progression of thyroid cartilage calcification as it relates to the utilization of laryngeal ultrasound. Laryngoscope. 2016;126:913. doi: 10.1002/lary.25582.CrossRefPubMedGoogle Scholar
  19. 19.
    Gray H. The larynx. In: Anatomy of the human body. Philadelphia, PA: Lea & Febiger; 1918. http://www.bartleby.com/107/236.html. Accessed April 22, 2014.
  20. 20.
    Kirsch T, Claassen H. Matrix vesicles mediate mineralization of human thyroid cartilage. Calcif Tissue Int. 2000;66(4):292–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Division of Endocrine Surgery, Department of Surgery, Queen Mary HospitalThe University of Hong KongHong KongChina

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