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Scientific Oral Presentations

Laryngology/Broncho-Esophagology

Session: Scientific Oral Presentations 2 - Laryngology/Broncho-Esophagology

Feasibility of Laryngeal Joint Replacement: A Proof of Concept Study in Cadavers

Sunday, September 29, 2024

9:48 AM – 9:54 AM EDT

Location: MBCC, 224

Disclosure(s):

Robert C. Wang, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Suparna N. Shah, MD, MBA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Posterior laryngeal stenosis is a vexing problem despite efforts at early tracheostomy in those intubated on ventilatory support. Treatment relies on permanent tracheostomy, or irreversible arytenoidectomy/cordectomy which is a compromise between voice, swallowing and airway. While having intact laryngeal neuromuscular function, there is immobility of the vocal cord due to scarring and ankylosis of the cricoarytenoid joint in this condition. In this proof of concept study, we explore the feasibility of repairing cricoarytenoid joint function with joint replacement in the fresh cadaver model.

Methods: Two laryngeal surgeons attempted to expose the joint posterolaterally without injury to the neuromuscular and ligamentous components of the cricoarytenoid joint from an external cervical approach in 3 fresh human cadavers. Working with an orthopedic joint replacement surgeon and researcher and an oral surgeon with expertise in dental implants, a hemiarthroplasty system was devised based on existing 3D-printed dental implant technology.

Results: One surgeon familiar with the joint anatomy was able to reproducibly expose the joint by exposing and opening the joint capsule without injury to the surrounding intrinsic laryngeal neuromuscular or cricoarytenoid joint ligamentous structures in 2 cadavers, and the other surgeon was able to as well after observing the first surgeon’s approach. Next, it was demonstrated that a 4 mm titanium implant screw was able to be placed through the posterior cricioid joint facet into the cricoid cartilage below the joint, onto which a 3D-printed ceramic artificial joint can be inserted.

Conclusions: We demonstrate for the first time that it is feasible to expose the cricoarytenoid joint without neuromuscular or joint ligamentous injury from an external approach, and insert a joint replacement hemiarthroplasty system.

Presenting Author(s)

Robert C. Wang, MD

Professor; Chair, Otolaryngology
University of Nevada School of Medicine
Las Vegas, NV, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

Robert C. Wang, MD

Professor; Chair, Otolaryngology
University of Nevada School of Medicine
Las Vegas, NV, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Suparna N. Shah, MD, MBA

Assistant professor, Laryngology, Dept of Otolaryngology-Head & Neck Surgery
Kirk Kerkorian School of Medicine at UNLV
Las Vegas, Nevada, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
JM

Jeff Moxley, DDS

Kirk Kerkorian School of Medicine at UNLV, United States

Disclosure information not submitted.
Muhammed F. Shand, MD

Chief Resident
Department of Otolaryngology-Head & Neck Surgery, University of Nevada - Las Vegas
Las Vegas, NV, United States

Disclosure information not submitted.