Foreign body sensation in the throat due to displacement of the superior cornu of the thyroid cartilage: two cases and a literature review

Imaging of Neck Visceral Trauma

The neck visceral space is a complex region housing several vital structures. Diagnostic imaging plays an important role in the evaluation of neck visceral injuries. Many injuries are initially missed by both clinicians and radiologists because of their infrequency and the high likelihood of other more obvious injuries. Understanding which diagnostic modality to apply at given point in the work-up; recognizing relevant clinical signs, symptoms, and injury mechanisms; and knowing pertinent direct and indirect imaging findings of injury allow radiologists to either directly render the correct diagnosis or choose the most appropriate tool for doing so.

Anterior cervical pain syndrome: Risk factors, variations in hyolaryngeal anatomy, and treatments

OBJECTIVE

Anterior cervical pain syndromes (ACPS) are a poorly understood entity associated with lateral neck discomfort when talking, chewing, or yawning, and with occasional excruciating pain and dysphagia. This investigation aims to describe patients with ACPS presenting symptoms and treatments.

STUDY DESIGN

Retrospective chart review of all patients with ACPS presenting to a tertiary care laryngology practice in 1 year.

METHODS

All patients diagnosed with ACPS for 1 year were reviewed. Patient gender, age, body mass index (BMI), and pain triggers were documented. The hyolaryngeal complex was measured on computed tomography (CT) scans of the neck. Treatments were recorded.

RESULTS

Nine patients were diagnosed with an ACPS in a 1-year period. Sixty-seven percent were female with an average age of 47.3 years ± 16.6. The average BMI of a patient with ACPS was 24.8 ± 3.69. The most common symptom was point tenderness at the lateral aspect of the hyoid or superior cornu of the thyroid cartilage (89%). Pain triggers included speaking (67%), head turn (56%), chewing (44%), yawning (56%), and swallowing (56%). On CT imaging, eight of nine patients had abnormalities of the hyoid bone or the superior cornu of the thyroid cartilage, correlating 100% with point tenderness location. Treatments include physical therapy (33%), steroid injection (44%), lidocaine injection (22%), and surgical intervention (56%).

CONCLUSION

ACPS is a frustrating condition for patients and physicians. Evaluation of anterior cervical pain with point tenderness should include imaging measurement of the thyrohyoid complex. Effective treatments include local steroid injection and surgical resection of the abnormal structure.

LEVEL OF EVIDENCE

4 Laryngoscope, 130:702-705, 2020.

Laryngeal anatomical variants and their impact on the diagnosis of mechanical asphyxias by neck pressure

The aims of this investigation were to determine the characteristics and prevalence of anatomical variants of the larynx apparatus and to evaluate the impact of these variants on the accurate diagnosis of laryngeal fractures. A population-based study was carried out, analyzing a series of 207 consecutive autopsied cases in the Institute of Legal Medicine of Galicia (Northwestern Spain). The prevalence of triticeal cartilage was 52.7% and that of agenesis of thyroid horns 10%. Calcification of the stylo-hyoid ligament accounted for 1.4%. We identified three new anatomical variants: the terminal segmentation of the thyroid horns (11.6%), ectopic superior thyroid horns (8%) and lateral thyrohyoid ossification (5.3%). These three names, based on anatomical criteria, are the author's proposal to solve the lack of uniformity in the designation of these variants. Agenesis of thyroid horns were related to the presence of ectopic superior thyroid horns in 93% of cases, either uni or bilateral. The combination of variants was present in 6.8% of the cases, being the terminal segmentation of the thyroid horns in association with triticeal cartilage the most frequent (3.8%). The probability of misdiagnosis due to the presence of anatomical variations in deaths by pressure on the neck was high in this population (71.5%). The prevalence of triticeal cartilage in more than half of the sample, determined an important rate of potential errors (46.4%), followed by the mistaken diagnoses induced by terminal segmentation of thyroid horns (7.3%) and by ectopic superior thyroid horns (6.3%). The likelihood of a misdiagnosed laryngeal fracture was greater if the thyroid cartilage was affected, with a higher proportion of false positives comparing to the hyoid bone (p<0.001). The higher frequency of thyroid fractures in neck pressure together with the prevalence and location of triticeal cartilage on the lower third of the lateral thyrohyoid ligament are the main reasons for these results. Further studies should be done with larger samples to expand epidemiological data and consolidate these results and their influence on the diagnosis of mechanical asphyxias.

Buckled Thyroid Cartilage: An Anatomic Variant

OBJECTIVE

Anatomic abnormalities in the larynx can cause significant and bothersome symptoms. Identified here is an anatomical variant of the thyroid cartilage.

STUDY DESIGN

This study is a retrospective case series of 11 subjects diagnosed with an anatomic variant of the thyroid cartilage.

METHODS

Patients with an anatomic inward buckling of the thyroid cartilage, termed here as buckled thyroid cartilage, were identified through a 20-year retrospective chart review of a tertiary care laryngology practice.

RESULTS

We describe 11 patients with fullness or asymmetry in the area of the false vocal fold and an associated inward buckling of the thyroid cartilage on computed tomography scan. All patients presented with a bothersome voice-related complaint. The most common presenting complaints were hoarseness (54%), globus sensation (45%), or vocal fatigue (27%). One patient was found to have a history of known laryngeal trauma. Surgical correction through an external approach on one patient was successfully performed with subsequent resolution of symptoms.

CONCLUSION

We postulate that deformity and protrusion of the false vocal fold can result in a dampening effect on the vibratory capacity of the vocal fold that can lead to symptomatic hoarseness and vocal fatigue. Buckled thyroid cartilage is, therefore, an important anatomical variant to be aware of and be able to recognize.

[Paresthesias of the upper respiratory tract]

This review concerns the modern views of etiology, diagnostics, and treatment of the patients presenting with paresthesias of the upper respiratory tract. Various concepts of etiology of this pathology are described along with the relevant diagnostic and therapeutic approaches. Special attention is given to the debatable aspects of diagnostics and treatment of the patients complaining of the feeling of a lump in the throat ("globus sensation"). The opinions of the domestic and foreign authors concerning this problem are considered. The necessity of the search for the new additional therapeutic procedures for the treatment of paresthesias of the upper respiratory tract, including the non-medicamental modalities, is substantiated. It is concluded that the development of the new adequate diagnostic and therapeutic algorithm is indispensable for the enhancement of the effectiveness of the management of the patients with paresthesias of the upper respiratory tract and complaints of "globus sensation".

An unusual cause of foreign-body sensation in the throat: a displaced superior cornu of the thyroid cartilage

Foreign-body sensation is a nonspecific symptom of aerodigestive tract diseases. We describe the case of a 42-year-old man who presented with a foreign-body sensation in the throat that was found to be caused by a displaced superior cornu of the thyroid cartilage. Such a displacement is not well known, but we believe that it may not be rare. These cases can be overlooked and misdiagnosed as chronic nonspecific pharyngitis or laryngopharyngeal reflux. However, a careful laryngoscopic examination by an otolaryngologist who considers the possibility of such a pathology may result in an accurate diagnosis, which might spare an affected patient from a lifelong pharmacotherapeutic regimen.

Superior thyroid cornu anatomical variation causing globus pharyngeous and Dysphagia

Objective. Rare case presentation of thyroid cartilage variation causing globus sensation and dysphagia. Method. Case report and review of the literature concerning thyroid cartilage variant of clinical significance. Results. Middle-aged male patient presented with globus sensation and painful swallow without previous injury of the larynx. Clinical examination and diagnostic procedures revealed a rare anatomic aberrance of the thyroid cartilage. Surgical treatment was declined by the patient who accepted a yearly followup. Conclusion. Morphometric studies do not report the dislocation of the superior thyroid cornu, and very few cases have been described either of which were attributed to trauma or to unknown cause. The present case is to be added to the very few cases of superior thyroid cornu dislocation of unknown aetiology. Clinicians should be aware of this rare variation using CT neck as the imaging study of choice. Direct endoscopy rules out any synchronous disease or malignancies.

Superior Thyroid Cornu Syndrome: An Unusual Cause of Cervical Dysphagia

Objectives:

Ossification of a superior thyroid cornu in men may cause pharyngeal airway impingement and result in cervical dysphagia. We report on a clinical case series of this rare condition, called superior thyroid cornu syndrome. This is the first report of a case series of this entity as a possible cause of cervical dysphagia that was successfully treated with an endoscopic procedure.

Methods:

A clinical case series of 12 patients were identified as having superior thyroid cornu syndrome (years 2001 to 2006). Eleven patients were male and 1 was female; their mean age was 54.6 years. They complained of unresolved throat pain, difficulty swallowing, and/or pain on swallowing. On flexible laryngoscopy, there was an asymmetric indentation of the pharynx due to a prominent superior thyroid cornu. Laryngeal manipulation produced the pain and exposed the prominent cornu in the airway. Computed tomographic evidence of calcification of the superior thyroid horn without other abnormality was noted.

Results:

After maximal medical treatment with proton pump inhibitors, anti-inflammatory agents, nasal steroids, antihistamines, and/or other allergy treatments, 8 of the patients who had persistent symptoms were treated by transoral pharyngotomy and resection of an approximately 2.0 × 0.5-cm segment of a thyroid cornu. Vast improvement in symptoms occurred in 6 patients, and complete symptom resolution occurred in 3 of those 6. Two of 8 patients reported improvement in swallowing, but persistent pain. The follow-up duration was between 2 and 15 months from the time of surgery.

Conclusions:

Superior thyroid cornu syndrome may be a rare cause of cervical dysphagia. It may be diagnosed by careful laryngoscopy with laryngeal palpation followed by a computed tomography scan. Surgical resection of the affected superior thyroid cornu by transoral pharyngotomy appears to be effective in relief of symptoms.

The morphometric development of the fetal larynx during the fetal period

OBJECTIVE

The aim of the present study was to investigate morphometric growth patterns of the cartilaginous components and vocal cords in human fetal larynx.

METHODS

This study was performed in the Anatomy Department of Meram Medicine Faculty in 2007. The fetuses were obtained from the Gynaecology Department of the Meram Medicine Faculty of Selcuk University, and Dr. Faruk Sükan Maternity Hospital (Konya, Turkey). Forty spontaneously aborted fetuses (25 males and 15 females) without detectable malformations were evaluated. The dimensions of the larynx and its cartilaginous components were measured and the relationship between the obtained data was statistically assessed with Student's t-test.

RESULTS

Correlations were found between the cartilaginous components, size of the larynx, and gestational age. No gender differences were identified. The anatomical variations in the epiglottis cartilage dimensions and types were found in 15% of cases. The foramen thyroideum was observed in 12.5% of cases.

CONCLUSION

The data of this study may contribute to the knowledge of the fetal larynx regarding laryngomalacia.