Phonomicrosurgical management of vocal fold polyps: The subepithelial microflap resection technique

Vocal fold polyps are typically caused by acute and chronic trauma to the microvasculature of the superficial lamina propria (SLP). Shearing stresses that are induced by hyperfunctional glottal sound production lead to bleeding into the SLP and malformed neo-vascularized masses. Because the primary process does not involve the epithelium, the authors designed a technique to resect hemorrhagic polyps by epithelial cordotomy with partial or complete preservation of the vocal fold epithelium. This approach is different from the traditional microsurgical resection of hemorrhagic polyps by amputation with or without the carbon dioxide laser. Forty patients who underwent microlaryngoscopic resection of hemorrhagic polyps from 1996 through 1998 were reviewed retrospectively. Thirty-six of the 40 procedures were by epithelial cordotomy and subepithelial removal of the polyp contents. Sixteen of 36 were assisted by a subepithelial infusion of saline and epinephrine, and all were 3 mm to 6 mm. Four of 40 polyps were amputated; all of these were less than 3 mm and were pedicled on a narrow base. Cold instruments were used exclusively in all 40 patients. Postoperative laryngeal stroboscopy within 2 weeks revealed improved mucosal wave propagation and improved glottal closure in all 33 patients in whom postoperative strobovideolaryngoscopy was available. The epithelial cordotomy technique was introduced to minimize disturbance of normal SLP and epithelium. Despite the hemorrhagic nature of these lesions, cold instruments could be used exclusively with facility due to careful microdissection between the polyp and the residual normal SLP and the enhanced hemostasis provided by the subepithelial infusion of saline and epinephrine. The rapid return to improved glottal function is the result of this ultra tissue-sparing technique.     

Magnetic fabrics in fault-related fold and its relation with finite strain: an example from Mingjiang thrust structures in Western Sichuan

The anisotropy of magnetic susceptibility (AMS) is a quick, effective and sensitive technique used to measure the weakly deformed sedimentary rocks, and also a reliable method to reveal the deforming mechanisms of fault-related folds. In Longmenshan front belt, a typical cross-section of fault-related folds is chosen to study the AMS. A total of 224 oriented specimens have been drilled at 23 different sampling sites which were distributed at the key structural positions of this structural section developed in the Xujiahe formation of the upper Triassic. Six elementary types of magnetic fabrics are recognized and established through this AMS study: 1) a sedimentary fabric; 2) an initial deformation fabric; 3) a pencil structure fabric; 4) a weak cleavage fabric; 5) a strong cleavage fabric; 6) a stretching lineation fabric. It has been found that most of magnetic fabrics are characterized by fabrics of weak deformation which belong to the pure-shear results of a pre-folding layer parallel shortening (LPS). In the fault-bend fold, almost all magnetic fabrics are the initial deformation fabrics of weak deformation, and denote that the deformation in the forelimb is stronger than that in the backlimb and no finite strain is shown in the footwall. While in the fault-propagation fold， finite strains are concentrated in the trishear zone where magnetic fabric results are approximately consistent with the estimated consequences of the kinematic model. The tectonic stress field indicated by the magnetic fabrics is basically the same along the whole structural section and shows a NW to SE compression and shortening which is accordant with the regional compressive stress field of the Longmenshan fold-thrust belt.     

南阳凹陷边界断层三维几何学及运动学特征

新野断层位于南襄盆地南阳凹陷南部的控凹边界断裂,研究其三维几何学和运动学特征对分析南阳凹陷的形成演化至关重要。以2/3D地震、钻井及测井资料为基础,以正断层相关褶皱理论和构造复原理论为指导,深入剖析新野断层的三维几何学和运动学特征及其对凹陷形成的控制作用。根据断层平面走向,结合倾角和断距变化,将新野断层分为西、中、东3段;空间上认为,新野断层是由多个等倾角面构成的复杂曲面,通过两个垂向轴面和4个横向轴面,将新野断层断面分为11个等倾角区。根据平衡地质剖面复原结果对比,认为新野断层西段、东段形成于晚白垩世,中段形成于始新世大仓房期并逐渐与西段、东段硬连接形成一条断层;断层及其上盘地层旋转程度自西向东逐渐增强;断层反转强度自西向东亦逐渐变大。新野断层西段为"座椅式"正断层,中段由"转折式"正断层转"犁式"正断层,东段为"犁式"正断层。沿断层走向的差异沉降和断面形态差异是南阳凹陷构造特征及形成演化的重要控制因素。     

Studying edge effects near rectangular mine workings weakened by a crack

Edge effects in a rock mass near a system of periodic mine workings crossed by a crack (fold fault) are considered. The stress state near the mine workings is determined by solving an elastic problem using the piecewise-homogeneous medium model. The original differential problem is reduced to a discrete problem based on the concept of a base scheme. Methods are proposed to solve the discrete problem, and the issue of optimizing the numerical analysis is discussed. The stress distribution around mine workings is analyzed. The stress isolines that represent the boundaries of edge effect zones and indicate their maximum decay length are plotted __________ Translated from Prikladnaya Mekhanika, Vol. 44, No. 1, pp. 74–78, January 2008.     

Laryngeal Myasthenia Gravis: Report of 40 Cases

Myasthenia gravis, an autoimmune disorder of the neuromuscular junction, is usually recognized because of ocular complaints or generalized weakness. We report a series of 40 patients who presented with dysphonia as their initial and primary complaint. Diagnostic testing included strobovideolaryngoscopy, electromyography (EMG) with repetitive stimulation and Tensilon testing, and laboratory and radiographic evaluation. Strobovideolaryngoscopy most commonly revealed fluctuating impairment of vocal fold mobility, either unilateral or bilateral. EMG detected evidence of neuromuscular junction abnormalities in all patients. Only one patient had evidence of antiacetylcholine receptor (ACh-R) antibodies, but many other abnormalities suggestive of autoimmune dysfunction were present. Pyridostigmine therapy was initiated in 34 patients but was not tolerated in 4. Of the remaining 30 patients, 23 reported improvement of symptoms. We conclude that myasthenia gravis can present with symptoms confined primarily to the larynx and should be included in the differential diagnosis of dysphonia.     

Minifenestration Type I Thyroplasty Using an Expanded Polytetrafluoroethylene Implant

Several methods have been used to treat laryngeal incompetence, but no ideal technique has been identified. This paper describes a clinical experience with minifenestration type I thyroplasty using a new device made of expanded polytetrafluoroethylene (ePTFE). The device, a thin ribbon of ePTFE, is inserted through a 4-mm fenestration to produce vocal fold medialization. At our center, 26 of these devices have been implanted in the past 3 years. Good or satisfactory results were achieved in 96% of cases. Advantages of this technique include easy insertion of the implant, nominal cost and biocompatibility of the ePTFE device, ready availability of all instruments required for the procedure, and elimination of the need to perform arytenoid adduction.