Objective To determine the 3-dimensional (3D) conformation of the injected bolus in the larynx in vocal fold injections, to understand how the bolus interacts spatially with elements of the laryngeal framework, and to relate the above to clinical observations in performing vocal fold injections. Study Design Excised cadaveric larynx study. Setting Laboratory. Subjects and Methods Vocal folds of 12 human excised cadaveric larynges were injected with calcium hydroxylapatite. High-resolution computed tomography scans were obtained of the injected larynges. Densities corresponding to the injected bolus and the laryngeal framework were extracted and processed with MATLAB routines to generate selective 3D reconstructions of the injected bolus within the laryngeal framework. Histology analysis was also performed to correlate with observations from the 3D reconstructions. Results Boluses injected into the lateral aspect of the thyro-arytenoid muscle tended to be irregularly shaped, appeared to fill up the paraglottic space, and were associated with significant muscle compression. The vertical thickness of the injected boluses averaged 9.5 mm for lateral boluses and 7.6 mm for medial boluses, which were comparable to the vertical thickness of uninjected vocal folds. Conclusion Laterally injected boluses are shaped by spatial constraints imposed by elements of the laryngeal framework. Compression of vocal fold muscle may be a mechanism accounting for stiffness from overinjection. The irregular shapes of some boluses may affect the outcome of subsequent medialization attempts. Injections may enhance the vocal fold contact height as a favorable effect beyond simple medialization.

OBJECTIVE: 1) Better appreciate the perioperative concerns affecting patients considering thyroidectomy. 2) Understand that concerns may vary depending on the population, and age.3) Ensure that perioperative counseling is directed towards the areas of greatest concerns experienced by patients considering thyroidectomy. METHOD: Patients scheduled for thyroid surgery at the McGill University Thyroid Cancer Center in Montreal, Canada were recruited. To date, 30 individuals completed the 18-item questionnaire adapted from the Western Surgical Concern Inventory (WSCI). The WSCI is used to elucidate the different perioperative areas of concern of these individuals. Outcomes included descriptive statistics as well as sub-analyses pertaining to age and the type of surgery (total vs. hemi-thyroidectomy). RESULTS: Top areas of concern included: the nodule being cancerous (highest), needing a second operation (2nd highest), and having a change in voice (3rd highest). Areas of minor concern included: being judged, embarrassed, and not being able to participate in social activities post-operatively. The younger the patients, the more concerned they were about: resuming work following surgery(rϭ-0.54, p Ͻ 0.01); being judged (rϭ-0.48, p Ͻ 0.01); and participating in social activities post-surgery (rϭ-0.48, p Ͻ 0.01). There were no significant differences or trends in the overall level of pre-surgical concerns between total and hemi-thyroidectomy patients (t(28)ϭ0.21, pϭ0.83), except for a higher degree of concern for pain in total thyroidectomy patients compared to hemithyroidectomy patients (t(28)ϭ1.72, pϭ0.097). CONCLUSION: This study establishes a mean which will permit adequate physician counseling and a better management of patients' perioperative worries.

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