Linear Measurements of Vocal Folds and Laryngeal Dimensions in Freshly Excised Human Larynges

Mobashir, Mohamed; Mohamed, Abd El Raof S.; Quriba, Amal S.; Anany, Ahmed; Hassan, Ekram M.

doi:10.1016/j.jvoice.2017.08.024

Cited by 20 publications

(20 citation statements)

References 8 publications

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“…The glottis is already the narrowest portion of the airway in adults. Human vocal folds are similar in length to the porcine specimens in this study: human male vocal folds have mean length 24.9 mm, and human female vocal folds have mean length 17.5 mm . Described techniques shorten the vocal folds by as much as 50%; however, there is little information on how this shortening affects the glottic opening and subsequently the glottic area.…”

Section: Discussionmentioning

confidence: 99%

“…Human vocal folds are similar in length to the porcine specimens in this study: human male vocal folds have mean length 24.9 mm, and human female vocal folds have mean length 17.5 mm. 27 Described techniques shorten the vocal folds by as much as 50%; however, there is little information on how this shortening affects the glottic opening and subsequently the glottic area. This study simulated glottic opening by externally tensing the posterior cricoarytenoid muscles at various stages of vocal fold shortening.…”

Section: Discussionmentioning

confidence: 99%

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An ex vivo porcine model of the anterior glottoplasty for voice feminization surgery

Rohlfing

Kuperstock

Friedman³

et al. 2019

The Laryngoscope

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Objective Perceived gender identity is correctly assigned when a combination of physical and vocal attributes become congruent. Several voice feminization procedures have gained popularity, but current evidence of their impact on vocal feminization is limited to case series. This study establishes an ex vivo porcine phonatory model to evaluate the ideal extent of anterior glottic web formation in relation to frequency elevation and airway patency. Methods Six fresh porcine larynges were obtained and fitted with arytenoid adduction sutures. Compressed air was passed through the larynges, and the vocal folds were adducted to induce phonation. Vocal fold length, posterior glottic width, fundamental frequency, and sound pressure intensity were measured as the vocal folds were progressively shortened as per the anterior glottic web surgical technique. Results The average fundamental frequency prior to web formation was 109.7 Hz. The maximum frequency achieved after web formation was 403.7 Hz, and the web proportions varied from 11.8% to 61.0% of the length of the membranous vocal folds. The glottic cross‐sectional area showed an expected inverse linear relationship to the length of the glottic web. Creation of an anterior glottic web caused consistent elevation of pitch, but there was a gradual plateau of effect with increased length of the web. Conclusion The ex vivo porcine larynx is demonstrated as an effective, available, and low‐cost model for further study of vocal pitch elevation surgical techniques. We demonstrate that in addition to progressively reducing the cross‐sectional area of the airway, additional benefit from increased web length is limited. Level of Evidence NA Laryngoscope, 130:E206–E212, 2020

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

An ex vivo porcine model of the anterior glottoplasty for voice feminization surgery

Rohlfing

Kuperstock

Friedman³

et al. 2019

The Laryngoscope

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show abstract

“…12,13 Differences in female and male VF length have also been reported. 12,14,15 In a study of 10 professional female singers, Vorik et al 11 measured laryngeal dimensions using CT scan data during phonation and found that the mean VF length was 18.3 to 19.4 mm and elongated with increased pitch. Their measurements of subglottic AP diameter also closely matched our results.…”

Section: Discussionmentioning

confidence: 96%

Computed Tomography Data to Generate a Reproducible, Anatomically Accurate Hemilaryngeal Model

Hintze

Myers

McPhail

et al. 2019

Otolaryngol.--head neck surg.

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Objective The study aims to demonstrate the reproducibility and feasibility of creating a hemilaryngeal model with a medialized vocal fold (VF) using 3-dimensional (3D) modeling techniques in both healthy larynges and those affected by cancer. Study Design Three-dimensional modeling of human larynges. Setting Tertiary academic referral center and regenerative medicine laboratory. Subjects and Methods Computed tomography (CT) scans from 10 healthy control and 10 patients with laryngeal cancer were segmented and imported into 3D modeling software. The larynx was cut sagittally to create a hemilaryngeal model and the vocal fold medialized. Measurements were taken from the CT and 3D model data and compared. Results All control modeling data closely matched the CT data and were not statistically different from each other. There was a significant correlation between subglottic anteroposterior diameter and VF length ( r2 = 0.78, P = .0008), and it may be a valuable tool to infer true VF dimension in cases where disruption has occurred. The modeling data from patients with cancer did not show statistical difference to the control data, showing that accurate modeling can also be achieved in patients with laryngeal cancer. Conclusion CT scan-based 3D modeling of the larynx and VF is possible and reproducible. The results closely match those previously reported in the literature and can also be replicated in cases with laryngeal cancer. This study paves the way for future de novo fabricated laryngeal scaffolds that can be synthesized using 3D printers and tailored to meet surgical demands.

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“…20 Other studies also showed a similar proportion of membranous vocal folds difference. 25 Therefore, vocal fold should be shortened 25% more of its original length while remaining a minimal of 11 mm for female sized membranous vocal folds when considering voice feminization. Vocal thickness also has a morphometric difference between males and females.…”

Section: Morphometric Differences Of the Laryngeal Framework And Vocamentioning

confidence: 99%

<p>Vocal Feminization for Transgender Women: Current Strategies and Patient Perspectives</p>

Kim¹

2020

IJGM

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Voice feminization for transgender women is a highly complicated comprehensive transition process. Voice feminization has been thought to be equal to pitch elevation. Thus, many surgical procedures have only focused on pitch raising for voice feminization. However, voice feminization should not only consider voice pitch but also consider gender differences in physical, neurophysiological, and acoustical characteristics of voice. That is why voice therapy has been the preferred choice for the feminization of the voice. Considering gender difference of phonatory system, the method for voice feminization consists of changing the following four critical elements: fundamental frequency, resonance frequency related to vocal tract volume and length, formant tuning, and phonatory pattern. Voice feminizing process can be generally divided into non-surgical feminization and surgical feminization. As a non-surgical procedure, feminization voice therapy consists of increasing fundamental frequency, improving oral and pharyngeal resonance, and behavioral therapy. Surgical feminization usually can be achieved by external approach or endoscopic approach. Based on three factors (length, tension and mass) of vocal fold for pitch modulation, surgical procedure can be classified as one-factor, two-factors and three-factors modification of vocal folds. Recent systematic reviews and meta-analysis studies have reported positive outcomes for both the voice therapy and voice feminization surgery. The benefits of voice therapy, as it is highly satisfactory, mostly increase vocal pitch, and are noninvasive. However, the surgical voice feminization of three-factors modification of vocal folds is also highly competent and provides a maximum absolute increase in vocal pitch. Voice feminization is a long transition journey for physical, neurophysiological, and psychosomatic changes that convert a male phonatory system to a female phonatory system. Therefore, strategies for voice feminization should be individualized according to the individual's physical condition, the desired change in voice pitch, economic conditions, and social roles.

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Linear Measurements of Vocal Folds and Laryngeal Dimensions in Freshly Excised Human Larynges

Cited by 20 publications

References 8 publications

An ex vivo porcine model of the anterior glottoplasty for voice feminization surgery

An ex vivo porcine model of the anterior glottoplasty for voice feminization surgery

Computed Tomography Data to Generate a Reproducible, Anatomically Accurate Hemilaryngeal Model

<p>Vocal Feminization for Transgender Women: Current Strategies and Patient Perspectives</p>

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