Medialisation laryngoplasty with bone wax in a sheep model

ObjectiveTo evaluate the safety and biocompatibility of bone wax as an implant material for medialisation laryngoplasty in a large animal model.MethodsThree Dorper-cross ewes underwent type I thyroplasty of the right vocal fold with bone wax. The animals were monitored for four weeks for general wellbeing. The animals were euthanised and the larynges harvested. Histological evaluation was performed to assess for adverse tissue reaction and biocompatibility.ResultsThe mean (± standard deviation) amount of bone wax implanted was 0.49 g (± 0.12 g). No adverse events were reported. Ex vivo vibration was present on high-speed imaging for all medialised vocal folds. Histology demonstrated implanted paraffin embedded within the thyroarytenoid muscle with no evidence of resorption, a minimal inflammatory infiltrate, and a thin fibrotic capsule.ConclusionThe results of this investigation suggest that bone wax may be a safe and efficacious implant material for medialisation laryngoplasty. Further studies are necessary to assess its long-term safety and efficacy

High-resolution manometry of the pharynx and esophagus

© 2018, Springer International Publishing AG. This chapter describes the use of high-resolution manometry (HRM) for the assessment of pharyngeal, upper esophageal sphincter, and esophageal function during deglutition. Based on color plot technology, pressure patterns in both the pharynx and the esophagus are described in health and swallow pathology. The analysis of these patterns is determined by specific metrics that describe the deglutitive motor function that can be driving bolus flow as seen on videofluoroscopy or detected by impedance. Esophageal motor function is worldwide classified using the Chicago classification. Although currently such a classification is not available yet for the pharynx and UES dysfunction, recently much progress has been made in deriving clinically relevant pharyngeal HRM metrics. HRM can, combined with videofluoroscopic or impedance assessment, identify the motor patterns driving the pathogenesis of different dysphagic phenotypes.status: publishe

Chicago Classification of Esophageal Motility Disorders: Applications and Limits in Adults and Pediatric Patients with Esophageal Symptoms.

The Chicago classification (CC) is most valued for its systematic approach to esophageal disorders and great impact in unifying practice for esophageal manometric studies. In view of the ever-growing wealth of knowledge and experience gained by the expanding use of high-resolution manometry (HRM) in various clinical scenarios, the CC is regularly updated. Its clinical impact and ability to predict clinical outcome, both in adults and pediatrics, will be further promoted by recognizing its current limitations, incorporating new metrics in its diagnostic algorithms and adjusting the HRM protocols based on the clinical question posed. Herein, we discuss the current limitations of the CC and highlight some areas of improvement for the future