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At a certain point, there’s no stopping a sneeze. But with conscious effort, we can control how loud it is.

Forensic examination of the hyoid-larynx complex (HLC) is crucial in diagnosing (inflicted) neck trauma. Clinical Total-Body CT (TBCT) scans of the (non-)calcified HLC lack sensitivity for fracture detection. Micro-computed tomography (micro-CT) is an upcoming imaging modality capable of scanning samples at microscale resolution up to 1 µm. Soft-tissue contrast can be established with iodine staining, known as diffusible iodine-based contrast-enhanced CT (diceCT). We study the additional value of micro- and diceCT in detecting HLC fractures and hemorrhages in forensic cases, compared to standard forensic imaging techniques and findings at autopsy. Fifteen, during forensic autopsy excised, adult HLCs were scanned with micro-CT. Subsequently, the samples were stained with buffered Lugol’s solution (B-Lugol) and scanned with contrast-enhanced micro-CT. The scans were examined on fractures and hemorrhages. Total body CT, optimized clinical CT of the explant and autopsy reports were compared with the micro- and diceCT scans and the results were confirmed using histological examinations. Sixteen potential fractures were identified in the micro-CT scans and with diceCT, nine hyperdensities were detected around potential fractures. Two previously undiscovered vital fractures were found, which were verified by histological examination. This research demonstrated that micro-CT can be a valuable tool to detect fractures of the HLC in forensic neck trauma cases and diceCT enables us to image the injured HLC in detail and indicate possible hemorrhages. With increasingly better stain and scan protocols and more experience gained by forensic radiologists, micro-CT could become invaluable for the examination of HLC trauma. [Display omitted] •Micro- and diceCT provide detailed images of the hyoid larynx complex.•Micro-CT reveals subtle fractures in the hyoid-larynx complex missed by standard CT.•DiceCT imaging can detect hemorrhages, aiding in forensic evaluation of neck trauma.•Two vital fractures, undetected by traditional methods, were confirmed via histology.•Micro-CT and diceCT combined enhance accuracy in forensic neck trauma assessment.

ObjectivesTo assess the diagnostic accuracy (ACC) of post-mortem computed tomography (PMCT) for fractures of the isolated larynx-hyoid complex (LHC) in comparison to post-mortem fine preparation (PMFP).MethodsThis monocentric prospective study enclosed 54 LHCs that were extracted during autopsy, fixed in formalin, and underwent a PMCT scan (64-row multidetector CT, helical pitch). Two radiologists independently analyzed the LHC scans for image quality (IQ) and fractures (4-point Likert scales). A specialized forensic preparator dissected the specimens under the stereomicroscope. The PMFP results were standardized documented, and used as the standard of reference for the comparison to PMCT.ResultsThe PMCT-IQ of 95% of the LHC images was rated as good or excellent. IQ was decreased by decay, incisions during autopsy, and separation of the hyoid from the cartilaginous components in 7, 3, and 12 specimens, respectively. PMFP detected 119 fractures in 34 LHCs (63.0%). PMCT identified 91 fractures in 32 specimens (59.3%). PMFP and PMCT significantly agreed concerning the location (Cohen’s κ = 0.762; p < 0.001) and the degree of dislocation (κ = 0.689; p < 0.001) of the fractures. Comparing PMCT to PMFP resulted in a sensitivity of 88.2%, a specificity of 90.0%, and an ACC of 88.9% for the LHC. The ACCs for the hyoid, thyroid, and cricoid were 94.4%, 87.0%, and 81.5%, respectively. PMCT procedure was significantly faster than PMFP (28.9 ± 4.1 min vs. 208.2 ± 32.5 min; p < 0,001).ConclusionsPMCT can detect distinct injuries of the isolated LHC and may promptly confirm violence against the neck as cause of death. PMFP outmatches PMCT in the detection of decent injuries like tears of the cricoid cartilage.Key Points• Post-mortem computed tomography is able to assess fractures of the larynx-hyoid complex.• Prospective monocentric in vitro study showed that post-mortem computed tomography of the larynx-hyoid complex is faster than post-mortem fine preparation.• Post-mortem computed tomography can confirm violence against the neck as cause of death.

Post-mortem computed tomography (PMCT) is routinely used at many forensic institutions to guide the following autopsy and is especially useful for diagnosing fractures. This systematic review aims to investigate the sensitivity and specificity of a PMCT scan in fracture diagnosis of the hyoid-larynx complex (HLC) compared to traditional autopsy in cases involving traumatic neck injuries. We searched PubMed, SCOPUS and Web of Science and included papers with cases n ≥ 3 published between January 2000 and April 2023 reporting on PMCT and autopsy findings of fractures of the HLC. The search provided 259 results of which 10 were included. Overall sensitivity and specificity were 0.70 [0.59; 0.79] and 0.92 [0.80; 0.97] for hyoid bone fractures and 0.80 [0.62; 0.91] and 0.76 [0.63; 0.85] for the thyroid cartilage. The results show great variation, and a large range between studies. These results indicate that PMCT cannot replace autopsy in cases with HLC fractures. Future larger prospective studies are needed, examining fracture details, scan protocols and different slice thicknesses using uniform reporting.

Baleen whales (mysticetes) use vocalizations to mediate their complex social and reproductive behaviours in vast, opaque marine environments 1 . Adapting to an obligate aquatic lifestyle demanded fundamental physiological changes to efficiently produce sound, including laryngeal specializations 2 – 4 . Whereas toothed whales (odontocetes) evolved a nasal vocal organ 5 , mysticetes have been thought to use the larynx for sound production 1 , 6 – 8 . However, there has been no direct demonstration that the mysticete larynx can phonate, or if it does, how it produces the great diversity of mysticete sounds 9 . Here we combine experiments on the excised larynx of three mysticete species with detailed anatomy and computational models to show that mysticetes evolved unique laryngeal structures for sound production. These structures allow some of the largest animals that ever lived to efficiently produce frequency-modulated, low-frequency calls. Furthermore, we show that this phonation mechanism is likely to be ancestral to all mysticetes and shares its fundamental physical basis with most terrestrial mammals, including humans 10 , birds 11 , and their closest relatives, odontocetes 5 . However, these laryngeal structures set insurmountable physiological limits to the frequency range and depth of their vocalizations, preventing them from escaping anthropogenic vessel noise 12 , 13 and communicating at great depths 14 , thereby greatly reducing their active communication range. Studies of vocal production in baleen whales show that their larynx has evolved unique structures that enable their low-frequency vocalizations but limit their active communication range.

BackgroundNon-invasive ventilation is sometimes unable to provide the respiratory needs of very premature infants in the delivery room. While airway obstruction is thought to be the main problem, the site of obstruction is unknown. We investigated whether closure of the larynx and epiglottis is a major site of airway obstruction.MethodsWe used phase contrast X-ray imaging to visualise laryngeal function in spontaneously breathing premature rabbits immediately after birth and at approximately 1 hour after birth. Non-invasive respiratory support was applied via a facemask and images were analysed to determine the percentage of the time the glottis and the epiglottis were open.HypothesisImmediately after birth, the larynx is predominantly closed, only opening briefly during a breath, making non-invasive intermittent positive pressure ventilation (iPPV) ineffective, whereas after lung aeration, the larynx is predominantly open allowing non-invasive iPPV to ventilate the lung.ResultsThe larynx and epiglottis were predominantly closed (open 25.5%±1.1% and 17.1%±1.6% of the time, respectively) in pups with unaerated lungs and unstable breathing patterns immediately after birth. In contrast, the larynx and the epiglottis were mostly open (90.5%±1.9% and 72.3%±2.3% of the time, respectively) in pups with aerated lungs and stable breathing patterns irrespective of time after birth.ConclusionLaryngeal closure impedes non-invasive iPPV at birth and may reduce the effectiveness of non-invasive respiratory support in premature infants immediately after birth.

Background Laryngeal injury associated with traumatic or prolonged intubation may lead to voice, swallow, and airway complications. The interplay between inflammation and microbial population shifts induced by intubation may relate to clinical outcomes. The objective of this study was to investigate laryngeal mechanics, tissue inflammatory response, and local microbiome changes with laryngotracheal injury and localized delivery of therapeutics via drug-eluting endotracheal tube. Methods A simulated traumatic intubation injury was created in Yorkshire crossbreed swine under direct laryngoscopy. Endotracheal tubes electrospun with roxadustat or valacyclovir- loaded polycaprolactone (PCL) fibers were placed in the injured airway for 3, 7, or 14 days (n = 3 per group/time and ETT type). Vocal fold stiffness was then evaluated with normal indentation and laryngeal tissue sections were histologically examined. Immunohistochemistry and inflammatory marker profiling were conducted to evaluate the inflammatory response associated with injury and ETT placement. Additionally, ETT biofilm formation was visualized using scanning electron microscopy and micro-computed tomography, while changes in the airway microbiome were profiled through 16S rRNA sequencing. Results Laryngeal tissue with roxadustat ETT placement had increasing localized stiffness outcomes over time and histological assessment indicated minimal epithelial ulceration and fibrosis, while inflammation remained severe across all timepoints. In contrast, vocal fold tissue with valacyclovir ETT placement showed no significant changes in stiffness over time; histological analysis presented a reduction in epithelial ulceration and inflammation scores along with increased fibrosis observed at 14 days. Immunohistochemistry revealed a decline in M1 and M2 macrophage markers over time for both ETT types. Among the cytokines, IL-8 levels differed significantly between the roxadustat and valacyclovir ETT groups, while no other cytokines showed statistically significant differences. Additionally, increased biofilm formation was observed in the coated ETTs with notable alterations in microbiota distinctive to each ETT type and across time. Conclusion The injured and intubated airway resulted in increased laryngeal stiffness. Local inflammation and the type of therapeutic administered impacted the bacterial composition within the upper respiratory microbiome, which in turn mediated local tissue healing and recovery.

Treatment strategies in laryngeal squamous cell cancer (LSCC) straddle the need for long term survival and tumor control as well as preservation of laryngeal function as far as possible. We sought to identify prognostic factors affecting LSCC outcomes in our population. Clinical characteristics, treatments and survival outcomes of patients with LSCC were analysed. Baseline comorbidity data was collected and age-adjusted Charlson Comorbidity Index (aCCI) was calculated. Outcomes of overall survival (OS), progression-free survival (PFS) and laryngectomy-free survival (LFS) were evaluated. Two hundred and fifteen patients were included, 170 (79%) underwent primary radiation/ chemoradiation and the remainder upfront surgery with adjuvant therapy where indicated. The majority of patients were male, Chinese and current/ex-smokers. Presence of comorbidity was common with median aCCI of 3. Median OS was 5.8 years. On multivariable analyses, high aCCI and advanced nodal status were associated with inferior OS (HR 1.24 per one point increase in aCCI, P<0.001 and HR 3.52; p<0.001 respectively), inferior PFS (HR 1.14; p = 0.007 and HR 3.23; p<0.001 respectively) and poorer LFS (HR 1.19; p = 0.001 and HR 2.95; p<0.001 respectively). Higher tumor (T) stage was associated with inferior OS and LFS (HR 1.61; p = 0.02 and HR 1.91; p = 0.01 respectively). In our Asian population, the presence of comorbidities and high nodal status were associated with inferior OS, PFS and LFS whilst high T stage was associated with inferior LFS and OS.

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Significantly new data have been published on laryngeal cancer management since the last edition of the guidelines. This paper discusses the evidence base pertaining to the management of laryngeal cancer and provides updated recommendations on management for this group of patients receiving cancer care.