Tags

Type your tag names separated by a space and hit enter

Montgomery's Aperture: An External Anatomic Landmark for Surgical Identification of the Anterior Commissure.
J Voice. 2020 Jun 17 [Online ahead of print]JV

Abstract

OBJECTIVES

This study evaluates the consistency of palpable identification of an external landmark for the anterior commissure (AC), termed Montgomery's aperture (MA), in cadaveric and surgical settings.

METHODS

Part 1: In human cadaveric larynges, palpation of the external laryngeal framework was used to identify MA by three blinded otolaryngologists. The vertical height (VH) of the thyroid cartilage and distance from MA to the inferior border of the thyroid cartilage were measured, larynges were bisected, and the AC was identified and measured. Surface anatomy was demonstrated visually using 3D imaging. Part 2: Retrospectively collected case series used palpation of MA in thyroplasty type 1 (TT1) and compared the result to ½ VH.

RESULTS

Part 1: MA was identified in seven cadavers by three surgeons. In four of seven MA was palpated at the location of AC. The average difference between the AC and MA was -0.95 ± 0.96 mm. The average difference between AC and ½VH was 0.08 ± 0.72 mm. Part 2: In 49 patients (57% females) who underwent TT1, MA correlated within ½VH in 67% of cases. MA was inferior to ½VH in 27% of cases, on average 1.08 mm ± 0.51 mm below ½VH. MA was not palpable in 6% (3 of 49) of patients.

CONCLUSION

We define the MA as the external indentation or flattening of the thyroid cartilage located within 1 millimeter inferior or at ½ VH of the thyroid cartilage. MA is a reliable, reproducible, palpable landmark for the anterior commissure. It serves as an important landmark that can be used in laryngoplastic surgery in which accurate prediction of the glottis is important.

Authors+Show Affiliations

University of Cincinnati College of Medicine, Department of Otolaryngology Head & Neck Surgery, Cincinnati, Ohio.University of Cincinnati College of Medicine, Department of Otolaryngology Head & Neck Surgery, Cincinnati, Ohio.ENT Associates of Alabama, Birmingham, Alabama.Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, Ohio.Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, Ohio.University of Cincinnati College of Medicine, Department of Otolaryngology Head & Neck Surgery, Cincinnati, Ohio.University of Cincinnati College of Medicine, Department of Otolaryngology Head & Neck Surgery, Cincinnati, Ohio. Electronic address: howellrb@ucmail.uc.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32561213

Citation

Epperson, Madison V., et al. "Montgomery's Aperture: an External Anatomic Landmark for Surgical Identification of the Anterior Commissure." Journal of Voice : Official Journal of the Voice Foundation, 2020.
Epperson MV, Tang AL, Owens P, et al. Montgomery's Aperture: An External Anatomic Landmark for Surgical Identification of the Anterior Commissure. J Voice. 2020.
Epperson, M. V., Tang, A. L., Owens, P., Tabangin, M. E., Altaye, M., Khosla, S., & Howell, R. (2020). Montgomery's Aperture: An External Anatomic Landmark for Surgical Identification of the Anterior Commissure. Journal of Voice : Official Journal of the Voice Foundation. https://doi.org/10.1016/j.jvoice.2020.04.033
Epperson MV, et al. Montgomery's Aperture: an External Anatomic Landmark for Surgical Identification of the Anterior Commissure. J Voice. 2020 Jun 17; PubMed PMID: 32561213.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Montgomery's Aperture: An External Anatomic Landmark for Surgical Identification of the Anterior Commissure. AU - Epperson,Madison V, AU - Tang,Alice L, AU - Owens,Patrick, AU - Tabangin,Meredith E, AU - Altaye,Mekibib, AU - Khosla,Sid, AU - Howell,Rebecca, Y1 - 2020/06/17/ PY - 2020/03/12/received PY - 2020/04/22/revised PY - 2020/04/23/accepted PY - 2020/6/21/entrez KW - Anterior commissure KW - Larynx KW - Montgomery's aperture KW - Surgical landmark KW - Thyroplasty JF - Journal of voice : official journal of the Voice Foundation JO - J Voice N2 - OBJECTIVES: This study evaluates the consistency of palpable identification of an external landmark for the anterior commissure (AC), termed Montgomery's aperture (MA), in cadaveric and surgical settings. METHODS: Part 1: In human cadaveric larynges, palpation of the external laryngeal framework was used to identify MA by three blinded otolaryngologists. The vertical height (VH) of the thyroid cartilage and distance from MA to the inferior border of the thyroid cartilage were measured, larynges were bisected, and the AC was identified and measured. Surface anatomy was demonstrated visually using 3D imaging. Part 2: Retrospectively collected case series used palpation of MA in thyroplasty type 1 (TT1) and compared the result to ½ VH. RESULTS: Part 1: MA was identified in seven cadavers by three surgeons. In four of seven MA was palpated at the location of AC. The average difference between the AC and MA was -0.95 ± 0.96 mm. The average difference between AC and ½VH was 0.08 ± 0.72 mm. Part 2: In 49 patients (57% females) who underwent TT1, MA correlated within ½VH in 67% of cases. MA was inferior to ½VH in 27% of cases, on average 1.08 mm ± 0.51 mm below ½VH. MA was not palpable in 6% (3 of 49) of patients. CONCLUSION: We define the MA as the external indentation or flattening of the thyroid cartilage located within 1 millimeter inferior or at ½ VH of the thyroid cartilage. MA is a reliable, reproducible, palpable landmark for the anterior commissure. It serves as an important landmark that can be used in laryngoplastic surgery in which accurate prediction of the glottis is important. SN - 1873-4588 UR - https://www.unboundmedicine.com/medline/citation/32561213/Montgomery's_Aperture:_An_External_Anatomic_Landmark_for_Surgical_Identification_of_the_Anterior_Commissure L2 - https://linkinghub.elsevier.com/retrieve/pii/S0892-1997(20)30152-1 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.