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Role of the Aortic Arch in Idiopathic Unilateral Vocal Fold Paralysis

Behkam, Seyyed Reza (2020) Role of the Aortic Arch in Idiopathic Unilateral Vocal Fold Paralysis. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

Vocal fold paralysis is the most common neurogenic disorder of the larynx, which is
associated with impaired swallowing, voice production, and breathing. There are various
etiologies for vocal fold paralysis, including malignancy, trauma, iatrogenic surgical injuries
and idiopathic. Impaired function of the recurrent laryngeal nerve (RLN) is known to be the
primary cause of unilateral vocal fold paralysis (UVP). The RLNs on both sides are closely
interacting with the cardiovascular system. Specifically, the left RLN originates from the
vagus nerve, loops underneath the arch and ascends toward the larynx. Due to the proximity of the RLN to the aortic arch, one possible cause of damage to the left RLN may be
associated with the supraphysiological forces imposed on the nerve by the aortic arch. In this
dissertation, we investigated an association between the left-sided idiopathic unilateral vocal
fold paralysis (iUVP) and the biomechanical behavior of the aortic arch. We studied the
compliance of the aortic arch in a group of iUVP patients and age-gender matched controls.
The results showed that the aortic arch is hypercompliant in iUVP patients. As the compliance variation might originate from differences in the aortic arch material properties, we
utilized an inverse �nite element approach to characterize the in vivo mechanical properties
of the aortic wall. We showed that the matrix and �fiberber stiff�ness values are significantly lower
in iUVP patients. In the last stage of this work, we utilized a porcine model to study
the microstructure of the RLN connective tissue under mechanical insult. Our study showed
that the RLN biomechanical response under compression is a function of anatomical location and animal age. In conclusion, this work advanced our understanding of a possible iUVP etiology related to the cardiovascular system. Furthermore, our study suggested that RLN
connective tissues develop in response to the environmental forces to preserve the integrity
of the axons under various loading conditions. Also, the proposed computational framework
based on the in vivo information can be used to investigate the pivotal role of the aortic arch
biomechanics as it relates to the onset and development of other cardiovascular diseases.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Behkam, Seyyed Rezaseb159@pitt.eduseb159
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairVande Geest, Jonathanjpv20@pitt.edujpv20
Committee MemberBARKMEIER-KRAEMER, JulieJulieB.Kraemer@hsc.utah.edu
Committee MemberAbramowitch, Stevensdast9@pitt.edu
Committee MemberAlmarza, Alejandroaja19@pitt.edu
Date: 29 January 2020
Date Type: Publication
Defense Date: 10 September 2019
Approval Date: 29 January 2020
Submission Date: 11 September 2019
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 75
Institution: University of Pittsburgh
Schools and Programs: Swanson School of Engineering > Bioengineering
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Vocal fold paralysis - Aortic arch - RLN
Date Deposited: 29 Jan 2020 14:28
Last Modified: 29 Jan 2020 14:28
URI: http://d-scholarship.pitt.edu/id/eprint/37630

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