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PubMed1981

Complications of combined radiation therapy and surgery for carcinoma of the larynx and inferior hypopharynx.

A group of 554 patients was studied to determine and compare the complications of combined preoperative radiation therapy with surgery and combined surgery with postoperative radiation therapy when used for treatment of carcinoma of the larynx and inferior hypopharynx. The complications recorded were infection, slough, carotid blowout, glottic insufficiency, pharyngeal stricture, operative death, chondritis, fistula, and margins of resection involved with tumor. The highest complication rates were in the partial laryngopharyngectomy-postoperative radiation group (63.6%) and in the supraglottic laryngectomy-postoperative radiation group (52.9%). Most of the increase in total complication rate was attributable to higher rates of glottic insufficiency and margins involved with tumor categories. The lowest complication rates were in the hemilaryngectomy with no radiation group (4.5%) and the total laryngectomy-postoperative radiation group (12.8%). The complication rate for the supraglottic laryngectomy-postoperative radiation group (52.9%) was significantly higher than for the preoperative radiation-supraglottic laryngectomy group (26.4%). Within the partial laryngopharyngectomy group, there was no significant difference in total complication rate between the use of preoperative (47.2%) or postoperative radiation (63.6%). Within the total laryngectomy group there was no significant difference between complication rates when either preoperative or postoperative radiation was employed. There was no significant difference in the rate of carotid blowout, chondritis, operative death, slough, or fistula, between preoperative or postoperative radiation in any of the surgical groups. In general, patients with conservation surgery seem to tolerate postoperative radiation without a prohibitive increase in complications.

Adult↗

PubMed1994

Contraction and relaxation of upper airway muscles during expiratory application of negative pressure at the mouth.

Upper airway muscles (UAM) are activated during inspiration, but little is known about their activity during expiration. We studied six healthy volunteers in supine position. Negative pressure (-10 to -30 cm H2O) was applied cyclically at the mouth during expiration. Subjects actively breathed during inspiration and either contracted or relaxed their UAM during expiration. Supraglottic pressure (Psg) was measured with a catheter with the tip at the supraglottic level. During relaxation, but not during contraction, there was expiratory flow limitation (FL) accompanied by high frequency pressure and flow oscillations (70 +/- 5.7 Hz at -30 cm H2O). The average linear supraglottic resistance was higher during relaxation than during contraction at both -10 and -20 cm H2O (p < 0.05), but not at -30 cm H2O. Amplitude of expiratory genioglossus electromyogram was 3.6 +/- 2.5 mm during quiet breathing, 7.0 +/- 3.8 mm during contraction (p < 0.05) and 4.1 +/- 1.8 mm during relaxation. Average mouth pressure, which immediately preceded pressure (and flow) oscillations was -2.1 +/- 0.9 cm H2O. In one subject cineradiography of the neck during expiratory application of -30 cm H2O showed anterior flexion and high frequency oscillations of the soft palate during relaxation. During contraction, the soft palate was close to the posterior pharyngeal wall without oscillations. We conclude that cyclically applied negative pressure at the mouth during expiration produced expiratory flow limitation during relaxation but not during contraction, and that expiratory contraction of UAM stabilizes upper airways during negative pressure application at the mouth.

Adult↗

PubMed1994

[Aspiration pneumonia following various types of partial horizontal laryngectomy].

The authors present a retrospective study of 463 partial horizontal laryngectomy of various types (horizontal supraglottic laryngectomy and its modifications, supracricoid laryngectomy with CHP and CHEP, glottic laryngectomy) performed in the years 1970-1991 in the ENT Clinic of Pomeranian Medical Academy in Szczecin. The aspiration pneumonia in 46 (about 10%) patients was observed as a result of insufficient lower airway protection. In cases of extended supraglottic laryngectomy (including the removal of one arytenoid cartilage and/or one vocal cord) aspiration pneumonia appeared more often (16%) than after classic supraglottic laryngectomy (6%). Reconstruction of elevation of arytenoid cartilage and/or vocal cord and base of tongue its extended resection augmented the efficacy lower airway protection.

Arytenoid Cartilage↗

PubMed1977

Results of radiation therapy and a combination of radiation and surgery in the laryngeal cancer.

A total of 348 out of 349 patients with laryngeal cancer were treated over the period 1960-1970. Radiation therapy alone was used in 262 of them and surgical intervention with postoperative irradiation in 86. Results in the form of a five-year survival rate in the group treated solely by irradiation were superior by 12% in the case of glottic than in that of supraglottic carcinoma (48.8% and 36.8% respectively). In the group of patients operated upon and subsequently irradiated, relatively satisfactory results were obtained in the advanced, i. e. the III stage of supraglottic carcinoma (5-year survival in 61.4%). The overall 5-year survival rate in the patients operated upon and then irradiated proved to be better by 24.5% in supraglottic and by 4.1% in the glottic carcinoma, than in patients subjected solely to irradiation. Of 27 cases of relapses, 6 patients were successfully treated by laryngectomy. Post-irradiation complications involved most frequently minor cases of endolaryngeal edema; among the more serious ones were 2 cases of radiation myelitis. The discussion on the problem of radiation dosage in cancer of the larynx, the treatment of regional metastases and combined surgico-radiation therapy.

Aged↗

PubMed1997

[Significance of the circumferential involvement of the superior horn tip of the thyroid cartilage in pharyngo-laryngeal cancer].

UNLABELLED: The term "laryngopharyngeal carcinoma" indicates an advanced tumor involving both the supraglottic larynx and the pharynx in which the lesion origin may be difficult to assess. In 1981, Larsson et al. reported on the CT signs useful to distinguish the laryngeal/hypopharyngeal origin of advanced laryngopharyngeal carcinoma. We describe a new CT sign which may serve this purpose, namely the involvement of the thyroid cartilage superior horn tip. The thyroid cartilage superior horn, in fact, is involved early in the lesions originating in the pyriform sinus because of its close anatomic relationship with the posterolateral wall of the hypopharynx. MATERIALS AND METHODS. To assess the significance and specificity of this sign, we examined 15 patients with advanced laryngopharyngeal carcinoma with clinical, endoscopic and surgical evidence suggestive of tumors originating in the pyriform sinus. All CT examinations were performed with contiguous 4 mm slices before and after i.v. administration of iodinated contrast agents. Eighteen patients with surgically confirmed advanced supraglottic carcinoma were also examined. RESULTS: The thyroid cartilage superior horn tip was involved only in 3/18 supraglottic carcinoma patients; transcommissural infiltration of the larynx, involving both pyriform sinuses, was found in 2 of these cases and extensive invasion of the whole thyroid cartilage and of the cricoid ring in 1 case. CONCLUSIONS: The thyroid cartilage superior horn tip is a reliable sign of the pyriform sinus origin of advanced laryngopharyngeal cancer which is both sensitive (100%) and specific (83%). Moreover, this sign could play a major role because it represents, in most cases, the only and earliest sign of cartilage involvement. Finally, the encasement of the thyroid cartilage superior horn tip by abnormal tissue indicates tumor spread beyond the posterior pharyngeal wall. Therefore, these data can be very important for its early detection and useful for subsequent surgical planning.

Adult↗

PubMed1997

[Computerized tomography in the evaluation of the larynx after surgical treatment and irradiation].

INTRODUCTION: The follow-up of the patients submitted to surgery for laryngeal carcinoma requires both clinical and CT examinations, particularly in the cases at high risk of recurrence. Our series consisted of 72 laryngeal carcinoma patients operated on and regularly followed-up with CT to distinguish relapse from normal or abnormal postoperative changes. MATERIALS AND METHODS: Seventy-two laryngeal carcinoma patients were submitted to surgery: total laryngectomy was performed in 33 cases, supraglottic laryngectomy in 16 cases, Labayle subtotal laryngectomy in 18 cases and Mayer Piquet subtotal laryngectomy in 5 cases. The patients were followed-up postoperatively with CT and 94 examinations were performed in all; pathology was performed in all the cases with radiologic suspicion of recurrence (19 patients) and further clinical examinations were performed to exclude recurrence in the 14 cases where imaging findings were questionable. RESULTS AND DISCUSSION: Local recurrences were confirmed in 16 of 19 patients with positive CT findings. Radiologically, the recurrence appeared as an irregular thickening of the pharyngo-laryngeal wall with inhomogeneous density after i.v. contrast agent infusion. The patients submitted to total or supraglottic laryngectomy recurred most often at the cranial site of resection (5/6 cases), those submitted to Labayle surgery at the mucosa adjacent to the cricoarytenoid unit (3/3 cases) and those submitted to Mayer Piquet surgery in the supraglottic region. Two more patients submitted to emergency tracheotomy recurred at this level. Lymph node recurrences were found in 6 total laryngectomy patients. Misinterpretations were most frequently due to postirradiation changes (5 of 14 cases) or to atypical postoperative images (4/14 cases). Three more patients presented a secondary lesion misinterpreted as a relapse. CONCLUSIONS: Our results confirm the role of CT in the follow-up of the patients operated on for laryngeal carcinoma when CT findings are closely correlated with clinical and endoscopic results, permitting to correctly assess the extent of relapse and possible nodal spread.

Adult↗

PubMedDate not supplied

[Oncologic surgery of the larynx after failure of radiotherapy].

The treatment of early-stage laryngeal cancer using either partial surgical techniques or irradiation still is controversial. The performance of rescue surgical procedures after irradiation is related to increased postsurgical complications and lower survival rates. We made a retrospective study of 73 patients who underwent rescue surgery after failure of radiotherapy in our department in the last 10 years. A statistical analysis was made of the complications and survival rate of these patients in accordance with tumor location and clinicopathological stage compared with patients who underwent surgery alone (n = 435). More rescue surgery was performed for glottic carcinomas (52/73) than for supraglottic carcinomas (21/73). No significant differences were found in the complication rate (23.6%) compared with the control group (19.6%). There was a significant reduction in survival in patients who underwent previous irradiation of supraglottic tumors compared with glottic tumors and the control group. In view of these results, we conclude that irradiation is not a good option as an initial treatment for supraglottic tumors and that the procedure of choice should be surgical.

Adult↗

PubMed1998

Laryngeal recovery following type I thyroplasty.

OBJECTIVE: To describe the pattern of laryngeal recovery and its relationship to voice improvement following thyroplasty. DESIGN: We used a 5-point scale to rate 5 laryngeal characteristics preoperatively and 1 day, 1 week, 1 month, and 3 months following thyroplasty. SETTING: A university-affiliated health center. PATIENTS: Forty-four patients who underwent thyroplasty to correct incomplete glottal closure. RESULTS: Improved glottal closure and reduced supraglottic activity followed thyroplasty. Although evidence of postoperative irritation (erythema, edema, or hematoma) was present in many patients, it resolved within the first 1 to 4 weeks postoperatively in 22 (73%) of the 30 subjects available for follow-up at 3 months following thyroplasty. CONCLUSIONS: Thyroplasty is an effective procedure in correcting incomplete glottal closure and works to reduce excessive supraglottic activity in some patients. Recovery from postoperative vocal-fold irritation occurs rapidly, typically between the first week to first month, depending on the type and severity of irritation. These findings may help explain variations in postoperative voice improvement.

Adult↗

PubMed2002

Near-total laryngectomy for laryngeal carcinomas with subglottic extension.

OBJECTIVE: To investigate whether Pearson classic near-total laryngectomy is a sensible surgical treatment modality for laryngeal carcinomas with subglottic extension. DESIGN: Retrospective analysis of patients treated by near-total laryngectomy in a university hospital that is an academic tertiary health care center. PARTICIPANTS AND INTERVENTION: Medical and computer records of 135 patients who were treated by near-total laryngectomy for laryngeal and hypopharyngeal carcinomas between April 1, 1989, and June 30, 2000, were searched thoroughly, and the final outcomes were confirmed by telephone contact. MAIN OUTCOME MEASURES: Survival rates of the patients with laryngeal carcinomas with subglottic extension treated by near-total laryngectomy were compared with those of the patients with malignancies of other laryngeal regions given the same treatment. RESULTS: Of the 135 patients in the study, 74 were available for determination of 5-year survival. The rate was 65.8% (27/41) for transglottic tumors, 53.8% (7/13) for supraglottic tumors, and 20.0% (4/20) for tumors with subglottic extension. Only 3 of 16 patients with laryngeal carcinomas with supraglottic or transglottic localization died of local recurrence; the rest of the deaths were from regional recurrence or distant metastasis. However, 6 of 13 patients with subglottic extension died of local recurrence, 5 of peristomal recurrence, and only 2 of distant metastasis. CONCLUSIONS: Success was directly related to adherence to precise indications in cancer surgery. While near-total laryngectomy is an effective and reliable treatment modality in laryngeal cancer surgery, its effectiveness in laryngeal cancers with subglottic extension is debatable. These subglottic lesions should be treated by total laryngectomy, which is a more radical surgery.

Adult↗

PubMed2003

The role of airway fluoroscopy in the evaluation of stridor in children.

OBJECTIVE: To determine the role of airway fluoroscopy in comparison with other diagnostic modalities in diagnosing the site of partial airway obstruction in children with stridor. DESIGN: Prospective study comparing direct laryngoscopy and bronchoscopy with nasopharyngoscopy, airway fluoroscopy, and plain films. Children with stridor or partial airway obstruction were evaluated by the Department of Otolaryngology at Columbus Children's Hospital, Columbus, Ohio. A history review and physical examination, including flexible fiberoptic laryngoscopy, plain films, airway fluoroscopy, and direct laryngoscopy and bronchoscopy, were performed for all children. SETTING: Tertiary care children's hospital. PATIENTS: From November 1996 to September 1999, 64 children aged 1 week to 12 years, with a mean age of 1.8 years and male-female ratio of 3:2, were evaluated for stridor. MAIN OUTCOME MEASURES: The sensitivity and specificity of airway fluoroscopy in diagnosing the site of partial airway obstruction in comparison with nasopharyngoscopy and plain films. RESULTS: Airway fluoroscopy had a sensitivity of 80% for subglottic, 73% for tracheal, and 80% for bronchial sites of obstruction. It was less sensitive for supraglottic and glottic sites-33% and 14%, respectively. Nasopharyngoscopy was more sensitive for supraglottic and glottic sites of obstruction. Overall, airway fluoroscopy was far more sensitive than plain films for diagnosing site of obstruction. CONCLUSIONS: Airway fluoroscopy is a quick, noninvasive, and dynamic study of the entire airway that provides important additional information to the history review and physical examination and is a valuable adjunct to flexible fiberoptic laryngoscopy. It was far superior to plain films and may serve as a cost-effective screening tool in the evaluation of stridor in children, especially for lesions of the lower airway.

Airway Obstruction↗

PubMed1986

Liposarcoma of the larynx. Case report and literature review.

Primary liposarcoma of the larynx is extremely rare. To our knowledge, only eight cases have been documented in the English literature. We report a ninth case in a 54-year-old man. The recurrent 2-cm tumor was well differentiated and was treated with a supraglottic laryngectomy with partial neck dissection followed by radiotherapy. There has not been a second recurrence in 16 months. The majority of liposarcomas arising in the larynx have been of a favorable histologic type (well differentiated or myxoid). The tumor tends to occur in a supraglottic location in men of 40 years or more, and multiple recurrences are typical. The primary mode of treatment is wide surgical excision, with or without postoperative radiation therapy.

Combined Modality Therapy↗

PubMed1993

Cricohyoidopexy in selected infrahyoid epiglottic carcinomas presenting with pathological preepiglottic space invasion.

Nineteen patients who presented with infrahyoid epiglottic squamous cell carcinoma with gross pathological preepiglottic space invasion, not amenable to a partial horizontal supraglottic laryngectomy, were offered a supracricoid partial laryngectomy with a cricohyoidopexy technique; this was an attempt to preserve physiological phonation, respiration, and deglutition while achieving the same local control rate as with a total laryngectomy. Preoperative chemotherapy and bilateral jugulocarotid lymph node dissection were performed in all cases. Patients were monitored for at least 5 years or until death. No patients were unavailable for follow-up. The 5-year actuarial survival (Kaplan-Meier method) was 84.2%. Local recurrence, nodal recurrence, and distant metastasis occurred once in our series, while six patients presented with a second primary tumor. We present, analyze, and compare functional results with those of the previously reported series. Our experience with the supracricoid partial laryngectomy with a cricohyoidopexy, in the face of selected infrahyoid epiglottic squamous cell carcinoma invading the preepiglottic space, not amenable to a partial horizontal supraglottic laryngectomy, suggested that a total laryngectomy might be avoided without decreasing the cure rate.

Adult↗

PubMed1995

Laryngeal oncocytic cystadenomas. Eight cases and a literature review.

OBJECTIVE: To describe an uncommon clinical entity, laryngeal oncocytic salivary adenomas. BACKGROUND: While the nomenclature of these lesions may differ depending on their histologic appearance, these tumors are all generally part of a spectrum of clinically benign cystic and papillary lesions derived from oncocytic metaplasia and hyperplasia of minor salivary ducts. DESIGN: Eight cases of laryngeal oncocytic lesions collected from two institutions. Further clinical background and follow-up data were obtained on five of eight patients. RESULTS: Patients were mostly in their seventh and eighth decades of life, and all who were questioned had smoking histories. Hoarseness was a common presenting complaint, and all patients had polypoid laryngeal masses. One patient presented with progressive upper airway obstruction, which was ultimately fatal; the laryngeal oncocytic cystadenoma was diagnosed in this case during postmortem examination. The laryngeal lesions were predominantly supraglottic. Histologically, they consisted of oncocytic metaplasia of the minor salivary ducts, cystic dilation, and papillary and microcystic hyperplasia. No recurrences were seen in those patients with follow-up (four of eight). CONCLUSIONS: Laryngeal oncocytic lesions usually present as supraglottic masses in older patients. While they are oncologically benign and nonrecurring after endoscopic removal, they may occasionally be the cause of significant upper airway obstruction.

Aged↗

PubMed1996

Analysis of voice outcomes in pediatric patients following surgical procedures for laryngotracheal stenosis.

OBJECTIVE: To evaluate long-term (> 2 years) voice function and corresponding anatomical features in children who have undergone augmentation procedures for laryngotracheal stenosis. DESIGN: Follow-up survey assessment. SETTING: Academic pediatric referral center. PATIENTS OR OTHER PARTICIPANTS: The families of 50 patients were contacted by mail, and completed home questionnaires. Of these 50 patients, 33 agreed to participate in a comprehensive hospital-based voice assessment, and 28 of these underwent fiberoptic endoscopy. INTERVENTIONS: Hospital-based evaluation and parental questionnaire. MAIN OUTCOME MEASURES: (1) Perceptual voice assessment from taped samples by using the Vocal Profile Analysis protocol performed by 3 speech and language therapists, (2) fiberoptic laryngeal endoscopy assessment performed by 3 otolaryngologists, and (3) parental assessment of voice by questionnaire. The conditions of the patients were categorized by etiology, the degree of stenosis, coexisting laryngeal lesions, and the type of surgical procedure that was done based on a review of medical records. RESULTS: Eight of 33 patients were judged perceptually by using an amended version of the Vocal Profile Analysis scheme to have "normal" voices. In the remaining 25 patients, abnormalities were demonstrated in the parameters, including harshness (52%), whisper (36%), ventricular band phonation (21%), continuity (27%), mean pitch (27%), and falsetto voice (12%). By using endoscopy, 3 of 25 larynges were judged to be anatomically normal. Abnormalities that were found in the other patients included altered vocal fold mobility (42%), abnormal subglottis (38%), supraglottic vibration (31%), and anterior commissure blunting (31%). Supraglottic vibration corresponded with the perceptual judgment "ventricular band phonation type," and was seen in children with glottic insufficiency. Only 12% of parents indicated by questionnaire that deterioration of voice and dissatisfaction with voice function occurred after surgical procedures were performed. CONCLUSIONS: A substantial proportion of children who have undergone laryngotracheal surgical procedures for stenosis demonstrate chronic voice and endoscopic abnormalities. The effects of these surgical procedures and preexisting laryngeal abnormalities on voice continue to be difficult to establish in the pediatric population. Careful management by speech and language therapists who are familiar with such children is essential for optimal voice function.

Adolescent↗

PubMed1997

Concomitant cisplatin/5-FU infusion and radiotherapy in advanced head and neck cancer: 8-year analysis of results.

BACKGROUND: The purpose of this study was to analyze long-term follow-up of a single institution's experience with a regimen of concomitant cisplatin/fluorouracil (5-FU) infusion and radiation given every other week. This analysis was stimulated by results of a randomized trial showing superiority for this regimen over induction cisplatin/5-FU chemotherapy followed by radiotherapy, especially in regional disease control. METHODS: All patients with stage III/IV disease who were referred by surgeons for nonoperative therapy and had a follow-up of at least 2 years were included. Concomitant chemoradiotherapy was administered days 1-5 of a 2-week treatment cycle, for a total of 7 cycles, with cisplatin 60 mg/m2 day 1, 5-FU 800 mg/m2 given over 24 hours days 1-5, and radiation 2 Gy days 1-5. RESULTS: Seventy-eight patients with stage III (n = 16) or IV (n = 62) were treated and followed for a median of 8 years. Six patients died during treatment, of aspiration pneumonia, sudden death, gastrointestinal bleeding, and stroke. When assessed 6 weeks after the end of treatment, 45 patients (63%) had no clinical evidence of disease, whereas 27 (37%) still had some persistent abnormality. However, 17 of these "partial responders" have not recurred. In all, 24 patients (31%) have recurred or progressed, 13 at the primary site, 5 after 3 years. None of 16 stage III and 24 (39%) of 62 stage IV patients ever progressed. Tongue and glottic larynx did best, with only 1 of 22 patients ever failing (none locally). Supraglottic and oral cavity cancers other than tongue had the worst failure rates. Nineteen patients (24%) died of other causes (DOC), tumor-free. Patients who DOC correlated strongly with T stage (p < .002) but not with N stage or with AJC stage. The 5-year progression-free survival was 60% (confidence interval [CI] = 49% to 72%), and overall survival was 43% (CI = 33% to 56%). CONCLUSIONS: Disease control for this advanced head and neck cancer population was excellent. This regimen was especially effective in advanced tongue and glottic cancers and all stage III disease sites. Advanced supraglottic and hypopharynx cancers are problematic. These, and especially T4 lesions, are associated with high DOC rates, possibly in part related to swallowing malfunction. Nevertheless, the long-term survival without surgical intervention was high with this regimen.

Adult↗

PubMed2000

Multiple primary malignant neoplasm in patients with laryngeal carcinoma.

BACKGROUND AND OBJECTIVES: The aim of this study was to study the incidence, localization, and nature of second primary tumors arising in patients with primary laryngeal carcinoma and their correlation with the site, staging, and grade of differentiation. METHODS: Between 1979 and 1996, 877 patients underwent laryngeal surgery (850 male and 27 female; age range = 30.5-76 years). The second primary tumor was multicentric in 7 cases (14%), systemic in 16 cases (33. 3%), and "coincidental" in 25 cases (52%). In 3 cases the tumors were simultaneous, in 7 cases they were synchronous, and in 38 cases they were metachronous. In the 48 patients with multiple primary malignant neoplasm, the index tumor was glottic in 38 cases and supraglottic in the remaining 10, but the incidence of second tumors in these two groups was virtually matching, respectively: 38/709 (5. 3%) and 10/168 (5.9%). RESULTS: This study did not identify any correlation between the second primary tumor and the extension of the first neoplasm (T) and the presence of laterocervical lymph node metastases (N). Our data showed a higher incidence of second tumor in patients having G1 carcinomas compared with the other series with G2 and G3 carcinomas. As far as survival rates are concerned, a significant reduction was observed in patients developing a second primary tumor, regardless of whether the index tumor was glottic or supraglottic. CONCLUSIONS: The incidence of new tumors in patients with laryngeal carcinoma is not linked to the site, size, staging, or grade of differentiation of the index tumor.

Adult↗

PubMed1979

Swallowing disorders in three types of head and neck surgical patients.

This study examined swallowing transit times and motility problems in three groups of patients following ablative surgery for oropharyngeal carcinoma and in a control group of 10 normal subjects. A total of 30 patients was studied: 10 after anterior floor of mouth resection, 12 after tonsil/base of tongue resection, and 8 after supraglottic laryngectomy. Videofluoroscopic studies of liquid, thin paste, thick paste, and thick paste plus liquid swallows were completed 1 week post-initiation of oral feeding following surgery. From the videotapes, oral and pharyngeal transit times were measured, and motility disturbances were defined during each stage of the swallow. All three types of patients in this study showed severe problems with swallowing. The anterior floor of mouth resection patients had problems with preparation for the swallow and oral transit. Tonsil/base of tongue resection patients had slowing in the preparation for the swallow and in the oral and pharyngeal stages. After supraglottic laryngectomy, patients showed only slight slowing in oral transit and pharyngeal transit as compared to other types of surgical patients.

Adult↗

PubMed2004

Identification and characterization of a specific sensory epithelium in the rat larynx.

A specific laryngeal sensory epithelium (SLSE), which includes arrays of solitary chemoreceptor cells, is described in the supraglottic region of the rat. Two plates of SLSE were found, one on each side of the larynx. The first plate was located in the ventrolateral wall of the larynx, and the second was located in the interarytenoidal region. In SLSE, immunoblotting showed the presence of alpha-gustducin and phospholipase C beta2 (PLCbeta2), which are two markers of chemoreceptor cells. At immunocytochemistry, laryngeal immunoreactivity for alpha-gustducin was localized mainly in solitary chemosensory cells. Double-label immunocytochemistry using confocal microscopy demonstrated that alpha-gustducin-expressing cells in large part colocalize type III IP3 receptor (IP3R3), another key molecule in bitter taste perception. However, some IP3R3-expressing cells do not colocalize alpha-gustducin. At ultrastructural immunocytochemistry, these cells showed packed apical microvilli, clear cytoplasmic vesicles, and cytoneural junctions. SLSE was characterized by high permeability to a tracer due to poorly developed junctional contacts between superficial cells. Junctions were short in length and showed little contact with the terminal web. Ultrastructural analysis showed deep pits among the superficial cells. In SLSE, high density of intraepithelial nerve fibers was found. The lamina propria of the SLSE appeared thicker than that in other supraglottic regions. It was characterized by the presence of a well-developed subepithelial nerve plexus. The immunocytochemical and ultrastructural data suggested that SLSE is a chemoreceptor located in an optimal position for detecting substances entering the larynx from the pharynx or the trachea.

Animals↗