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PubMedDate not supplied

Management of laryngeal radionecrosis: animal and clinical experience.

Radiation necrosis of the laryngeal cartilages is an uncommon complication of radiotherapy for laryngeal carcinoma. It is a devastating process for which there is no one acceptable treatment. Medical management offers only temporary, symptomatic relief, which further necessitates surgical treatment. Surgical management may start with a tracheotomy; however, it often ends with a total laryngectomy. Physiologically, the necrotic cartilages are the source of the problem. It is a general surgical principle that nonviable tissue must be excised to promote healing. Therefore, if the affected laryngeal cartilages were removed, the larynx should heal. Total or near total removal of the thyroid and cricoid cartilages with preservation of the endolaryngeal soft tissues has not been reported in the literature. Theoretically, if the entire cartilaginous framework is removed, there would be no structural support for the airway. We have found using animal models, that submucosal resection of the laryngeal cartilages, leaving the perichondrium and endolaryngeal soft tissues intact can result in a competent airway. Animal and clinical experience will be presented.

Animals↗
PubMed1985

Delayed cricoid reconstruction by use of a free graft of autogenous "patient banked" cartilage.

Avulsed cartilage may be "banked" or preserved by subcutaneous implantation in the traumatized patient for delayed reconstruction of the defect when immediate reconstruction is contraindicated. The perichondrium of the avulsed cartilage should be preserved if possible. In the reconstructive procedure the cartilage graft must be surrounded by vascularized flaps developed from adjacent neck tissue. These vascularized flaps increase the local vascular supply for revascularization of the free graft. In addition, they allow complete separation of the free graft from the airway to minimize the possibility of secondary infection arising from the airway. Mucosal coverage of the defect does not appear to be necessary as long as well-vascularized soft tissue is available for complete coverage of the defect. The use of this technique may be considered for patients with avulsion of portions of the laryngeal cartilages when immediate reconstruction is contraindicated or when the viability of adjacent soft tissue necessary for reconstruction is uncertain. The success of this procedure may be related to the adequacy of the closure or separation of the airway from the free cartilage graft, and the ability to provide coverage of the graft with vascular tissue to allow graft revascularization. This new technique follows the traditional principles vital for successful management of laryngotracheal injuries. This procedure provides an additional method of therapy for those patients with an avulsion injury of the laryngeal cartilage. Additional surgical procedures must be performed utilizing the indications and principles presented here before this method is universally accepted for the management of severe laryngotracheal injury.

Adult↗
PubMed1979

Proteoglycans of the intervertebral disc. Absence of degradation during the isolation of proteoglycans from the intervertebral disc.

Proteoglycans extracted with 4M-guanidinium chloride from pig intervetebral discs, and purified by equilibrium density-gradient centrifugation in CsCl, were of smaller hydrodynamic size than those extracted and purified in the same way from the laryngeal cartilage of the same animal. Whether this difference in size arose from degradation during the extraction and purification of the proteoglycans of the disc was investigated. Purified proteoglycans labelled either in the chondroitin sulphate chains or in the core protein were obtained from laryngeal cartilage by short-term organ culture. These labelled proteoglycans were added at the beginning of the extraction of the disc proteoglycans, and labelled cartilage and unlabelled disc proteoglycans were isolated and purified together. There was no appreciable loss of radioactivity after density-gradient centrifugation nor decrease in hydrodynamic size of the labelled cartilage proteoglycans on chromatography on Sepharose 2B, when these were present during the extraction of disc proteoglycans. It is concluded that disc proteoglycans are intrinsically of smaller size than cartilage proteoglycans and this difference in size does not arise from degradation during the extraction.

Animals↗
PubMed1987

Extended and globular protein domains in cartilage proteoglycans.

Electron microscopy after rotary shadowing and negative staining of the large chondroitin sulphate proteoglycan from rat chondrosarcoma, bovine nasal cartilage and pig laryngeal cartilage demonstrated a unique multidomain structure for the protein core. A main characteristic is a pair of globular domains (diameter 6-8 nm), one of which forms the N-terminal hyaluronate-binding region. They are connected by a 25 nm-long rod-like domain of limited flexibility. This segment is continued by a 280 nm-long polypeptide strand containing most chondroitin sulphate chains (average length 40 nm) in a brush-like array and is terminated by a small C-terminal globular domain. The core protein showed a variable extent of degradation, including the loss of the C-terminal globular domain and sections of variable length of the chondroitin sulphate-bearing strand. The high abundance (30-50%) of the C-terminal domain in some extracted proteoglycan preparations indicated that this structure is present in the cartilage matrix rather than being a precursor-specific segment. It may contain the hepatolectin-like segment deduced from cDNA sequences corresponding to the 3'-end of protein core mRNA [Doege, Fernandez, Hassell, Sasaki & Yamada (1986) J. Biol. Chem. 261, 8108-8111; Sai, Tanaka, Kosher & Tanzer (1986) Proc. Natl. Acad. Sci. 83, 5081-5085; Oldberg, Antonsson & Heinegård (1987) Biochem. J. 243, 255-259].

Animals↗
PubMed1990

Ultrastructural characterization of embryonic chick cartilage proteoglycan core protein and the mapping of a monoclonal antibody epitope.

The ultrastructure of embryonic chick cartilage proteoglycan core protein was investigated by electron microscopy of specimens prepared by low angle shadowing. The molecular images demonstrated a morphological substructural arrangement of three globular and two linear regions within each core protein. The internal globular region (G2) was separated from two terminally located globular regions (G1 and G3) by two elongated strands with lengths of 21 +/- 3 nm (E1) and 105 +/- 22 nm (E2). The two N-terminal globular regions, separated by the 21-nm segment, were consistently visualized in well spread molecules and showed little variation in the length of the linear segment connecting them. The E2 segment, however, was quite variable in length, and the C-terminal globular region (G3) was detected in only 53% of the molecules. The G1, G2, and G3 regions in chick core protein were 10.1 +/- 1.7 nm, 9.7 +/- 1.3 nm, and 8.3 +/- 1.3 nm in diameter, respectively. These results are similar to those described previously for proteoglycan core proteins isolated from rat chondrosarcoma, bovine nasal cartilage, and pig laryngeal cartilage (Paulsson, M., Morgelin, M., Wiedemann, H., Beardmore-Gray, M., Dunham, D., Hardingham, T., Heinegard, D., Timpl, R., and Engel, J. (1987) Biochem. J. 245, 763-772). However, a significant difference was detected between the length of the elongated strand (E2) of core proteins isolated from chick cartilage, E2 length = 105 +/- 22 nm, compared to bovine nasal cartilage, E2 length = 260 +/- 39 nm. The epitope of the proteoglycan core protein-specific monoclonal antibody, S103L, was visualized by electron microscopy, and the distance from the core protein N terminus to the S103L binding site was measured. The S103L binding site was localized to the E2 region, 111 +/- 20 nm from the G1 (N terminus) domain and 34 nm from the G3 (C terminus) domain. cDNA clones selected from an expression vector library of chicken cartilage mRNA also show this epitope to be located near the C-terminal region (R. C. Krueger, T. A. Fields, J. Mensch, and B. Schwartz (1990) J. Biol. Chem. 265, 12088-12097).

Aggrecans↗
PubMedDate not supplied

[Variants and early symptoms of congenital diseases of larynx and trachea].

Congenital laryngeal and tracheal anomalies found in 1980-1995 in 91 children consisted of vascular tumors, laryngeal membranes, laryngeal cartilage anomaly, tracheomalacia, laryngeal papillomatosis, cysts, stridor (36.2%, 16.5%, 13.2%, 3.3%, 13.2%, 5.5%, 9.9%, respectively). Other causes are responsible for the defects in 2.2% of cases. Early symptoms of the above diseases are detailed. This information contributes to valid preliminary diagnosis and to optimal planning of further examination and treatment.

Child, Preschool↗
PubMed2005

Individual subject laryngeal dimensions of multiple mammalian species for biomechanical models.

OBJECTIVES: This report provides a detailed knowledge base of individual subject laryngeal cartilage dimensions across multiple species to assist researchers in creating subject-specific biomechanical laryngeal models. METHODS: The raw data from previous laryngeal cartilage studies were grouped by species (for human, canine, and ovine) and by cartilage (arytenoid, thyroid, and cricoid) by means of a previously reported labeling scheme. No animals were sacrificed specifically for the present study. RESULTS: More than 1,500 measurements from 37 subjects are presented in 15 tables. No comparisons of the average measures were attempted, as they were done in previous studies. CONCLUSIONS: By means of a database of individual subject dimensions, a laryngeal model could be designed and tested to morph from one subject to the next, predicting subject-specific results of laryngeal function. Eventually, this would lead to modeling patient-specific laryngeal disorders and the prediction of therapeutic outcomes. An electronic downloadable version of the database is made available to assist in this effort.

Animals↗
PubMed1991

The intraoperative management of the thyroid gland during laryngectomy.

The standard of care of laryngeal cancer surgery is wide field excision of the larynx combined with ipsilateral thyroid lobectomy. A retrospective review of 247 laryngectomies performed between 1979 and 1989 was undertaken to determine specific intraoperative indications for thyroid gland removal. The incidence of thyroid disease in our patients with laryngeal cancer was compared to the normal population. Eight percent of thyroid specimens removed during laryngeal cancer surgery demonstrated invasion by squamous cell carcinoma. All patients having thyroid invasion had T3 or T4 laryngeal lesions that were stage IV at the time of surgery. All these lesions were found to have transglottic growth and laryngeal cartilage invasion by the pathologist. All of these patients also had abnormal thyroid glands intraoperatively and laryngeal cartilage destruction that was evident intraoperatively. Total thyroidectomy with bilateral paratracheal and pretracheal lymph node dissection is indicated when squamous cell carcinoma of the larynx involves the thyroid gland. Prophylactic ipsilateral thyroid lobectomy and isthmusectomy is warranted for large laryngeal cancers (T3, T4) that involve the anterior commissure, the subglottic area, or extend transglottically. Routine thyroid gland removal is not indicated for the majority of laryngeal cancers that do not meet the aforementioned criteria. Finally, abnormal thyroid histopathology was diagnosed in 37% of the surgical thyroid gland specimens removed during laryngectomy.

Adenocarcinoma↗
PubMedDate not supplied

Histopathologic study of carcinoma of the hypopharynx: implications for conservation surgery.

A total of 38 specimens obtained by laryngopharyngectomy were subjected to a whole organ section study. Of the 38, 31 were pyriform sinus (PS), three were postcricoid (PC), and four were posterior wall (PW) carcinomas. The results were as follows. 1) The thyroid cartilage was involved much more frequently than the other laryngeal cartilages. 2) Joint involvements were infrequent. 3) The interarytenoid, thyroarytenoid, and lateral cricoarytenoid muscles frequently were invaded by PS carcinomas, whereas PC carcinomas frequently involved the interarytenoid and posterior cricoarytenoid muscles. 4) The recurrent laryngeal nerve (RLN) was involved in all PC T3 cases, but RLN involvement was rare in PS cases. 5) Involvements of the paraglottic space and periarytenoid region were closely related to fixation of the larynx on the affected side (hemilarynx) in PS carcinomas. 6) Neither hemilarynx fixation nor PS apex involvement was a reliable landmark for determining the exact extent of laryngeal involvement. 7) Conservation surgery could have been employed in 18 of the 38 cases.

Humans↗
PubMed2006

[Histopathological study on the regularity of pyriform sinus carcinoma invading adjacent tissue and structure].

OBJECTIVE: To explore the regularity invading adjacent tissue of pyriform sinus carcinoma. METHODS: The whole organ serial section of 68 total or partial laryngectomy and hypopharyngectomy specimen of pyriform sinus carcinoma were histopathologically studied. RESULTS: In 68 pyriform sinus carcinoma, invaded ventricular and paraglottic spaces was 63 and 38 cases respectively, the difference of invasive frequency of both spaces was significantly marked (chi2 = 21.37, P < 0.01). Thyroid cartilage had the most invaded frequency of 92.6% (63/68). The all touching and pressing invasion of laryngeal cartilage was 89 times, and infiltrating invasion was 51 times. The invasive frequency of lateral cricoarytenoid muscle, posterior cricoarytenoid one, thyroarytenoid and interarytenoid ones were 63.2% (43/68), 57.4% (39/68), 55.9% (38/68), 51.5% (35/68) respectively. The invasive frequency of cricoarytenoid and cricothyroid joints were 30.9% (21/68), 17.6% (12/68) respectively. The invasive frequency of superior laryngeal nerve was 67.7% (44/65) , and more than that of recurrent laryngeal nerve (18/65, 27.7%). The pyriform sinus medial wall carcinoma was 14 cases, lateral wall carcinoma 18 cases, medial and lateral wall carcinoma 36 cases. The invaded pyriform sinus apex was 34 cases, normal its apex was 26 ones, submucous invasion of its apex was 8 ones. Light lymphocytic invasion was 66.2% (45/68) and seen most in pyriform sinus carcinoma. Submucous and leaping invasion of pyriform sinus carcinoma were 24 and 8 cases. CONCLUSIONS: Intralaryngeal invasion of pyriform sinus carcinoma arose through paraglottic space first. Laryngeal cartilage membrane and their cartilage were anatomical obstacle against cancerous invasion. Lateral cricoarytenoid muscle, posterior cricoarytenoid one, thyroarytenoid and interarytenoid ones were often invaded. Pyriform sinus medial wall carcinoma invaded intralaryngeal structure easily, its lateral wall carcinoma may invade upward, downward and outward along thyroid cartilage interior wall, medial and lateral wall carcinoma may invade intralaryngeal and extralaryngeal structure, and was the most serious lesion. The invasion of pyriform sinus apex is an important sign of pyriform sinus carcinoma spreading downward to inferior and peripheral tissues of hypopharynx.

Adult↗
PubMed1996

[Magnetic resonance imaging of laryngeal cancer].

MRI data of twenty-four cases of laryngeal cancer were analysed and compared with the findings of postsurgical pathology. The results revealed that MRI could clearly demonstrate the three dimensional representations of tumor pathology, and correctly depict invasion of paraglottic space (PGS), and preepiglottic space (PES), and precisely display involvement of laryngeal cartilage by cancer. It was considered that MRI was of great importance in determining appropriate therapy for laryngeal cancer.

Adult↗
PubMed2003

Using MR imaging to predict invasion of the recurrent laryngeal nerve by thyroid carcinoma.

OBJECTIVE: We evaluated the accuracy of MR imaging findings for predicting invasion of the recurrent laryngeal nerve by thyroid carcinoma and established an optimal criterion on which to base this prediction. MATERIALS AND METHODS: We reviewed MR imaging findings (lesion size and posterior extension of tumor; encirclement of and invasion into the laryngeal cartilage, trachea, and esophagus by the tumor; and the amount of effaced fatty tissue in the tracheoesophageal groove or between the laryngeal cartilage and hypopharyngeal wall) in 66 patients with thyroid carcinoma. The amount of effaced fatty tissue was classified as one of five grades: 1, normal amount of fatty tissue; 2, partly effaced; 3, completely effaced in one MR imaging slice; 4, completely effaced in two contiguous MR slices; and 5, completely effaced in three or more contiguous MR slices. RESULTS: Thirty-two (48%) of the 66 patients had surgically or pathologically verified recurrent laryngeal nerve invasion. Logistic modeling revealed that the amount of effaced fatty tissue (p < 0.001) and the lesion size (p = 0.033) were the significant factors. Using the threshold values for the lesion size to predict invasion, we found that a threshold of more than 2.9 cm showed the highest accuracy, 76%, with 78% sensitivity and 74% specificity. For the amount of effaced fatty tissue, a grade of 3 or more had the highest accuracy, 88%, with 94% sensitivity and 82% specificity. Addition of the lesion size to this criterion did not improve the diagnostic accuracy of using the amount of effaced fatty tissue alone. CONCLUSION: Invasion of the recurrent laryngeal nerve by thyroid carcinoma was accurately predicted by the finding of effaced fatty tissue on MR imaging.

Adult↗
PubMedDate not supplied

Computed tomography of the larynx: a clinical and pathologic study.

Recent interest in the application of computed tomography (CT) to the evaluation of laryngeal tumors, and the fact that the larynx offers the unique opportunity of whole organ study after total laryngectomy, led to a prospective study of laryngoscopy, conventional tomography, and CT in relation to pathologic findings. The results showed that CT gives an exact assessment of laryngeal anatomy and tumor involvement, particularly in the paracordal and pre-epiglottic spaces. The laryngeal cartilages, which are not well demonstrated by any other means, are accurately delineated by CT. There is also good demonstration of the laryngeal surface of the epiglottis, including the anterior commissure, which is poorly shown by other radiologic methods and is sometimes poorly seen on laryngoscopy. Because CT and conventional tomography present images at 2 different planes, at right angles to each other, we believe that CT is entirely complementary to conventional tomography.

Adult↗
PubMed1993

Nuclear morphometry as a prognostic factor in laryngeal squamous cell carcinomas. Preliminary study.

A preliminary report concerning the prognostic significance of certain nuclear morphometric parameters in laryngeal squamous cell carcinoma (SCC) is presented. 18 cases of primarily glottic laryngeal SCC were graded according to the criteria outlined by Jakobsson et al., and assessed for the presence of infiltration of laryngeal cartilage. Nuclear width (short axis) and perimeter were found to be smaller in the "favourable prognosis" group than in the "unfavourable prognosis" one, on an indicative basis only, due to the small number of cases. The nuclear perimeter was furthermore found to be larger in cases with carcinomatous infiltration of the laryngeal cartilage than in cases without, on a statistically highly significant basis. The clinical utility of these results in a biopsy report of a laryngeal SCC is discussed.

Adult↗
PubMed1982

Visualisation of the intralaryngeal joints: a low voltage radiological study.

Low-voltage radiography of the neck was adjusted for visualisation of the crico-arytenoid joints. Sixty-four patients (48 males, 16 females) with laryngeal tumours were examined. The degree of ossification in the laryngeal cartilage around the crico-arytenoid joints was different in the males and the females. All males had ossification in the plate of the cricoid, and 94% in the arytenoids. The articular facets on the cricoid were visible in 94%, and on the arytenoid in 85%. All females had ossification in the arytenoids, and 94% in the plate of the cricoid. The articular facets on the arytenoids were visible in all females, and on the cricoid in 88%. One or both articular facets in the crico-arytenoid joints were visible in all patients, making the method useful in detecting erosive arthritis in the joints.

Adult↗
PubMed1996

Morphological modeling via isosurfacing: the laryngeal skeleton of gekkonid lizards as a test case.

A novel technique for modeling microscopic anatomical structures in three dimensions was developed as part of a survey of gekkonid laryngeal skeletal morphology (Reptilia: Gekkonidae). Excised larynges were transversely sectioned at 10 microns and stained using standard procedures. With a projection microscope, outline drawings of the sectioned laryngeal cartilages were made at regular intervals, depending on the rate and degree of structural change observed while sampling. The drawing set was digitized with a flatbed scanner, and aligned using 'NIH Image' for Macintosh computers. Physical connectivity between successive outlines was provided by inserting one or more artificial slices between those that had been digitized, and draping a skin of rendered contours over all of the interstitial spaces present in the template. The Application Visualization System, a general purpose visualization package for UNIX-based computer systems, was used to visualize and render the resulting 'isosurfaces', which appear as solid three-dimensional objects and can be viewed from any perspective. Since isosurfaced reconstructions can be based on as little as 20% of the cross-sections available, this procedure has the potential to be a valuable research tool for future morphological work at the microscopic level.

Animals↗
PubMedDate not supplied

The reliability of endoscopic examination in assessment of arytenoid cartilage movement in horses. Part I: Subjective and objective laryngeal evaluation.

Videorecordings of the laryngeal activity of 108 unsedated horses were obtained at rest by passing a flexible videoendoscope into the nasopharynx through the right ventral meatus. All videotaped images were reviewed once, and 72 were reviewed twice, by three veterinarians. Laryngeal cartilage movement was assessed subjectively with a five-tier grading system. The mean intraobserver agreement was 83.3% (range, 75.0%-90.2%) with a kappa statistic of .65 to .98. The mean interobserver agreement was 79.0% (range, 70.4%-80.6%) with a kappa statistic of .51 to .90. A computer program was developed to measure the left:right ratio of the rima glottidis. The mean left:right ratio for horses assigned a median laryngeal grade of I was 0.84 (range, 0.55-1.03); for grade II, 0.82 (0.50-1.12); for grade III, 0.59 (0.39-0.91); and for grade IV, 0.24 (0.07-0.35).

Animals↗