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Calcitonin gene-related peptide-immunoreactive nerves in the tongue, epiglottis and pharynx of the rat: occurrence, distribution and origin.

The occurrence, distribution and nature of calcitonin gene-related peptide (CGRP) in the tongue, epiglottis and pharynx of the rat was investigated by immunocytochemistry and radioimmunoassay. Numerous CGRP-containing nerves were found to innervate and terminate freely within the epithelium of the tongue, epiglottis and pharynx. Immunoreactive fibres were also found in the muscle layer and around blood vessels in the tongue, and in motor end plates in the muscle of the epiglottis and pharynx. Section of the trigeminal nerve induced a marked reduction in the number of immunoreactive nerves in the anterior portion of the tongue, whereas glossopharyngeal denervation results in a depletion of CGRP immunoreactivity in the posterior portion of the tongue. Immunoreactive nerves of the epiglottis and pharynx were depleted only after superior laryngeal nerve section. A subpopulation of labelled primary sensory neurones were observed in trigeminal and glossopharyngeal ganglia following injection of True blue retrograde tracer in the tongue. Most of the labelled cells were also immunoreactive for CGRP. Following systemic treatment with capsaicin, a loss of intra- and subepithelial CGRP-immunoreactive nerves was observed in all investigated tissues, while immunoreactive motor end plates remained unchanged.

Animals↗

Responses of lamb nucleus of the solitary tract neurons to chemical stimulation of the epiglottis.

Previous research has shown that applications of chemical stimuli to the epiglottis produced distinct patterns of activity in the lamb superior laryngeal nerve. To determine the response characteristics of second-order neurons, we recorded from single cells in the lamb nucleus of the solitary tract (NST) while stimulating the epiglottis with 0.5 M KCl, NH4Cl, NaCl, LiCl, distilled water, 0.005 M citric acid and 0.01 N HCl. Most neurons responded to more than one of the chemical solutions. The order of effective stimuli was KCl = NH4Cl greater than distilled water greater than HCl greater than citric acid greater than NaCl greater than LiCl. An analysis of the variation in response frequency over time found that different chemical stimuli produced significantly different response patterns in NST neurons. A comparison of the mean neural response profiles of NST neurons and superior laryngeal nerve fibers for each of the stimuli found that only the response profiles elicited by NH4Cl were significantly different. In addition to their responses to chemical solutions, almost one-third of the NST neurons responded to the rinse following application of at least some of the stimuli and 80% of the neurons were excited by mechanical stimulation of the epiglottis with a soft brush. Also, a small number of neurons exhibited a rhythmic response coordinated with respiration. The majority of recording sites were located in areas of the NST linked to swallowing and respiration suggesting that the response patterns of NST neurons elicited by chemical stimulation of receptors on the epiglottis may play a role in upper airway reflexes.

Animals↗

Responses of neurons in the lamb nucleus tractus solitarius to stimulation of the caudal oral cavity and epiglottis with different stimulus modalities.

Receptors located in the posterior oral cavity and on the epiglottis play an important role in the initiation of upper airway reflexes such as swallowing, gagging, coughing and apnea. Peripheral nerves which innervate these receptor areas terminate in the nucleus tractus solitarius (NTS). We have recorded the responses of 61 neurons in the lamb NTS to stimulation of the caudal tongue, palate and epiglottis with mechanical, chemical and thermal stimuli and mapped receptive field location. Although there was some overlap in the areas of the NTS from which neurons with oral cavity and epiglottal receptive fields could be recorded, a significant difference was observed in the mean recording sites of the two groups of neurons. Neurons with oral cavity receptive fields were located more rostral, lateral and ventral in the NTS than neurons with receptive fields on the epiglottis. Little convergence of sensory input onto single cells in the NTS was observed between the oral cavity and the epiglottis. Only one NTS neuron had a receptive field in both of these receptor areas. In contrast, a large number of neurons with oral cavity receptive fields received input from two receptor areas. These neurons had a receptive field on the tongue which was located directly beneath the receptive field on the palate. Mechanical stimuli were the most effective for neurons with either oral cavity or epiglottal receptive fields and thermal stimuli were the least effective. Neurons which responded to mechanical stimuli responded better to a moving stimulus than to a punctate one, and large increases in the strength of a punctate stimulus were required to elicit significant increases in response frequency. Most NTS neurons responded to more than one of the stimulus modalities. However, a significant difference in the mean number of stimulus modalities which elicited responses was observed between neurons with oral cavity and epiglottal receptive fields. The number of multimodal neurons with epiglottal receptive fields was higher than those with oral cavity receptive fields. The multimodal nature of neurons which responded to epiglottal or oral cavity stimulation combined with their location in reflexogenic areas of the NTS suggests that these neurons could be important in the integration of afferent input from the oral cavity and upper airway. If these NTS neurons are involved in the control of oral and upper airway reflexes it would be important for them to respond to as many of the stimulus cues as possible and the majority of these neurons do just that.

Action Potentials↗

Bifid epiglottis.

Bifid epiglottis is a rare congenital defect that is often associated with other congenital annomalies. The most common defect associated with a bifid epiglottis are anomalies of the hands and/or feet (90%) while the most dangerous and potentially lethal anomaly if not recognized and treated are hypothalamic hamartomas and hypopituitarism (50%). A bifid epiglottis will often result in severe respiratory distress secondary to laxity of the cartilage and chronic aspirations, which may require surgical intervention. We present the case of a 10-week-old child who was sent for evaluation of stridor and aspiration. Office laryngoscopy demonstrated a true bifid epiglottis and further evaluation demonstrated a hypothalamic hamartoma consistent with Pallister-Hall syndrome. Management of our case as well as those previously presented in the literature are reviewed.

Child, Preschool↗

[The epiglottis, a glosso-laryngeal structure: an anatomic study of its innervation].

The epiglottis is known as a laryngeal structure. The authors studied the innervation of epiglottis using the Sihler method on six human epiglottises. Innervation of the epiglottis depended on the rami from the vagus, glossopharyngeal and hypoglossal nerves. By its innervation, epiglottis seems to be a glosso-laryngeal structure, as is confirmed by embryology, histology and clinical applications.

Aged↗

Retroverted epiglottis presenting as a variant of globus pharyngeus.

We describe a series of four patients who presented with 'high globus pharyngeus', who all had an abnormally curled epiglottis tip touching and indenting the tongue base. The actual incidence of 'curling epiglottis', as well as the potential impact of this variation in persistent globus symptoms, is not known. We therefore describe for the first time a series of patients with this anatomical variant of the epiglottis, each of whom experienced unresolved globus symptoms despite receiving intensive medical treatment. In the literature, the success rate for improvement in symptoms following medical treatment ranges from 68 to 80 per cent. Following CO2 laser partial epiglottectomy, all four patients experienced complete relief of their symptoms. We advocate consideration of this treatment for high globus pharyngeus that fails to respond to conservative treatment, in cases with proven curled epiglottis on endoscopic examination.

Adult↗

Persistent frenulum of the epiglottis in four foals.

OBJECTIVE: To report the clinical signs and management of 4 foals with persistent frenulum of the epiglottis. STUDY DESIGN: Case report. ANIMALS: Four newborn foals. METHODS: Foals were admitted with a complaint of oronasal reflux after nursing. Variable systemic signs of aspiration pneumonia were evident. Nasal endoscopy confirmed persistent dorsal displacement of the soft palate. Persistent frenulum of the epiglottis, confirmed by oral endoscopic examination, was transected. RESULTS: After surgery, all foals had the epiglottis positioned normally, dorsal to the soft palate. Clinical signs of oronasal reflux resolved by the second nursing attempt in 3 foals, whereas this was difficult to assess in one foal that was nursed intermittently because of the mares behavior. This foal died 2 days later. The other 3 foals have had normal epiglottic function for 2-4 years. CONCLUSIONS: Persistent frenulum of the epiglottis should be considered in foals with oronasal reflux from birth. With appropriate medical and surgical management the prognosis for resolution should be good.

Animals↗

A peculiar site of chondroma: the epiglottis.

Chondroma of the laryngeal cartilage is an uncommon benign cartilaginous neoplasm. The commonest location is the posterior lamina of the cricoid cartilage, followed by the thyroid cartilage. The occurrence of chondroma in the epiglottis is extremely rare. Depending on the size and location of epiglottic chondroma the clinical manifestations are variable and include a lump in the neck, difficulty in swallowing fluids and dyspnea. In this study, an additional rare case of chondroma arising in the epiglottis is reported. The mass was located over the tip of the epiglottis and caused no significant clinical manifestations except for a foreign body sensation in the throat. Endoscopic excision with an adequate free margin was achieved via suspension laryngoscopy under general anesthesia with intubation. The patient was disease-free during a 1-year follow-up period. We present this case to highlight the occurrence of this rare benign lesion in the epiglottis, and stress that it should not be neglected in the differential diagnosis of an epiglottic mass. Conservative surgical excision is the initial treatment of choice and long-term follow-up is necessary.

Adult↗

Epiglottis acuta treated with nasotracheal intubation.

Twenty children, ranging in age from 1--9 years, and one adult suffering from epiglottis acuta were treated with nasotracheal intubation performed under general anaesthesia and with ampicillin. Clinical cure was obtained in all cases with a mean intubation time of 34 hours. The diagnosis, epiglottis acuta, was suspected by the referring physician in 10 cases. The incidence of epiglottis acuta compared to laryngitis acuta was found to be 1:30. The mean hospital stay was 5.4 days. It is concluded that treatment of acute epiglottis by nasotracheal intubation in the hands of experienced anaesthesiologists and with close observation in an intesnive care unit, is a safe method of management with negligible morbidity and mortality.

Acute Disease↗

Morphological and histologic examination of the epiglottis: implications for improving epiglottic closure technique.

OBJECTIVES: We conducted a histologic examination and measured the tension on the epiglottis to determine how dehiscence of the epiglottis can be prevented after epiglottic closure surgery. METHODS: We classified configurations of the epiglottis into flat, intermediate, and omega types and studied the histology of each type. We also measured the tension in each of these 3 morphological types on 4 regions of the epiglottis (upper, middle, and lower points, and the cuneiform tubercle) at 3 different times: before incision, after median incision, and after reversed-Y incision. RESULTS: No histologic differences were evident among the epiglottic types. In the flat and intermediate types, the tension measured before incision decreased significantly upon completion of the median incision at every point. In these 2 types, the reversed-Y incision resulted in a further significant decrease in tension at the middle and lower points. In the omega type, the tension was low before incision and was not significantly reduced by either incision. CONCLUSIONS: We demonstrated that a median incision alone effectively decreased tension sufficiently to prevent dehiscence. The reversed-Y incision was even more effective for decreasing tension at the middle and lower points.

Adult↗

Electromyographic activity of the hyoepiglotticus muscle and control of epiglottis position in horses.

OBJECTIVE: To determine whether the hyoepiglotticus muscle has respiratory-related electromyographic activity and whether electrical stimulation of this muscle changes the position and conformation of the epiglottis, thereby altering dimensions of the aditus laryngis. ANIMAL: 6 Standardbred horses. PROCEDURE: Horses were anesthetized, and a bipolar fine-wire electrode was placed in the hyoepiglotticus muscle of each horse. Endoscopic images of the nasopharynx and larynx were recorded during electrical stimulation of the hyoepiglotticus muscle in standing, unsedated horses. Dorsoventral length and area of the aditus laryngis were measured on images obtained before and during electrical stimulation. Electromyographic activity of the hyoepiglotticus muscle and nasopharyngeal pressures were measured while horses exercised on a treadmill at 50, 75, 90, and 100% of the speed that produced maximum heart rate. RESULTS: Electrical stimulation of the hyoepiglotticus muscle changed the shape of the epiglottis, displaced it ventrally, and significantly increased the dorsoventral length and area of the aditus laryngis. The hyoepiglotticus muscle had inspiratory activity that increased significantly with treadmill speed as a result of an increase in phasic and tonic activity. Expiratory activity of the hyoepiglotticus muscle did not change with treadmill speed in 4 of 6 horses. CONCLUSIONS AND CLINICAL RELEVANCE: Findings reported here suggest that contraction of the hyoepiglotticus muscle increases dimensions of the airway in horses by depressing the epiglottis ventrally during intense breathing efforts. The hyoepiglotticus muscle may be an important muscle for dilating the airway in horses, and contraction of the hyoepiglotticus muscle may induce conformational changes in the epiglottis.

Animals↗

Distribution of taste buds on the epiglottis of the rat and house shrew, with special reference to air and food pathways.

We investigated the positioning of the epiglottis in the pharyngo-laryngeal region and the distribution of taste buds on the epiglottis in the rat and house shrew, animals which have different feeding habits. In the fixed samples of both species, when the mouth was closed or slightly opened, the epiglottis was found to protrude into the nasopharyngeal hiatus above the soft palate. But it retracted from its position when the mouth was widely opened. In omnivorous rats (n = 6), the mean number (mean density +/- s.d.) of taste buds was 52 (12.6 +/- 2.2/mm2) on the laryngeal surface but only 4 (1.3 +/- 1.0/mm2) on the oral surface. The three-dimensional view was reconstructed from serial sections. The taste buds were distributed most densely close to the caudal base and became fewer toward the more rostral tip. In insectivorous house shrews (n = 2), 4 taste buds on average were found only on the laryngeal surface of the epiglottis. Epiglottal taste buds may work as chemosensory detectors to initiate the reflex reaction to protect the airway from oral substances during swallowing and drinking.

Animals↗

[Method of epiglottis reconstruction].

A new technique of epiglottis reconstruction is proposed because of its loss at laryngeal resection for tumor or severe laryngeal injury or scarring. New epiglottis is created from a full-thickness graft taken from oral fundus in the projection of the lower edge of the root of the tongue. Outline of the epiglottis with the petal up is cut on the skin in this region (2.5 x 3.5 cm). The anterior margin of the outline is round, the bottom is square. Hairy skin inside the outline is removed. A cut is made throughout the layers of the oral cavity fundus only in that part of the outline which belongs to the petal. Along the outline only skin and subcutaneous fat are cut horizontally. The created petal is pushed to the pharyngeal cavity. The hole in the oral bottom is closed with connection of its upper edge with the lower one using two thick silk sutures through all thickness of the wall. Illustrations are provided for reconstruction of the epiglottis and lateral wall of the larynx removed during laryngeal resection for tumor.

Epiglottis↗

[The application of epiglottis and cervical anterior muscle to laryngeal reconstruction].

OBJECTIVE: To evaluate the methods of reconstruction of laryngeal function after the extended laryngectomy. METHODS: The laryngeal functions were reconstructed after the extended laryngectomy performed on 22 cases with the laryngocarcinoma of T2 and T3 stages of glottic type, using epiglottis and cervical anterior muscle to reconstruct the laryngeal cavity and larynx bracket, from September 1998 to October 1999. RESULTS: Twenty cases recovered normal swallow function in 20 days post-operation as well as the entire function of larynx was recovered, and the rate of decannulation was 90.9% (20/22). One case with pharyngeal fistula recovered a month later, but the other case recovered to normal diet by operation repaired. All the patients pronounced clearly and were able to keep the characteristics of their own voice. The fibred laryngoscope examination showed that the sphincter valves were formed at the larynx atrium in all postoperative cases. The rate of 3-year survival for T2 and T3 stages was 100% (9/9) and 92.3% (12/13), respectively. CONCLUSION: The laryngeal cavity could be enlarged and the laryngeal atrium was reconstructed by employing epiglottis ifraplacement and cervical anterior muscle to reduce the tension of epiglottis and minimize the injury of the membrane as well as to overcome the shortcomings of insufficient material if mere employing epiglottis. The application of combined methods to reconstruct the laryngeal cavity is a practical way to restore the larynx function and improve the life quality.

Adult↗

Chondrosarcoma of the epiglottis: report of a case treated with CO2 laser epiglottectomy.

Chondrosarcoma of the larynx is a rare slow-growing malignant tumour with approximately 240 cases reported in the literature: the cricoid cartilage is the most commonly affected site (72-75%), in rare case was described of epiglottis (1-2%). We report a case of a chondrosarcoma of the epiglottis treated with CO2 laser epiglottectomy. The patient was referred with dysphonia, dysphagia and halitosis that started four months before. Indirect laryngoscopy revealed a large smooth mass with a roundish appearance and a pearly-grey colour, as big as a nut, apparently arising from the laryngeal surface of the epiglottis, causing obliteration of the piriform fossa. The definitive histopathological report showed microscopically, the tumour was low-grade (grade I) chondrosarcoma. A literature review regarding chondrosarcomas of the epiglottis is presented. The diagnosis, histology and treatment of these tumours are discussed. In particular we examine the controversy of conservative surgery vs. total laryngectomy. A conservative surgical approach is typically appropriate in light of this tumour's low-aggressive nature.

Adult↗

Fungal infection of the epiglottis simulating a clinical malignancy.

Primary fungal infection of the larynx is rare. We present a case of primary laryngeal invasive fungal infection in a patient with Felty syndrome. The lesion in the epiglottis resembled a malignant process and the whole epiglottis was excised endoscopically. No neoplasia was found and the cultures of the epiglottis grew Candida glabrata. We propose that the diagnosis of laryngeal candidiasis be considered in adult patients with certain predisposing factors, eg, immunodeficiency syndromes, but the possibility of underlying malignancy must be ruled out.

Aged↗

Postnatal descent of the epiglottis in man. A preliminary report.

The function of the epiglottis in adult man is unclear. However, during early infancy the epiglottic cartilage appears to play an important role in separating the upper respiratory tract from the upper digestive tract. This separation is accomplished by approximation of the epiglottis to the palate, providing a continuous airway from the nose through the larynx into the trachea. This structural arrangement, however, is uniquely lost in man during postnatal development. Maturational descent of the epiglottis, found to occur between 4 and 6 months of age, is verified by cineradiography. This structural change, requiring a reorganization of respiratory function, represents a discrete developmental event manifesting the potential for oral tidal respiration from a pattern of obligate nasal breathing. This period, four to six months postnatally, interestingly coincides with the peak incidence of sudden infant death syndrome (crib death), which similarly occurs at 3 to 5 months of age.

Aging↗

A correlation between the shape of the epiglottis and obstructive sleep apnea.

The incidence of Obstructive Sleep Apnea (OSA) is increasing with the rise in the prevalence of obesity in the population. Upon performing esophagogastroduodenoscopy (EGD) on more than 50 patients with BMI ranging from 21 to 63, we noticed an increase in the concavity of the posterior surface of the epiglottis in correlation with the increase in BMI. Since OSA is caused by collapse of the airways, this same pressure seems to be responsible for the deformity of the epiglottis, which normally has a minimally concave posterior surface. Therefore the shape of the epiglottis reflects the degree of airway collapse and thus the severity of OSA. We recommend that patients with increased concavity of the posterior epiglottal surface seen endoscopically should be tested for OSA.

Body Mass Index↗