[Late postradiation injury of the larynx in relation to the intensity of local reaction during x-ray treatment of the cancer of larynx and lower pharynx].
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Humans↗
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[Partial resection of the larynx as a method in the treatment of cancer of the larynx].
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Adult↗
Cartilaginous tumors of the larynx. Chondrosarcoma of the larynx.
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Aged↗
[Lymphatic drainage of the larynx--effect on therapeutic decision in larynx carcinoma].
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Glottis↗
[Anatomy of the glottis and subglottis in the pediatric larynx].
BACKGROUND: The morphological development of the human larynx during the first years of life has previously not been studied in detail and has mainly been described on a qualitative basis. This study seeks to provide detailed morphometric data on the regular anatomy of the vocal cords, the subglottic airway and the tracheal airway dimensions gained from plastinated whole organ serial sections of 43 infant larynges and to determine morphological changes with age. Such information may be useful for the understanding of pediatric airway disease or for laryngeal surgery in children. MATERIAL AND METHODS: The larynges of 43 children aged 1 to 60 months were plastinated. Whole organ serial sections were obtained by cutting the resulting specimen with a diamond band saw. Morphometry of whole-organ sections was accomplished using a high resolution, computer-based image analyzer. The total length of the glottis, length of the cartilaginous and ligamentous glottis, subglottic cartilaginous cross-section, subglottic airway and tracheal airway were determined for each specimen. RESULTS: The subglottic airway increases considerably in size during the first 2 years of life (from 13 to 28 mm2 in the means). Further growth seems to follow a linear mode. The relative proportion of the mucosal lining of the subglottic airway decreases likewise. While it occupies approximately 50% of the subglottic cartilaginous cross-section during the first two years of age, its relative proportion decreases to some 30 to 40% between age three to five. Other than in adults, and comparable to most mammals, the cartilaginous glottis accounts for 60 to 75% of the vocal folds' length in children under two years of age. The anterior ligamentous part of the glottis outsizes its posterior cartilaginous portion during the third year of life. CONCLUSION: This study supplies detailed morphometric data on the growth and structure of the human larynx during the first years of life that have not been available to date. Previous studies on the anatomical configuration of the infant larynx have focused on the the perinatal larynx, the prepuberal and puberal larynx, and the development of collagen fibres in the developing larynx. The human larynx has undergone significant evolutionary adaptations. Among them are the descent of the larynx, the capability of vocal fold adjustment in length, tension and shape, and the prominent configuration of the membranous part of the vocal folds as opposed to the cartilaginous part. The infant larynx is not just a miniature of the adult organ. It shows differences in its position relative to the vertebrate column, in the composition of cartilages and soft tissues, and in environmental adaptation. The present study is the first to supply detailed morphometric data on the growth and structure of the human larynx during the first five years of life and on the morphological changes of the larynx during this period. From these data it seems that some of the adaption of the human larynx as opposed to other vertebrates are not fully developed at birth, but undergo postnatal maturation. The relative proportions of the cartilaginous and membranous parts of the vocal folds clearly demonstrate this maturation process: While the posterior "respiratory" glottis accounts for some sixty to 75% of the total glottic length in newborns, its relative proportion decreases throughout the first years of life and finally equals the proportions of the adult larynx. Other than in adults, and in accordance with the literature, no sexual dimorphism of the larynx could be detected in this series of infant larynges. Morphometric data on the growth and structure of the human vocal folds and the subglottic airway during childhood are presented. Plastinated whole organ serial sections were used in the study to show the infant laryngeal morphology. The study provides quantitative anatomical data of clinical interest that light up the anatomy of the pediatric airways.
Adult↗
Effects of lung volume on vertical larynx position during phonation.
The vertical position of the larynx seems to be relevant to voice function. As a high vertical larynx position is often seen in hyperfunctional and strained voices, a lowering of a habitually elevated larynx is sometimes a specific goal in clinical voice therapy and different larynx-lowering exercises are used to achieve this goal. Earlier investigations have shown that pitch and to some extent also vocal loudness are relevant to vertical larynx position. In the present investigation, we examine if lung volume affects vertical larynx position. Using a multi-channel electroglottograph, the larynx position was measured in 29 healthy, vocally untrained subjects, who phonated at different lung volumes, pitches, and degrees of vocal loudness. The main results were that high lung volume was clearly associated with a lower larynx position as compared to low lung volume. In addition, vertical larynx position was strongly correlated with pitch. Both of these dependencies were shown to be stronger in males than in females. Our results suggest that lung volume is a factor that is highly relevant to larynx height in untrained subjects.
Adult↗
Distinguishing tumor recurrence from irradiation sequelae with positron emission tomography in patients treated for larynx cancer.
PURPOSE: Distinguishing persistent or recurrent tumor from postradiation edema, or soft tissue/cartilage necrosis in patients treated for carcinoma of the larynx can be difficult. Because recurrent tumor is often submucosal, multiple deep biopsies may be necessary before a diagnosis can be established. Positron emission tomography with 18F-2fluoro-2deoxyglucose (FDG) was studied for its ability to aid in this problem. METHODS AND MATERIALS: Positron emission tomography (18FDG) scans were performed on 11 patients who were suspected of having persistent or recurrent tumor after radiation treatment for carcinoma of the larynx. Patients underwent thorough history and physical examinations, scans with computerized tomography, and pathologic evaluation when indicated. Standard uptake values were used to quantitate the FDG uptake in the larynx. RESULTS: The time between completion of radiation treatment and positron emission tomography examination ranged from 2 to 26 months with a median of 6 months. Ten patients underwent computed tomography (CT) of the larynx, which revealed edema of the larynx (six patients), glottic mass (four patients), and cervical nodes (one patient). Positron emission tomography scans revealed increased FDG uptake in the larynx in five patients and laryngectomy confirmed the presence of carcinoma in these patients. Five patients had positron emission tomography results consistent with normal tissue changes in the larynx, and one patient had increased FDG uptake in neck nodes. This patient underwent laryngectomy, and no cancer was found in the primary site, but nodes were pathologically positive. One patient had slightly elevated FDG uptake and negative biopsy results. The remaining patients have been followed for 11 to 14 months since their positron emission studies and their examinations have remained stable. In patients without tumor, average standard uptake values of the larynx ranged from 2.4 to 4.7, and in patients with tumor, the range was 4.9 to 10.7. CONCLUSION: Positron emission tomography with labeled FDG appears to be useful in distinguishing benign from malignant changes in the larynx after radiation treatment. This noninvasive technique may be preferable to biopsy, which could traumatize radiation-damaged tissues and precipitate necrosis.
Deoxyglucose↗
Video imaging to assess neuromuscular blockade at the larynx.
UNLABELLED: We describe video imaging as a technique for assessing neuromuscular blockade at the larynx. We sought to determine the stability and reproducibility of this technique and to compare the effect of succinylcholine at the adductor pollicis and the larynx. Ten patients were studied. Anesthesia was induced and maintained with propofol. The recurrent laryngeal nerve was stimulated superficially and movements of the vocal cords were recorded on videotape by using a fiberoptic bronchoscope passed via a laryngeal mask airway. Neuromuscular function was recorded at the adductor pollicis by using a mechanomyograph. Twenty images of the vocal cords were examined repeatedly by one investigator and by ten independent observers. The mean difference between the two sets of observations was 0.86 degrees with a correlation coefficient (r) of 0.997. For 3 min before the administration of relaxant the coefficient of variation in the cord movement during supramaximal stimulation ranged from 1%-4% (median 2.7%). After the administration of succinylcholine 1 mg. kg(-1) the times to loss of T1 at the larynx and hand were 63 +/- 15 s and 63 +/- 12 s respectively. Times to 25% recovery were 215 +/- 36 s at the larynx and 436 +/- 74 s at the hand and times to 75% recovery were 285 +/- 55 s and 525 +/- 85 s respectively. These results indicate that video imaging may be a useful research technique for estimating neuromuscular blockade at the larynx and that the time to onset of succinylcholine at the larynx is similar to that at the hand, whereas the duration of blockade is significantly shorter at the larynx. IMPLICATIONS: Assessment of neuromuscular blockade at the larynx is possible by using a video imaging technique. By using this technique, the time to onset of neuromuscular blockade at the larynx is similar to that at the hand after the administration of succinylcholine; this finding is different from previously published data obtained by using a cuff pressure measurement technique.
Adult↗
Role of vertical larynx movement and cervical lordosis in F0 control.
The role of vertical larynx movement in vocal frequency (F0) change has attracted the attention of many researchers. Recently, Hirai, Honda, Fujimoto, and Shimada (1994) proposed a mechanism of F0 control by vertical larynx movement based on the measurement of magnetic resonance images (MRI). In F0 changes, the larynx moves vertically along the cervical spine, which displays anterior convexity (lordosis) at the level of the larynx. Therefore, the vertical larynx movement results in the rotation of the cricoid cartilage and vocal fold tension changes. The present study reexamines the above mechanism based on a qualitative analysis of midsagittal MRI data using three male subjects with evident cervical lordosis. Tracings of the jaw, hyoid bone, laryngeal cartilage, and cervical spine were compared in high and low F0 ranges. In the high F0 range, the hyoid bone moved horizontally while the larynx height remained relatively constant. In the low F0 range, the entire larynx moved vertically, and the cricoid cartilage rotated along the cervical lordosis. These results indicate that the vertical movement of the larynx comprises an effective F0 lowering mechanism, and suggest that the human morphologies of low larynx position and spinal curvature contribute to voluntary use of the vocal function.
Cervical Vertebrae↗
[Establishment of a modified larynx transplantation model with inbred F344 rat].
BACKGROUND & OBJECTIVE: As a non-vital organ, transplantation of larynx lags behind that of the other organs, but it is supposed that if induction of immunologic tolerance of the host to the allograft comes true, larynx transplantation would be an optimal approach for management of advanced laryngeal cancer as well as functional reconstruction of the larynx. This study was designed to establish a modified rat model of larynx transplantation to improve survival rate of the recipients and vitality of the allografts, and provide an optimal rat model for further research on immunology and induction of immunologic tolerance in larynx transplantation. METHODS: A Strome's model of larynx transplantation was repeated with inbred F344 rats (40 rats in Stroma model A and 40 rats in Stroma model B). A modified model of larynx transplantation was developed (40 rats), in which both superior thyroid arteries and ascending pharyngeal arteries were preserved, combining with the hyoid, base of the tongue, hypopharynx, larynx, thyroid, part of the cervical trachea and cervical esophagus as an allograft complexity. The blood supply of the allograft was reconstructed through end-to-end anastomosis of the donors' carotid arteries with the recipients' carotid artery and anterior jugular vein. The recipients were injected with 15 ml of 5% glucose normal saline (GNS) through contralateral external jugular vein intraoperatively, and injected subcutaneously with 5 ml of 5% GNS daily for 3-5 days postoperatively. Morphology of the allografts and patency of the arteries and veins were observed under microscope 7 days after operation, and vitality of the allogafts was assessed pathologically. Survival of the recipients and vitality of the allografts in Strome model and modified model were compared. RESULTS: Survival rates of the recipient rats were 70% in Strome model A, 85% in Strome model B, and 95% in modified model; the survival rates of the allografts were 30% in Strome model A, 40% in Strome model B, and 80% in modified model, respectively. CONCLUSIONS: Compare with Strome models, the modified model of larynx transplantation reduces mortality of the recipients through enhancing perioperative care, improves vitality of the allografts through including both ascending pharyngeal arteries and superior thyroid arteries in the allograft complexity, which increases blood supply of the allografts and reduces micro-circulation resistance, therefore, reduces the micro-circulation malfunction of the allografts.
Anastomosis, Surgical↗
[Rehabilitation of the olfactory sense after laryngectomy -- the larynx bypass].
BACKGROUND: Patients after laryngectomy lose their previous sense of smell, since air normally circulates via the tracheostoma and active air intake through the nose is no longer possible. The larynx bypass with a throat mask is an aid here. Nasal air circulation is made possible by this connecting piece between the mouth and tracheostoma. MATERIALS AND METHODS: Twenty patients (17 men and 3 women, mean age 60 years) who underwent laryngectomy between November 2003 and February 2004 were examined using Sniffin' Sticks with and without the larynx bypass. Moreover, patients were asked about the practicability of the larynx bypass using a visual analog scale (VAS). In addition to larynx bypass function, we were also interested in the handling for the laryngectomized patients. RESULTS: Overall, patients were able to correctly identify more items with the larynx bypass. The results were significantly better with than without the larynx bypass (p < 0.001). However, the first application of the larynx bypass was considered cumbersome. The median VAS was 5. CONCLUSION: Patients had a better sense of smell with the larynx bypass. However, due to its rather moderate practicability, the larynx bypass does not seem to be suited for daily use in its present form.
Aged↗
The sexually dimorphic larynx of Xenopus laevis: development and androgen regulation.
The aims of this study were to characterize sexual dimorphism in the larynx of adult Xenopus laevis and to determine how sex differences arise during postmetamorphic development. The larger male larynx is a result of greater cell numbers in both cartilage and muscle. The dilator laryngis muscle of the male larynx has 6-7 times more muscle fibers than that of the female. At metamorphosis, the larynx is sexually monomorphic and feminine in phenotype. The DNA content of the male larynx doubles during the first 6 months following metamorphosis; there is no net DNA increase in the female larynx during this time. Both sexes experience a marked increase in laryngeal DNA content and mass between 6 months and adulthood. The number of muscle fibers in the male larynx increases at an average rate of 150 fibers a day during the first 10 months of postmetamorphic development. There is no net change in fiber numbers in the female larynx from metamorphosis to adulthood. Administration of the antiandrogen Flutamide to metamorphic frogs prevents the net addition of laryngeal muscle fibers in males. Thus, we propose that addition of postmetamorphic laryngeal muscle fibers in males is dependent upon the presence of circulating androgens. Exogenous testosterone administration results in an increase in laryngeal mass, DNA content, and cellular proliferation in juvenile frogs. Using [3H]thymidine injections to probe ongoing, as well as testosterone-induced, cell proliferation, we conclude that cellular proliferation is regulated differently in males and females during development. Thus androgen-induced proliferation is one cellular mechanism responsible for the sexual dimorphism observed in adults.
Androgens↗
[Diagnosis and therapy of diseases of the larynx in the history of medicine].
BACKGROUND: FIRST CLINICAL APPROACHES. Bozzini in Frankfurt, Germany, in 1806 constructed the first endoscope, by which cavities of the human body could be inspected through a tube, but he was hardly able to demonstrate the larynx. His attempts were continued by Avery in London in 1840 with special view to the larynx but were not successful. Babington in London in 1829 constructed a glottiscope combining an angled mirror with a depressor for the tongue. He will probably have been able to inspect the larynx in some cases, but he did not continue these studies. Liston in London in 1837 reported that he had seen pathological findings of the larynx in a few cases by means of an angled mirror. FIELD OF RESEARCH: PHYSIOLOGY OF THE VOICE. Ferrein in Paris in 1741 was the first to carry out experiments on human larynges. These were continued in a systematic way by the physiologist Johannes Müller in Berlin in 1837 analysing the movements of the vocal cords. Manuel Garcia, a Spanish singing teacher, first in Paris, later in London, had studied the anatomy of the larynx very carefully, especially the muscle fibres. In 1855 he succeeded in inspecting his own larynx by means of an angled mirror and observed and described the movements of the vocal cords in great detail. At first his discovery did not arouse great attention, but later he was honoured very much as the inventor of laryngoscopy. SYNTHESIS OF PHYSIOLOGY AND CLINIC: Vienna 1857/58: The physiologist Carl Ludwig was preparing the second edition of his textbook on physiology, in which he extensively referred to Garcia's technique of laryngoscopy. His collegue Ernst Brücke was working on the physiological basis of phonetics. Johann Nepomuk Czermak, also a physiologist, was a guest of Brücke's and Ludwig's in Vienna during the winter 1857/58 and was inspired by the research work of his hosts. The neurologist Ludwig Türck had made experiments to visualize the human larynx in bodies and patients without knowing of Garcia's achievements. Since he used sun light only he had interrupted his studies in autumn 1857 and had lent his instrument, a mirror similar to that used by Garcia, to Czermak. Czermak used artificial light and the perforated concave mirror that had recently been introduced into ophthalmology. He was at once successful in inspecting his own larynx. He reported on this as early as March 1858 without informing Türck, although he mentioned him and the mirror that he had lent him. There was a public dispute about the priority between Türck and Czermak which drew wide attention to the invention of laryngoscopy which now was readily introduced in practical medicine forming the new discipline of laryngology. This development is delineated with many anecdotal details.
Europe↗
Effects of an intubating dose of succinylcholine and rocuronium on the larynx and diaphragm: an electromyographic study in humans.
BACKGROUND: Paralysis of the vocal cords is one objective of using relaxants to facilitate tracheal intubation. This study compares the neuromuscular blocking effect of succinylcholine and rocuronium on the larynx, the diaphragm, and the adductor pollicis muscle. METHODS: Electromyographic response was used to compare the neuromuscular blocking effect of succinylcholine and rocuronium on the laryngeal adductor muscles, the diaphragm, and the adductor pollicis muscle. Sixteen patients undergoing elective surgery were anesthetized with propofol and fentanyl, and their tracheas were intubated without neuromuscular blocking agents. The recurrent laryngeal and phrenic nerves were stimulated at the neck. The electromyographic response was recorded from electrodes placed on the endotracheal tube and intercostally before and after administration of 1 mg/kg succinylcholine or 0.6 mg/kg rocuronium. RESULTS: The maximum effect was greater at the adductor pollicis (100 and 99%) than at the larynx (96 and 97%) and the diaphragm (94 and 96%) after administration of succinylcholine and rocuronium, respectively (P < or = 0.05). Onset time was not different between the larynx (58+/-10 s), the diaphragm (57+/-8 s), and the adductor pollicis (54+/-13 s), after succinylcholine (all mean +/- SD). After rocuronium, onset time was 124+/-39 s at the larynx, 130+/-44 s at the diaphragm, and 115+/-21 s at the adductor pollicis. After succinylcholine administration, time to 90% recovery was 8.3+/-3.2, 7.2+/-3.5, and 9.1+/-3.0 min at the larynx, the diaphragm, and the adductor pollicis, respectively. Time to 90% recovery after rocuronium administration was 34.9+/-7.6, 30.4+/-4.2, and 49.1+/-11.4 min at the larynx, the diaphragm, and the adductor pollicis, respectively. CONCLUSION: Neuromuscular blocking effect of muscle relaxants on the larynx can be measured noninvasively by electromyography. Although the larynx appears to be resistant to muscle relaxants, we could not demonstrate that its onset time differed from that of peripheral muscles.
Adult↗
Exocyclic malondialdehyde and aromatic DNA adducts in larynx tissues.
Cigarette smoking and alcohol consumption, known to cause free radical generation and lipid peroxidation, are established risk factors for larynx cancer. Malondialdehyde (MDA) is a naturally occurring product of lipid peroxidation, capable of interacting with DNA to form exocyclic MDA-DNA adducts. In the present study, we investigated if the production of MDA-DNA adducts was increased in larynx cancer patients with respect to controls using (32)P-DNA postlabeling techniques. Moreover, we examined the potential effects of cigarette smoking and alcohol consumption on endogenous DNA adducts. We then analyzed the same set of larynx tissues for the presence of (32)P-postlabeled aromatic DNA adducts to determine more about the levels and types of adducts formed in the larynx. We observed that cancer patients tended to have increased levels of MDA and aromatic DNA adducts with respect to controls. In addition, smoking and alcohol were found to influence the formation of endogenous adducts in the larynx tissues. Finally, the amounts of endogenous adducts were found to be comparable to those observed for aromatic DNA adducts in the same set of larynx tissues. These findings imply that endogenous lesions, if not repaired, may contribute to larynx cancer development.
Aged↗
[Pathomorphological aspects of transoral resection of hypopharyngeal carcinoma with preservation of the larynx. Patient selection, treatment results].
BACKGROUND: In primary surgery of hypopharyngeal cancer, transcervical resection was chosen in order to preserve the larynx. This treatment produces good oncological results but also a high degree of morbidity so that in recent years transoral resection has been recommended. For wider application of this method it is very important to apply clearly defined criteria for selection of patients. MATERIAL AND METHODS: To define the criteria for selection for transoral microsurgical resection, we analyzed step serial sections of 33 whole organ specimens of hypopharyngeal squamous cell cancer (SCC) after primary radical surgery, mostly carcinoma of the piriform sinus. Criteria concerning the primary and the involvement of the neck nodes were differentiated. Twenty of 84 patients with hypopharyngeal cancer of different stages were treated by transoral resection and delayed neck dissection between 1994 and 1996. Most of the patients were irradiated postoperatively because of neck metastases. The therapeutic results after a minimum period of 24 months follow-up is listed according to Kaplan-Meyer. RESULTS: Three types were defined according to their site, growth, and spread into the larynx: Type I comprises limited exophytic, highly differentiated SCC with a minor tendency for metastasis originating in the upper half of the sinus. These tumors are well suitable for transoral resection. Type II includes tumors spreading superficially without deeper invasion of the larynx, especially of the laryngeal framework. These can be totally resected and the larynx preserved in spite of extended metastasis. Type III, the most frequent type, grows with ulceration and deeply infiltrates into the larynx and the neck. These tumors cannot be resected transorally. Primary radical resection is indicated. Up to 25% of all hypopharyngeal SCC could be treated by transoral resection, mostly with delayed neck dissection and postoperative irradiation. Functional results were excellent in all cases. Eating, voice, and air passage were normal. Oncological results with 80% disease free five-year survival rate were very good. Three patients died because of recurrences in the neck, only one because of a recurrence in the larynx. The rate of patients with a second primary, however, was extremely high (50%). CONCLUSIONS: By strictly following the pathological and clinical criteria for selection, about 25% of the SCC of the hypopharynx can be treated by transoral resection combined with neck dissection and postoperative irradiation with good oncological and excellent functional results, preserving the larynx without endangering the life of the patients.
Carcinoma, Squamous Cell↗
The position and the state of the larynx during general anesthesia and muscle paralysis.
Based on a chance observation in two patients in whom the larynges could be visualized during direct laryngoscopy using topical anesthesia but not after general anesthesia and muscle paralysis, the authors postulated that there will be a shift in the position of the larynx with the onset of general anesthesia and muscle paralysis. To verify this the authors measured the position of larynx in lateral radiographs of necks taken in human volunteers when they were awake, and after induction of general anesthesia and muscle paralysis. The authors found that the hyoid bone and epiglottis were shifted anteriorly and the supraglottic region or the vestibule of the larynx was enlarged with the onset of general anesthesia and muscle paralysis. In addition, the larynx was also stretched longitudinally with wide separation of the vestibular and vocal folds. The authors conclude that consciousness is associated with tonic muscular activity that folds the larynx and partially closes it and that onset of general anesthesia and muscle paralysis opens the larynx wider and shifts it anteriorly, which might make visualization of the larynx during direct laryngoscopy difficult in some patients.
Anesthesia, General↗
American Society of Clinical Oncology clinical practice guideline for the use of larynx-preservation strategies in the treatment of laryngeal cancer.
PURPOSE: To develop a clinical practice guideline for treatment of laryngeal cancer with the intent of preserving the larynx (either the organ itself or its function). This guideline is intended for use by oncologists in the care of patients outside of clinical trials. METHODS: A multidisciplinary Expert Panel determined the clinical management questions to be addressed and reviewed the literature available through November 2005, with emphasis given to randomized controlled trials of site-specific disease. Survival, rate of larynx preservation, and toxicities were the principal outcomes assessed. The guideline underwent internal review and approval by the Panel, as well as external review by additional experts, members of the American Society of Clinical Oncology (ASCO) Health Services Committee, and the ASCO Board of Directors. RESULTS: Evidence supports the use of larynx-preservation approaches for appropriately selected patients without a compromise in survival; however, no larynx-preservation approach offers a survival advantage compared with total laryngectomy and adjuvant therapy with rehabilitation as indicated. RECOMMENDATIONS: All patients with T1 or T2 laryngeal cancer, with rare exception, should be treated initially with intent to preserve the larynx. For most patients with T3 or T4 disease without tumor invasion through cartilage into soft tissues, a larynx-preservation approach is an appropriate, standard treatment option, and concurrent chemoradiotherapy therapy is the most widely applicable approach. To ensure an optimum outcome, special expertise and a multidisciplinary team are necessary, and the team should fully discuss with the patient the advantages and disadvantages of larynx-preservation options compared with treatments that include total laryngectomy.
Clinical Trials, Phase III as Topic↗