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This paper reports the identification of the fragmented, distorted cricoid cartilage. The laryngeal findings in four patients with this acquired abnormality are presented. The postmortem whole organ serial section of their larynges is described and illustrated with horizontal sections from the Laryngeal Development Laboratory in Chicago. The histopathologic sequence, pathogenesis, and clinical relevance are elucidated.
This is the first report of an intralaryngeal struma in which particular case the thyroid tissue was connected with the extralaryngeal struma because of a defect in the thyroid cartilage below the beginning of the left vocal cord. Pathogenetically speaking, it cannot be fully explained how this could develop. Hypothetically, the thyroid tissue had already invaded the larynx before the median had fused with the lateral chondrification centers of the thyroid cartilage (before the 10th-13th embryonic week); later, in the course of the struma disease, the struma developed.
Eighteen New Zealand rabbits were artificially respired, orotracheally with a cuff pressure of approximately 35 mm Hg, for between 2 and 36 h. After 2 h artificial respiration cell degeneration was seen in the area of the cuff, above the cartilage rings, in the form of cytoplasmic degeneration. After a 4 h intubation period an epithelial loss was seen. The basal membrane was intact. A connective tissue oedema, which was limited to the region of the epithelial lesion, became more wide-spread over the 36 h of intubation. A well-developed ulcer could be identified under the light microscope after 36 h. Increased mucous production as well as an increase in bacteria could be observed after 4 h. At no time could a degeneration of the cartilage be seen in the electron micrographs. The intercartilaginous area also remained free from cell degeneration although signs of vascular congestion could be seen.
A greater difficulty in exposing the arytenoid cartilage during rotation surgeries has been observed for men. The objective of the present study was to describe the position of the cricothyroid articulation and the distance between the right and left articulations, and to compare these findings between genders. The following measurements were obtained for 16 cadavers (9 men and 7 women): angulation of the cricothyroid articulation in the cricoid ring, dimensions of the thyroid articular surface of the cricoid cartilage, and distance between the cricothyroid and cricoarytenoid articulations. The cricothyroid articulation angle was narrower in men than in women (p = .04). The major diameter of the articular facet of the thyroid cartilage was wider in men (p = .001). The longer lamina of the thyroid cartilage, as well as the more posterior position of the cricothyroid articulation, in men might explain the greater difficulty in exposing the arytenoid cartilage during laryngeal framework surgeries observed for this group of patients.
A 55-year-old man with carcinoma of the right pyriform fossa was treated with cobalt therapy. Subsequently, osteonecrosis of the right greater horn and the right superior horn of the thyroid cartilage developed, followed by pathologic fractures of the processes and spontaneous expulsion of the sequestrae.
OBJECTIVES: This pilot study evaluated the role of cartilage-derived morphogenic proteins (CDMPs) as promoters of cartilage growth and differentiation and as a possible alternative to autologous cartilage grafts in laryngotracheal reconstruction. METHODS: In phase 1, 6 New Zealand rabbits underwent subperichondrial injection of CDMP-1, CDMP-2, or CDMP-3 in the right thyroid ala and normal saline solution in the left thyroid ala as controls. In phase 2, 14 rabbits underwent anterior cricoid split and interposition of a fibrillar collagen sponge saturated with normal saline solution, CDMP-2, or CDMP-3. RESULTS: In both phases, saline solution failed to induce new cartilage or bone growth. Small foci of cartilage and/or bone formation were observed within the thyroid subperichondria of those rabbits injected with CDMP-2 or CDMP-3. In phase 2, a few small foci of new cartilage and/or bone formation were observed at the edges of the cricoid split with CDMP-2 and CDMP-3. CONCLUSIONS: A different carrier of CDMP, a change in dosage, or a combination of CDMPs might yield more significant neochondrification. The role of CDMPs as promoters of cartilage and differentiation could not be disqualified in this study and should be further investigated.
BACKGROUND: Swallowing disorders are common symptoms in many neurological diseases. The aim of this pilot-study was to analyse vertical laryngeal excursion during swallowing non-invasively using ultrasound sonographic techniques in patients with dysphagia compared with healthy volunteers. METHODS: Data were obtained from 42 healthy volunteers (mean age: 57 +/- 19 years) and 18 patients (mean age: 63 +/- 8 years) with dysphagia due to different neurological diseases using a 7.5 MHz linear array probe, which was placed in longitudinal position above the larynx. This allowed visualization of the contour and the acoustic shadow of the hyoid bone and the thyroid cartilage. The distance between the hyoid bone and the upper end of the thyroid cartilage during laryngeal elevation was readily assessed by video-mode function. RESULTS: In healthy subjects we found a mean distance of 220 (+/- 30) mm at rest; the shortest distance during swallowing of 5 or 10 ml water was 85 (+/- 11) mm and represents a reduction of 61 % (+/- 3) under physiological conditions. The mean relative laryngeal elevation in the patients with neurogenic dysphagia was reduced to only 42 % (+/- 10) (p < 0.0001). CONCLUSIONS: Ultrasound is a viable and non-invasive method in the investigation of laryngeal elevation during swallowing. It allows direct visualization of impaired laryngeal motion in patients with neurogenic dysphagia.
We present the case of a 70 year old man with cricoid chondrosarcoma treated with total laryngectomy. This report reviews the occidental literature, with nine cases reported by national authors in the las 25 years. We have recollected 104 laryngeal chondrosarcoma, in all. Clinical and diagnostical data, location, and treatment were analysed and compared with our case.
Warthin's tumor is the second most common salivary gland tumor preceded only by pleomorphic adenoma. In most cases it involves the parotid gland and can, at times, be bilateral. It can also arise in ectopic salivary tissue in the latero-cervical and para-parotid lymph nodes. This neoplasm consists of two histologic components: one epithelial, the other lymphoid. Malignant transformation involving each of these tissues has been reported. However, few cases give clear-cut examples of the epithelial malignant change. Therefore, primary malignant transformation of Warthin's tumor is extremely rare. This event appears related to the initial time of tumor onset and/or past radiotherapy for other malignant cervico-facial lesions. The authors report a case of epidermoid carcinoma arising on an ectopic Warthin's tumor in a 57-year-old male. Physical examination revealed a recent, smooth tumor mass on the left, located near the laryngeal thyroid cartilage. Fine needle aspiration cytology was suspicious of a malignant epithelial neoplasm. Functional latero-cervical dissection, modified by excision of the digastric and sternohyoid muscles plus a 2 x 2 cm section of the overlying skin, was performed in this case. Histology and immunocytochemical tests on the surgical specimen revealed a 14 cytokeratin-positive, malignant epidermoid neoplasm arising from the adjacent 14 cytokeratin-negative, oncocytic epithelium. This relationship may rule out metastasis and may, therefore, be a case of Warthin's tumor associated with an epidermoid carcinoma or a case of branchial cyst.
The reported incidence of arytenoid cartilage dislocation is low. This may be due to the wide range and orientation of motion allowed by the cricoarytenoid articulation and the laxity of its joint capsule. In two previously reported instances of arytenoid dislocation, the authors have suggested that endotracheal intubation is generally not sufficient to cause dislocation of an arytenoid cartilage, but that, in their cases, a predisposing factor had set the occasion for dislocation. In this communication, three cases of arytenoid cartilage dislocation, which each followed a single instance of endotracheal intubation are presented. In all three cases, painful swallowing was the main presenting symptom. Clinical features that differentiate arytenoid cartilage dislocation from vocal cord paresis are summarized. Early reduction of the dislocation, while the patient is under local anesthesia, is recommended, and the techniques are described in detail.
OBJECTIVE: To evaluate the value of the preoperative T staging of laryngeal cancer by MRI. METHODS: The MRI data of 59 cases of laryngeal cancer were retrospectively staged, and compared with the findings of laryngoscopy and postsurgical pathologic staging. RESULTS: The accuracy of staging in each T stage of laryngeal cancer was: T1:95% (20/21), T2:88% (15/17), T3:85% (11/13) T4:100% (8/8) by MRI, vs T1:91% (19/21), T2:88% (15/17), T3:47% (8/13), T4:13% (1/8) by laryngoscopy. The total accuracy of MRI vs laryngoscopy was 92% (54/59) vs 73%(43/59). P < 0.01. CONCLUSION: MRI can correctly depict the invasion of the preepiglottic space (PES), paraglottic space (PGS) and cartilage by laryngeal cancer and can greatly improve the accuracy of preoperative staging. It was considered that MRI of great importance in determining appropriate therapy for laryngeal cancer.
After laryngectomy the opening of the upper trachea is closed up to 3/4--4/5 by implantation of a cartilage plate (if possible from the epiglottis). The anterior part is left open. During exspiration the oesophago-pharyngeal flap is pressed upwards, whereas the position of the cartilage plate does not change much. The air can be expired by a 90 degrees turned 6--8 mm fistula (Staffieri) in the flap opposite of the cartilage plate (valve opened). As well as by its own weight as by flow of saliva, eating, drinking and vomiting the fistula is pressed on the cartilage plate (valve closed). By aid of this valve mechanism the patient can drink 1 week postoperatively without suffering from flow of saliva into the trachea. The patient's ability to speak developes well 10--14 days postoperatively.
A case of thyroglossal duct anomaly showing an unusual finding of foci of cartilage is presented. Although the concept of choristoma may explain the pathogenesis of cartilage within the present congenital anomaly, the histologic features were more in favor of a metaplastic process. In addition, the history of recurrent bouts of local inflammation supports the latter view.
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No significant inhibition of purified rheumatoid synovial collagenase was found when this enzyme was assayed in the presence of porcine or human cartilage proteoglycans. Reaction mixtures containing up to twice the amount of proteoglycan compared to that of collagen, w/w, had little effect on collagen degradation as judged by the reconstituted [4C]collagen fibril assay and polyacrylamide gel electrophoresis. Proteoglycans were not degraded by the synovial collagenase preparation. Although the human collagenases derived from rheumatoid synoviam, gastric mucosa, skin and granulocytes showed some reduction in activity when exposed to aggregated proteoglycans at high concentrations, disaggregated proteoglycans had no inhibitory effect. It is concluded that cartilage proteoglycans do not directly inhibit human collagenases in vitro, but in vivo they may provide some physical barriers which might limit the accessibility of the enzyme to its collagen substrate.
Calcification of the upper respiratory tract is exceptional in persons aged under 15 years, and only 9 cases have been published so far in the English or French literature. We present a new case and analyse those already reported.
Among thyroplasties, type I is the most frequently used for medialization of the vocal cord. Follow-up study on patients indicated that reversion of voice can occur after operation. Revision was done in five cases with improvement of voice. On the basis of this experience, modifications were made in the technique of thyroplasty type I. They include 1) cutting the calcified cartilage with minimal intervention in the soft tissue, 2) fixation of the window with a silicone plug to enhance medialization, and 3) overmedialization of the vocal cord and definition of criteria for it that can be used during surgery.
The gross and microscopic anatomy of the rat larynx was studied with particular attention to myology and neuromuscular structures to further validate it as a model to evaluate morphologic and functional changes induced by botulinum injection. A laryngeal alar cartilage (LAIC), alar cricoarytenoid (ACA) muscle, and a superior cricoarytenoid muscle (SCA) were identified as anatomic structures not previously described. Two portions (medial and lateral) of the thyroarytenoid muscle (TA) were distinguished. The function of the ACA was suggested to be similar to the aryepiglottis muscle in humans and the function of the SCA was suggested to be similar to the human interarytenoid muscle. The predominant pattern of motor endplate (MEP) distribution in rat laryngeal muscles (posterior cricoarytenoid, lateral cricoarytenoid, cricothyroid, and SCA) was to have MEPs concentrated mostly at the midbelly of muscle where they were distributed throughout the cross-sectional area of the midbelly. The TA and ACA differed from this pattern. The lateral TA had MEPs concentrated at the anterior third of its belly and those of the medial TA were located at the midbelly. Motor endplates in the ACA were located mostly at the posterior portion of muscle. Muscle fiber-typing showed subtle differences between the intrinsic laryngeal muscles. Fast fibers were predominant in the rat laryngeal muscles. This study supports the expanded use of rats in studies of laryngeal neuromuscular function and disease in humans.