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PubMed1977

[Nineteen years experience with surgical correction of disorders of swallowing and voice following vagus nerve paralysis (author's transl)].

An operation for the correction of swallowing and voice following paralysis of the vagus nerve is described. The operation is divided into four parts which are performed either in one or two stages. These include: 1. extramucosal myotomy of the pars fundiformis of the cricopharyngeus muscle; 2. correction of vocal cord paralysis by the rotation of the arytenoid cartilage and cartilage implant into the paralyzed vocal cord; 3. resection of the paralyzed wall of the pharynx; 4. fixation of the paralyzed soft palate to the posterior wall of the pharynx. Nineteen years experience with the four different parts of the operation are discussed.

Deglutition Disorders↗
PubMed2000

Discrimination between calcified triticeous cartilage and calcified carotid atheroma on panoramic radiography.

The differential diagnosis of calcified atherosclerotic plaque in the extracranial carotid vasculature includes a number of anatomic and pathologic radiopacities. Most of these are readily distinguishable on the basis of location and morphologic features. The calcified triticeous cartilage, however, can be a confounding alternative that is frequently misdiagnosed as a calcified atheroma. This paper describes the radiographic differences between these 2 entities, enabling clinicians to improve their diagnostic acumen when evaluating cervical soft tissue calcifications.

Arteriosclerosis↗
PubMedDate not supplied

[Forensic medical expertise in manual strangulations].

Presents analysis of mortality caused by strangulation by hands, based on files and author's own observations. The principal mechanisms of compression of the neck with parts of human body are singled out: with one or two hands, with one or two forearms, with the arm and forearm, with the knee, shin, or foot. The most incident injuries to soft tissues of the neck, sublingual bone, and laryngotracheal cartilages detected by experts at autopsy and at additional fractological examination of the hyoid laryngotracheal complex are described. A conclusion about the mechanism of formation of injuries of this complex inflicted by compression of the neck by hands is made.

Asphyxia↗
PubMed1988

Management of arytenoid chondropathy and failed laryngoplasty in horses: 75 cases (1979-1985).

By use of endoscopy, 75 horses with respiratory noise and/or exercise intolerance were determined to have structural arytenoid cartilage abnormalities (60 primary, 11 after previous laryngeal surgery), or failed left laryngoplasty (4 horses) for laryngeal hemiplegia in which the arytenoid cartilage still appeared normal. Eighty-eight percent of the horses were either Thoroughbred (54 horses; 72%) or Standardbred (12 horses; 16%) racehorses; only 9 horses (12%) had occupations not related to racing. Seventy-six percent of the racehorses were 2 to 4 years old; all non-racehorses were greater than 4 years old. The male:female ratio was approximately 2:1. Of the horses with cartilage abnormalities, 28 had left-sided involvement, 22 had right-sided involvement, and 21 had bilateral involvement. Sixty-two arytenoidectomies were performed, 58 for cartilage abnormalities (22 left, 19 right, 17 bilateral), and 4 for failed left laryngoplasties. Overall, 45% of the Thoroughbred racehorses that returned to racing after arytenoidectomy raced successfully (50% left, 75% right, 22% bilateral); only 20% of the Standardbreds were able to race. Seventy-five percent of non-racehorses were able to return to their previous use. Many horses were retired intentionally after surgery.

Animals↗
PubMed2000

Functional anatomy and physiology of the upper esophageal sphincter.

Upper esophageal sphincter (UES) refers to the high-pressure zone located in between the pharynx and the cervical esophagus. The physiological role of this sphincter is to protect against reflux of food into the airways as well as prevent entry of air into the digestive tract. UES is a musculocartilaginous structure with its anterior wall being formed by the full extent of the posterior surface of the cricoid cartilage and arytenoid and interarytenoid muscles in the upper part. Posteriorly and laterally the cricopharyngeus (CP) muscle is a definitive component of the UES. CP has many unique characteristics: it is tonically active, has a high degree of elasticity, does not develop maximal tension at basal length, and is composed of a mixture of slow- and fast-twitch fibers, with the former predominating. These features enable the cricopharyngeus to maintain a resting tone and yet be able to stretch open by distracting forces, such as a swallowed bolus and hyoid and laryngeal excursion. CP, however, constitutes only the lower one third of the entire high-pressure zone. The thyropharyngeus (TP) muscle accounts for the remaining upper two thirds of the UES. The UES pressure is not entirely the result of myogenic activity, as a component of the pressure is the result of passive elasticity of the tissues. The opening of the UES involves relaxation of CP and TP muscles and forward movement of the larynx by the contraction of hyoid muscles. The UES function is controlled by a variety of reflexes that involve afferent inputs to the motorneurons innervating the sphincter. These physiological reflexes elicit either contraction or opening of the UES. Inability of the sphincter to open leads to difficulty in swallowing. Opening of the sphincter without associated CP relaxation leads to the clinical syndrome of cricopharyngeal bar.

Esophagus↗
PubMed1976

Division of posterior cricoid plate in young children with subglottic stenosis.

Subglottic stenosis was corrected surgically in three young children. The key surgical maneuver is the anterior and posterior division of the cricoid cartilage. Endoscopic, xerographic and speech assessments have been done at intervals since decannulation. The anterior commissure is widened and the endolarynx deformed in two children examined. Radiographic studies indicated that increased airway diameters have been maintained to date. Speech has been adversely affected to some degree in all three patients.

Child, Preschool↗
PubMed1989

Isolation of the N-terminal globular protein domains from cartilage proteoglycans. Identification of G2 domain and its lack of interaction with hyaluronate and link protein.

The N-terminal fragment (G1-G2) of cartilage proteoglycan protein core contains two globular domains, binding region (G1) and a second globular domain (G2), G1-G2 was isolated after mild trypsin digestion of purified proteoglycan aggregates followed by chromatography first on Sepharose CL-2B under associative conditions and then on a TSK-4000 column in 4 M-guanidinium chloride. It migrated as a single band (apparent Mr 150,000) on SDS/polyacrylamide-gel electrophoresis. G2 was isolated by V8-proteinase digestion of G1-G2 followed by aggregation of the G1-containing fragments with hyaluronate and chromatography on TSK-4000. It migrated as a single band on SDS/polyacrylamide-gel electrophoresis of apparent Mr 66,000 after digestion with keratanase. G2 did not interact with proteoglycan monomer, hyaluronate, link protein or other extractable cartilage matrix proteins. A polyclonal antibody raised against G2 did not cross-react with G1 or link protein. These data show that, despite a high degree of sequence similarity, G1 and G2 do not share any functional properties nor have major antigenic sites in common.

Aggrecans↗
PubMed1983

Alloplastic implants of the larynx.

Biocompatible Teflon fluorocarbon polymer (Proplast) and porous polyethylene (Plasti-Pore) are porous alloplastic implant materials that are widely used in reconstructive head and neck surgery. These two materials were used in our study as replacement grafts for defects in three groups of 12 canines. For the first time, Plasti-Pore was found equal and perhaps superior to Proplast in deep implantation, this in the anterior cricoid cartilage when the internal and external perichondrium were preserved. Rejection of both substances occurred when the implant was exposed to air and aerodigestive tract contaminants after the removal of the perichondrium, subglottic, and upper tracheal mucosa. Airway exposure to the alloplasts, even when lined with buccal mucosa, resulted in infection and extrusion, but at a much slower rate.

Animals↗
PubMed2000

Differentiated thyroid carcinomas. Prediction of tumor invasion with MR imaging.

PURPOSE: To assess diagnostic accuracy for tumor invasion of surrounding organs by measurement of tumor circumferences on MR images in patients with differentiated thyroid carcinomas. MATERIAL AND METHODS: Surgical and MR imaging findings in 50 patients with differentiated thyroid carcinoma (43 primary, 7 recurrent lesions) were retrospectively reviewed. The degrees of circumference of tumor encroachment to the organs were measured, and the measurements and morphologic diagnosis of tumor invasion made by a head and neck radiologist were compared with surgical and pathologic findings using receiver operating characteristic curves. RESULTS: Diagnosis of tumor invasion by the radiologist was superior to the measurements of the carotid artery and cartilage, while the reverse was true for the trachea and esophagus. However, no statistical differences were noted between them for each structure. Optimal thresholds for tumor invasion were 90 degrees or more for the cartilage (94% accuracy) and esophagus (86% accuracy), 135 degrees or more for the trachea (86% accuracy), and 225 degrees or more for the carotid artery (90% accuracy). CONCLUSION: Tumor invasion was more accurately diagnosed by measurement of tumor circumferences of each organ on MR images.

Adenocarcinoma, Follicular↗
PubMed1980

[Estimation of age from skeletal material based on the degree of thyroid cartilage ossification].

Bone material estimation of an individual's age can in some cases be made by taking advantage of the degree and progression of thyroid cartilage ossification so long as the cartilage has remained preserved. X-ray pictures are taken to asertain the extent of the ossified parts of the thyroid cartilage to be compared with the proposed schema (Fig. 2). The estimated age is than charged with the value of the respective mean error of estimation (Tab. 1.). The method is simple and has stood the test of practice both in paleoanthropology and in forensic medicine to become another technique of estimating the age of unknown skeletal remains or unknown, particularly decomposed bodies.

Adolescent↗
PubMed1997

[Histological study of the tracheal adventitia, perichondrium and annular ligament].

The trachea begins at the lower border of the cricoid cartilage and passes down to bifurcate into the left and right mainstem bronchi. The presence of tracheal invasion is crucial factor influencing the prognosis for patients with cancers of the thyroid gland, hypopharynx, esophagus, etc. In order to understand the manner of invasion of the above tumors, precise knowledge of the normal tracheal structure is indispensable. This study was undertaken to clarify the normal microscopic structure of the trachea. Five normal tracheal specimens obtained at surgery were examined histologically and immunohistochemically. The loose connective tissue around the trachea, known as adventitia, was divided into a loose outer and a dense inner layer by hematoxylin and eosin (HE) staining. This two-layer pattern was clearly seen near the annular ligament but was obscured away from it. The connective tissue of the inner layer ran obliquely to joint the connective tissue of the annular ligament and ended in the submucosal layer. This arrangement of connective fibers seems to play a role in allowing the trachea to stretch and bend. Tracheal cartilage is covered with a dense fibrous membrane known as the perichoundrium. Between the superficial fibrous membrane and mature cartilage cells lies zone of immature cartilage made up of oval or spindle cells, and the inclusion of this zone in the perichondrium has long been a subject of controversy. In our study, the zone was homogeneously stained red by the elastica van Gieson's stain and was clearly distinguished from other structures. Immunohistochemical staining revealed a wide distribution of type I and type III collagen on the fibrous membrane and the zone of immature cartilage cells, while mature cartilage cells did not show such collagen. Based on these findings, we conclude that the zone of immature cartilage cells belongs to the periochondrium, which thus contains two layers, an outer fibrous layer and an inner transitional layer of immature cartilage cells. Our conclusions are as follows: 1. Tracheal adventitia is divided into two layers, an outer loose and an inner dense fibrous layer. 2. Tracheal perichondrium also consists of two layers, an outer fibrous layer and an inner transitional layer. 3. The fibrous bundle originating from the adventitia joins the connective tissue of the annular ligament, probably in order to allow the trachea to stretch and bend.

Collagen↗
PubMed1977

Structure of the normal rat larynx.

Recent studies have shown the rat larynx to be an important organ in the evaluation of irritancy of inhaled materials. Serial sections and scanning electron microscope observations have clarified its basic structure. In particular the cartilage pattern and the distribution of the epithelia lining the lumen have been determined. There are 2 specialised epithelia--stratified squamous (found in areas subject to wear) and ciliated pseudostratified columnar (which produces and transports mucus). Aways intervening between these is an unspecialised epithelium, the non-ciliated columnar. The marked variation in type of epithelium over a short distance within the larynx emphasises the need to take sections in the same plane when comparing different specimens.

Animals↗
PubMed1973

A histochemical study of extraneuronal accumulation of noradrenaline in the guinea-pig trachea.

1. Accumulation of noradrenaline in extraneuronal tissue of the guinea-pig trachea has been studied by the use of the fluorescence histochemical technique of Falck and Hillarp.2. After incubation in solutions of noradrenaline, fluorescence developed in cellular structures (tracheal smooth muscle, vascular smooth muscle and endothelium, fibroblasts and chondroblasts), in the intercellular matrix of the cartilage and throughout the loose connective tissue of the adventitia and submucosa.3. The effect of various experimental procedures on the development of this fluorescence has been examined i.e. incubation with noradrenaline at reduced temperature (0 degrees C), removal of fluorescence by washing with Krebs solution at 37 degrees C or 0 degrees C, incubation with phenoxybenzamine (10(-4)M) or metanephrine (10(-4)M).4. From these observations it has been concluded that noradrenaline accumulates in the trachea:(a) in cellular structures where it is firmly bound, i.e. not easily removed by washing at 0 degrees C, and where the accumulation is prevented by phenoxybenzamine, metanephrine or cold.(b) in the intercellular matrix of the cartilage where it is also firmly bound, but where the accumulation is not prevented by phenoxybenzamine, metanephrine or cold. This probably represents binding to sulphated mucopolysaccharides.(c) in the adventitia and submucosa where it is loosely bound and easily removed by washing.5. Some implications of these findings in pharmacological experiments with guinea-pig trachea are discussed.

Animals↗
PubMed1988

[Usefulness of the laser in post-radiotherapy arytenoid edema].

Laser treatment of post-radiotherapy arytenoid edema was applied to two groups of patients with either laryngeal mobility or immobility. When mobility was normal the technic was simple, since only resection of the arytenoid edema was necessary and results were always excellent. In the second group, resection of arytenoid edema must be combined with partial or total resection of arytenoid, but in this case there is a risk of chondritis. Results in this series were excellent and only one case of post-laser radionecrosis was noted.

Arytenoid Cartilage↗
PubMed1975

Effects of highly dosed ultrasound on the growing rabbit's larynx. Scanning electron microscopic and reflecting ligth microscopic findings.

The morphologically recognizable effects of highly dosed ultrasound application on the growing rabbit's larynx (5 Watt/cm2 for 10 min) were studied by means of scanning electron microscopic (SEM) and reflecting light microscopic (RLM) methods. It could be shown that the area of cartilaginous necrosis corresponded exactly to the location of ultrasound application and was sharply limited by the normal cartilage. After a survival period of six weeks, areas of chondroneogenesis became visible on the endolaryngeal perichondrium. After a survival period of twelve weeks, an outer zone of cartilaginous necrosis was still to be seen. Connective tissue directly affected by ultrasound and the endolaryngeal muscles did not show any retarded damage. The results of our experiments permit to state that highly dose ultrasound application on the cartilaginous framework leads to a growth retardation with a subsequent alteration in form and shape.

Animals↗
PubMed1984

Suitability of near-total laryngopharyngectomy in piriform carcinoma.

The surgical specimens from total laryngectomy and partial pharyngectomy in 20 consecutive cases of piriform sinus carcinoma were studied by whole-organ serial sectioning in the horizontal plane. There had been gross clinical involvement or fixation of the vocal cord in 19 of these cases. Histopathologic evidence of cartilage invasion or piriform apex involvement was found in 17 specimens. In 13 cases, it appeared, retrospectively, that the cancer could have been adequately encompassed without resecting the entire contralateral side of the larynx. When this element is spared, a sphincteric speaking shunt can be made. Careful preoperative assessment would have correctly predicted the suitability or danger of this approach in 18 of the 20 cases; the two indeterminate cases would have required intraoperative quick section. These findings have meaningful implications regarding the scope of conservation surgery in piriform carcinoma.

Aged↗