[EPIGLOTTIS STRUCTURES IN EPIGLOTTIS CANCER (HISTOPATHOLOGIC STUDY AND CLINICAL CONSIDERATIONS)].
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Carcinoma, Squamous Cell↗
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[Epiglottis entrapment. Overlapping of epiglottis by the arytenoepiglottic fold].
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Animals↗
[Videofluoroscopic evaluation of the functional significance of the epiglottis in adults].
Our intention was to define the functional role of the epiglottis. Accordingly, we analysed its movements and correlation in 53 videofluroscopic exams: 26 were good health volunteers, 25 were patients with dysphagia and two were persons with pharyngeal diverticula. The exams register the rest phase, chewing, and the swallowing movements during the intake of the saliva, water, barium solution and different volumes of mass made with crumbled bread mixed with barium powder. We can see three sequential stages in epiglottic movement during swallowing. The first stage involves an upward epiglottic shift determined by hioepiglottic ligament, associated with a simultaneous bending caused by the tongue backward projection. The second stage is a posterior rotation of the epiglottis, limited by the adjustment of the epiglottic tubercle to the vestibular fold, determined by laryngeal upward shift against hyoid bone. The third stage in which occurs an eversion of the free extremity of the epiglottis beyond the horizontal plane can be absent in slow pressure swallowing. All stages of the epiglottic dynamics are passive. We have shown that the epiglottis has a protective action on the repiratory airways not limited to swallowing. It participates, during swallowing and regurgitation (vomica), through the passive adjustment of the intralaryngeal posterior surface of the epiglottis (epiglottic tubercle) to the vestibular folds. Both before and after swallowing, when frequently there are escapes of residues and small volumes out of the oral cavity, the epiglottis protects the repiratory airways, through its participation in the formation of the valleculae and as an insertion point for the aryepiglottic folds. In association with epiglottis participation there is a stretching of the aryepiglottic folds that allow a definition of the lateral channels. The upward and forward movements of the larynx associated with the opening of the pharyngoesophageal transition, that occurs synchronously with the ejection of the swallowed bolus, has been shown to be an important factor in the protective laringeal mechanism. The increase in the laryngeal resistance, in which the epiglottis takes part, is only efficient when there is wide and synchronous opening of the pharyngoesophageal transition. In this context the epiglottis is a secondary element in the protection of the respiratory airways.
Adolescent↗
[Study of mechanisms of lightening aspiration and increasing decannulation rate in anastomosis of cricoid cartilage and base of tongue (epiglottis)].
OBJECTIVE: To study laryngopharyngeal anastomosis and fixing methods of super-cricoid laryngectomy with reconstruction of functions in lightening aspiration and increasing decannulation rate. METHODS: Recovering conditions of laryngeal functions in 66 patients who underwent supracricoid laryngectomy and anastomosis of cricoid cartilage and base of tongue (epiglottis) in recent eight years were summarized. Some relevant caliber distances in 21 residual larynges were measured. RESULTS: All cases restored their phonation. In 36 cases that underwent anastomosis of cricoid cartilage and base of tongue, 15 cases without aspiration, 18 with mild aspiration, 3 moderates. Decannulation rate is 94.4%. In 30 cases who underwent anastomosis of cricoid cartilage and base of tongue, 10 with mild aspiration, 17 moderate, 3 serious. All cases overcame aspiration within 3 weeks. 7 cases were cannulated. 3, 5, 10 year survival rates were 80.3%, 74.4%, and 3/7. The longitudinal and transverse calibers of epiglottis were 1.5-2.0 times longer than that of the entrance of cricoid cartilage. After anastomosis of cricoid cartilage and base of tongue (epiglottis), the epiglottis can exactly cover the entrance of cricoid cartilage to prevent aspiration fully and increase decannulation rate. Previously the cricoid cartilage was anatomized and fixed under the hyoid bone. Because some spaces exist between cricoid cartilage, base of tongue and epiglottis, aspiration is likely to occur. That hyoid bone covers the entrance of cricoid cartilage will bring constriction of the new laryngeal orifice and make decannulation difficult. Hyoidectomy and anastomosis of cricoid cartilage and base of tongue (epiglottis) overcame the two shortcomings and had good effects. CONCLUSION: Cricoid-hyoid-anastomosis was the main reason of severe aspiration and low decannulation rate. The ideal methods to lighten aspiration and increase decannulation rate are hyoidectomy and anastomosis of cricoid cartilage and base of tongue (epiglottis).
Adult↗
[Ultrasound diagnosis of the epiglottis].
In 1988 we described a method of diagnosis of the larynx using ultrasound, and called it echolaryngography. Now we discuss the ultrasound diagnosis of the normal epiglottis function and lesions of the epiglottis. In principle, three methods of examination are possible with simultaneous B- and M-mode display: transverse function test, sagittal function test and diagonal function test of the epiglottis. Transverse and sagittal transcutaneous access to the epiglottis is simple using a 7.5 MHz sector or linear transducer. Diagonal access, using a 5 MHz linear transducer, is not always successful. Lesions of the epiglottis in which ultrasound is useful include cysts, epiglottitis, and pretherapeutic staging of cancer. The pre-epiglottic space can also be assessed. The description of the clinical results is confined to carcinoma of the epiglottis. Ultrasound diagnosis before and after laser surgery for a lesion on the free edge of the epiglottis is described. In the second example the results of CT scans and ultrasound in a case of T4 supraglottic cancer of the larynx with invasion of the pre-epiglottic space are compared.
Cysts↗
Movement of the epiglottis in mammals.
In contrast to adult humans, the epiglottis of other mammals and infant humans is situated close to the soft palate. It has been argued that this posture is maintained during swallowing, with food passing laterally around an intact airway. To test this supposition, the movement of the epiglottis in two contrasting mammalian species, pigs and ferrets, was studied by placing radiopaque markers on the epiglottis and soft palate. Swallowing was observed with videofluoroscopy while the animals were feeding on hard and soft foods, liquids, and food mixed with barium sulfate. Analysis of the images showed that bolus formation and downward movement of the epiglottis away from the soft palate were unvarying phenomena in both animals for all tested foods. The duration of the epiglottic movement was approximately 0.3 S for liquids and slightly longer for solids. Because swallowing never occurred past an upright epiglottis, the results of this study do not support the hypothesis that adult animals maintain a patent airway during swallowing. Instead, the epiglottis in nonhuman mammals downfolds similarly to that of adult humans during swallowing.
Animals↗
Acquired laryngomalacia: epiglottis prolapse as a cause of airway obstruction.
Epiglottis prolapse during inspiration is an unusual cause of upper airway obstruction. It occurs primarily in patients who have lost pharyngeal airway support because of previous surgery or after head injury and coma. Eight cases of epiglottis prolapse are presented. One patient had epiglottis prolapse after resection of floor of mouth cancer and another after laryngeal fracture. The rest of the cases were seen in patients recovering from head injury and coma. Videolaryngoscopy shows the larynx to assume an ovoid shape within the pharynx. There is loss of the usual anterior to posterior pharyngeal and laryngeal dimension. The epiglottis is in a more horizontal position at rest. During inspiration, the epiglottis prolapses into the endolarynx, causing subtotal airway obstruction. Laryngeal obstruction due to epiglottis prolapse can prevent decannulation in the head-injured and can be the cause of obstructive sleep apnea. Endoscopic carbon dioxide laser epiglottectomy was successful in management of these cases.
Adult↗
Intrinsic fibre architecture and attachments of the human epiglottis and their contributions to the mechanism of deglutition.
Two mechanisms have been proposed which address the downfolding of the epiglottis during swallowing. The passive mechanism (Fink et al. 1979) focuses on passive mechanical forces transmitted through the median hyoepiglottic ligament and pre-epiglottic adipose tissue to the epiglottis. The active mechanism (Ekberg & Sigurjonsson, 1982) expands the passive mechanism to include active contributions from the aryepiglotticus and thyroepiglotticus muscles. By means of laryngeal microdissection and whole mount orcein staining, distinct bands of fascial condensations were identified running from the lateral edge of the epiglottis just superior to the attachment of the median hyoepiglottic ligament to the hyoid bone near the ends of the greater horns. Neither the proposed active nor the passive mechanisms address the possible contribution of these paired lateral hyoepiglottic ligaments to epiglottic downfolding. Computer image analysis of videofluoroscopic examinations of swallowing was then used to assess the dynamic movements of the larynx during swallowing. It was observed that the downfolding of the epiglottis occurred in the same video frame as initiation of anterior displacement of the hyoid bone and thyrohyoid approximation. Based on the anatomical and dynamic relationship of the epiglottis to other laryngeal structures, we propose that as the larynx elevates and the hyoid bone moves anteriorly, these lateral ligaments exert traction preferentially on the upper third of the epiglottis to bring it to a position below the horizontal.
Adult↗
Maturational descent of the epiglottis.
BACKGROUND: Otolaryngologists and anesthesiologists have described a maturational descent of the epiglottis that occurs in infancy and childhood. OBJECTIVE: To investigate the changing level of the epiglottis to confirm and characterize this phenomenon more completely. DESIGN: A survey of 500 images with 338 images selected for the study. SETTINGS: A tertiary care facility. PATIENTS: Asymptomatic children aged 1 day to 18 years. MAIN OUTCOME MEASURE: The position of the tip of the epiglottis was correlated with the cervical vertebral level. RESULTS: Data indicate that maturational descent of the epiglottis starts in infancy and continues into adolescence. These results are statistically significant (P < .01). CONCLUSION: Maturational descent of the epiglottis occurs in a predictable pattern. Understanding this phenomenon may facilitate laryngoscopic, as well as clinical and radiologic, evaluation of the airway in children.
Adolescent↗
Sensory nerve endings in the mucosa of the epiglottis--morphologic investigations with silver impregnation, immunohistochemistry, and electron microscopy.
This study was conducted in order to investigate the structure of sensory nerve endings of the human epiglottis and substance P immunoreactive nerve fibers of the canine epiglottis in relationship to physiologic functions of the larynx. The human epiglottis was observed by light microscopy (silver impregnation) and electron microscopy, and the canine epiglottis was studied by peroxidase-anti-peroxidase (PAP) immunohistochemistry. The results are summarized as follows: (1) In the membranes of the epiglottis, we observed free endings of simple or complex tree shape, corpuscle endings with glomerular patterns, and taste-bud-like structures, and (2) electron microscopic studies revealed varicosity of the terminal axon with processes that contained small, clear and large, dense cored vesicles. Substance P was observed in these structures, and it was suggested that substance P was related to perception in the larynx.
Animals↗
Congenital laryngeal stridor secondary to flaccid epiglottis, anomalous accessory cartilages and redundant aryepiglottic folds.
Most laryngeal anomalies are supraglottic and laryngomalacia is the most common. Cysts, bifid epiglottis and absence of the epiglottis are uncommon. An 18-year-old Caucasian man had long-standing stridor caused by anomalous supraglottic structures: a small floppy epiglottis, enlarged accessory cartilages and redundant aryepiglottic folds. These structures were excised and the airway was improved. The ventral portions of the fourth arches become the aryepiglottic folds and lateral segments of the epiglottis. A disturbance in this portion of the fourth arch may explain the anomaly. The cartilaginous contributions to the epiglottis were possibly isolated as accessory cartilages. Epiglottic anomalies may be associated with other anomalies, especially the digits of the hand. This patient had a short lingual frenulum and mild macroglossia.
Adolescent↗
Particular features of the innervation of taste buds of the epiglottis in monkeys.
The work is devoted to the study of the structure of the innervation apparatus of taste buds in the epiglottis of monkeys (Macacus rhesus). The Campos inpregnation method was used. It is established that several afferent myelinated fibers participate in the innervation of each taste bud of the epiglottis. The peculiarity of structure of their preterminal and terminal parts having the appearance of complex windings and spirals is noted. The polyaxonic principle of the innervation of taste buds of the epiglottis in monkeys is considered as a possible mechanism of generalization of the afferent impulses. It is suggested that the innervation apparatus of the taste buds of the epiglottis constitutes part of unique afferent system of this organ, ensuring its defensive function. The incongruity (from the histophysiological standpoint) of the term 'taste bud' in relation to the epiglottis is noted. It is proposed to call these formations special structures of the chemo-receptors.
Animals↗
Fine structure of taste buds located on the lamb epiglottis.
BACKGROUND: Taste buds located on the aryepiglottal folds and laryngeal surface of the epiglottis are the principal receptors responsible for the initiation of the laryngeal chemoreflex. In contrast to the wealth of information available concerning the ultrastructure of oral taste buds, little comparable data exists for taste buds located at the entrance to the larynx. Therefore, the present study was designed to investigate the fine structure of taste buds located on the lamb epiglottis. MATERIALS: Stained thick and semi-serial thin sections from taste buds located on the lamb epiglottis were examined with light and electron microscopy. RESULTS: Based on morphological criteria, three types of cells could be identified in the taste bud: Type I, Type II, and basal cells. Both Type I and Type II cells extended into the apical taste pore, but there were differences between these two cell types with regard to nuclear profiles, electron density, and the relative density of ribosomes, apical mitochondria, and rough and smooth endoplasmic reticulum. Basal cells did not extend a process into the taste pore. Nerve processes were observed throughout the taste bud. Synapses were observed between both Type I and Type II cells and nerve fibers. These synapses exhibited membrane thickenings and accumulations of clear and dense-cored vesicles of varying proportions in the taste cell cytoplasm adjacent to membrane specializations. CONCLUSIONS: The taste buds located on the lamb epiglottis share several structural similarities to taste buds located in the oral cavity and other regions of the pharynx and larynx of many mammalian species. The presence of synapses on both Type I and Type II cells of the lamb epiglottal taste bud suggests that both cell types are involved in laryngeal chemoreception.
Animals↗
[Morphology of "asphyxia-induced epiglottis form" in newborn infants, infants and young children].
A systematic histological study of cross-sections of the larynx from 52 fatalities (neonates, infants and young children) revealed a broad spectrum of anatomical variants in the epiglottis form, which were caused by variations in the epiglottic cartilage. There was no correlation between the epiglottis form and the age of the child. Furthermore, no differences in shape could be established between cases of SIDS and control cases. The term "asphyxial-related epiglottis form" appears to be inappropriate. The commonly found supraglottic laryngitis on the laryngeal aspect of the epiglottis was seen in combination with histologically proven infections in the upper and lower respiratory tract. Histological investigation of the larynx provides valuable information for the morphological diagnosis in fatal cases in early life.
Asphyxia Neonatorum↗
Movement of the epiglottis during deglutition. A cineradiographic study.
The movements of epiglottis during swallowing of barium were studied by high-speed cineradiography in 150 volunteers who had no dysphagia. In 137 individuals the epiglottis tilted down in a two-step fashion during deglutition. The first movement from an upright to transverse position was accomplished by elevation of the larynx and approximation of the hyoid bone and thyroid cartilage. This first movement is evidently a passive one and induced by the muscles that lift the hyoid bone. The second movement of the epiglottis, from transverse to an inverted position, occurs later in swallowing and seems related to contraction of the thyroepiglottic muscle. The second epiglottic movement was absent in 7 individuals, and 6 others demonstrated obliquity of their epiglottis (30-90 degrees) when studied in AP projection.
Adult↗
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↗