Arytenoid Area Research Articles

Laryngectomy Margin Assessment: A Little Help From a Template.

Laryngectomy margin assessment is an important part of patient care and can affect outcomes. There is no standard approach to grossing laryngectomy specimens, with variations in the published guidelines. A uniform approach to margin assessment may be helpful to improve patient care and future research. At the very least, sampling of all mucosal margins (arytenoid area, hypopharyngeal, and anterior epiglottis) and tracheal margin should be performed. Sampling of soft tissue margins may be delegated to the pathologist, and contingent on the tumor extent into soft tissue. If a tracheostomy is present, skin and soft tissue margins should be sampled from the stoma. This review provides a template for laryngectomy margin assessment and can be used as a guideline as to which margins should be assessed.

Characteristic Laryngeal Findings in Patients with Pemphigus Vulgaris.

Pemphigus Vulgaris (PV) is a rare autoimmune disease that could cause laryngeal lesions; however, only a few studies have described the localization of the laryngeal lesions associated with this disease owing to its rarity. Therefore, this study aimed to determine the localization of laryngeal lesions in patients with PV. Fourteen patients with PV accompanied by laryngeal or pharyngeal lesions, who underwent flexible laryngeal endoscopy performed by laryngologists, were examined retrospectively. The arytenoid area was the most frequently affected site in the larynx, followed by the epiglottis and aryepiglottic folds. Vocal folds and ventricular bands were the least affected. Lesions in the arytenoid area were observed more frequently in this study than in previous studies. This result suggests that a more careful inspection of arytenoid lesions in patients with PV is required under laryngeal fiber observation. Moreover, we proposed a novel classification system for laryngeal findings in patients with PV and a systematic observation method. This novel classification and method would be useful not only for determining the lesions but also for careful inspection in this field. 4 Laryngoscope, 134:3719-3725, 2024.

Lingual tuberculosis mimicking malignant lesion: A rare manifestation of a common disease

We report a rare case of tuberculosis (TB) of base of the tongue following pulmonary TB. Patient presented to us with chief complaints of sore throat, dysphagia, and hoarseness of voice for 20 days. Examination with 90° telescope revealed ulcerative lesion in the base of the tongue on the left side of size 0.5 cm and another lesion in the left arytenoid and inter arytenoid area extending to the false vocal cord of the left side with undermined edges along with whitish slough at the center of the ulcer. Infection of the oral cavity with Mycobacterium tuberculosis is rare, however, it should be considered among the differential diagnosis of the lesions of the oral cavity. The biopsy is necessary to confirm the diagnosis.

Second Case Report of Myxofibrosarcoma of Larynx

A 47 year-old woman admitted to the hospital with progressive hoarseness. On the physical examination of larynx, a 2.5 cm mass was detected on the left arytenoid area. The tumor was totally excised and histopathologic diagnosis was consisted with myxofibrosarcoma of intermediate grade. Myxofibrosarcoma is common soft tissue sarcoma mainly occur in the extremities. Head and neck region is seldom becoming a host for soft tissue sarcomas including myxofibrosarcoma. Here in, we present the second case of laryngeal MFS with its clinicopathological features, differential diagnosis, treatment modalities and prognostic factors with the review of the literature.

Exercise-induced stridor due to abnormal movement of the arytenoid area: Videoendoscopic diagnosis and characterization of the ?at risk? group

We evaluated 4 patients who developed severe, symptomatic stridor during maximal cardiopulmonary exercise testing, all referred due to exercise-related dyspnea. All underwent resting, unsedated transnasal fiberoptic laryngoscopy and had normal findings. Four patients performed repeat maximal exercise testing with fiberoptic laryngoscopy, and they form the basis of this report. They had normal vocal cord motion during exercise, but developed abnormal anterior motion of the arytenoid and aryepiglottic folds only at peak exercise, leading to partial airway obstruction and severe stridor. This report details the workup and characterizes patients at risk for this unusual phenomenon.

Sensory nerve supply of the human oro- and laryngopharynx: a preliminary study.

To date, the details of human sensory innervation to the pharynx and upper airway have not been demonstrated. In this study, a single human oro- and laryngopharynx obtained from autopsy was processed with a whole-mount nerve staining technique, Sihler's stain, to determine its entire sensory nerve supply. The Sihler's stain rendered all mucosa and soft tissue translucent while counterstaining nerves. The stained specimen was then dissected and the nerves were traced from their origins to the terminal branches. It was found that the sensory innervation of the human pharynx is organized into discrete primary branches that innervate specific areas, although these areas are often connected by small neural anastomoses. The density of innervation varied, with some areas receiving almost no identifiable nerve supply (e.g., posterior wall of the hypopharynx) and certain areas contained much higher density of sensory nerves: the posterior tonsillar pillars; the laryngeal surface of the epiglottis; and the postcricoid and arytenoid regions. The posterior tonsillar pillar was innervated by a dense plexus formed by the pharyngeal branches of the IX and X nerves. The epiglottis was densely innervated by the internal superior laryngeal nerve (ISLN) and IX nerve. Finally, the arytenoid and postcricoid regions were innervated by the ISLN. The postcricoid region had higher density of innervation than the arytenoid area. The use of the Sihler's stain allowed the entire sensory nerve supply of the pharyngeal areas in a human to be demonstrated for the first time. The areas of dense sensory innervation are the same areas that are known to be the most sensitive for triggering reflex swallowing or glottic protection. The data would be useful for further understanding swallowing reflex and guiding sensory reinnervation of the pharynx to treat neurogenic dysphagia and aspiration disorders.

Supracricoid partial laryngectomies: Oncologic and functional results

Background The authors present their study on oncologic and functional results of supracricoid partial laryngectomies (SPL) performed on 149 patients between January 1984 and December 1995. Methods Cricohyoidopexy (CHP) was carried out on 98 patients and cricohyoidoepiglottopexy (CHEP) on 51 patients. The patients were divided into two groups. The first group included those operated on between January 1984 and December 1992 and who therefore had a minimum follow-up period of 3 years. The second group included those operated on after December 1992 and who therefore had a follow-up period of less than 3 years. The statistical evaluation of this second group was carried out using an actuarial method according to Kaplan-Meier. Results In the first group, survival rate (regarding disease-related deaths) was 94% (95/101), whereas in the second group, survival rate was 95%. There were 9 recurrences in the 149 patients (6.71%), 8 of which occurred after CHP (6 for tumor [T] and 2 for node [N]) and 1 (for T) after CHEP. Three of the 6 recurrences for T after CHP occurred in the hypopharynx, 2 in the peristomal area, and 1 in the arytenoid area. The only recurrence for T after CHEP occurred in the paraglottic area. Decannulation was carried out in 85.7% of CHP patients (84/98) and in 98% of CHEP patients (50/51). The nasogastric tube was kept in position for an average of 28 days (range, 15–90 days) in the CHP patients and 15 days (range, 9–90 days) in the CHEP patients. Swallowing was excellent; only a small number of patients (n = 21) were forced to assume a particular posture during meals. Phoniatric controls performed on 104 patients also showed adequate speech recovery. Conclusions If the indications are applied scrupulously, CHEP is a valid alternative to partial laryngeal surgery and CHP is a possible alternative to total laryngectomy in the treatment of glottic and supraglottic tumors. © 1998 John Wiley & Sons, Inc. Head Neck20: 504–509, 1998.

喉頭の腺様嚢胞癌例

Adenoid cystic carcinoma of the larynx is very rare. Less than 0.25 per cent of all laryngeal carcinomas are adenoid cystic tumors, and only seventeen cases have been reported in the Japanese literature. In this paper, a case of adenoid cystic carcinoma originating in the supraglottic area of the larynx is reported.A 56-year-old woman complained of cough and hoarseness of two months duration. Indirect laryngoscopic examination revealed a smooth mass involving the left false cord and arytenoid area. The pathology report was compatible with adenoid cystic carcinoma. The patient underwent total laryngectomy and left neck dissection. She has remained well for the last two years with no evidence of recurrence or metastases.We examined the resected specimens histologically by whole organ serial sectioning and discuss the evaluation, treatment, clinical course and prognosis of adenoid cystic carcinoma of the larynx.

意識障害を来たした巨大なこう頭血管しゅ

The patient was a 47-year-old male with dyspnea, clouding of consciousness and hoarseness. Under Macintosh laryngoscopy and fiberscopy, a large dark-red tumor was found narrowing the air way. Laryngofissure revealed an extended tumor from the false cord to the arytenoid area on the right side. The tumor was removed together with the surrouding normal tissues. Two points of normal tissue near the tumor were coagulated by an electric coagulator. The incision was performed between them, so there was little bleeding. The normal laryngeal mucosa, which had overlain the tumor, was preserved and replaced to cover the raw surface.Histological examination revealed hemangioma cavernosa.

Histological study on the larynx

From cadavers ranging from newborn to 78 years of age, 122 laryngeal specimens were collected and the epiglottis, ventricular band, glottic space, vocal cords as well as the subglottis, lining epithelium of the arytenoid, tunica propria of mucous membrane, lymphatic structure and submucous tissue were morphologically studied. It was then noted that these tissues showed a systematic pattern of their changes with increasing age. The results were as follows:1) Epithelial cells of mucous membraneCiliated columnar epithelium lining the most part of the larynx except for the vocal cords which were covered by stratified squamous cells was gradually displaced by stratified squamous epithelium with aging process. On the laryngeal surface of the epiglottis stratified squamous epithelium spread from the upper to the lower part, and in the ventricle it spread from the ventricular band and the lateral edge of the vocal cord into the ventricle, and in the subglottis and arytenoid it spread toward the trachea. Over the age of 50 years, stratified squamous and ciliated columnar epithelium became thinner.2) Tunica propriaIt was particulary prominent in the epiglottis and ventricle in newborn but its increase and decrease in amount were related with development and regression of the subepithelial tissue associated with advancing age. This change was not prominent in the subglottis, and tunica propria became increased with associated inflammatory change in the arytenoid area.3) LymphaticsThe lymphatic system was not well developed in the lingual surface of the epiglottis, and in the laryngeal surface primary lymph nodules and in the arytenoid and ventricle primary and secondary nodules became apparent. The secondary nodules were no more detected over 30 years of age.4) Glandular tissueGlands were sparse in newborn but much better developed with growing age up to 19 years. Over 40 years regression of glandular tissue and increase of its surrounding connective tissue took place with increasing age. But in the subglottic area there was no remarkable change in the glandular tissue.5) Ligaments and muscles ot tne vocal cordsIn newborn larynx ligaments and muscles showed paucity of their amount, but in puberty elastic fibers in the ligaments were increased and after second decade the ligaments showed marked changes. Muscle bundle in the vocal cords much more developed with advancing age but after second decade it was changed morphologically and interstitial substance became abundant.

On Findings of the Pharynx and Larynx of Elementary and Middle School Pupils in the Air Polluted District

On the macroscopic examination of the mucous membrane of the pharynx and larynx of pupils of elementary and middle schools in the air polluted district, more significant increase of incidence of injection of the retropharyngeal wall, enlargement of the retropharyngeal lymphoid tissues, dilatation of vessels of the pharynx and injected swelling of the vocal cords, injection of the epiglottis and arytenoid area are found in the pupils of the elementary schools than in pupils of unpolluted districts.Among the pupils of the middle schools is also a significant incidence of enlargement of the retropharyngeal lymphoid tissues and dilatation of vessels of the pharynx.A further study will determine which group of pupils of the elementary schools and the middle schools are much more contaminated.