Arytenoid Region Research Articles

Die Sarcoidose des Kehlkopfes

Report on 9 patients with laryngeal sarcoidosis. 7 patients showed a very typical picture with a diffuse enlargement of the epiglottis, the aryepiglottic folds and the arytenoid region. In one patient a tumour like lesion of the vocal cord appeared and in another subglottical structures were diffusely swollen. Including a review of the literature, the clinical aspects, diagnostic problems and therapeutical possibilities of this rare disease are described.

A Basic study of the deglutition reflex mechanism

The purpose of this investigation is to elucidate the morphological and physiological aspects of the deglutition reflex. Two different procedures were used for this study: 1) microscopic and electronmicroscopic observations of the receptors in the human and feline larynges, 2) simultaneous recordings of electromyogram of 8 selected muscles, i. e., the cricothyroid, thyroarytenoid, posterior cricoarytenoid, mylohyoid, geniohyoid, hyopharyngeal, thyropharyngeal and cricopharyngeal muscles, with polygraphic recordings of laryngeal movement and subglottal pressure during deglutition elicited by water pouring into the pharynx of a cat. On the basis of the results, the following conclusions appear to be justified. 1) Free endings were found in the mucosa of the epiglottis in the feline. 2) Free endings and corpuscular endings were observed in the mucosa of the epiglottis in the human. 3) Free endings were observed in the mucosa of the arytenoid region and vocal fold in the human. 4) Electronmicroscopically, the receptor in the human was found to be adjacent to the basal cell layer of the epithelium with a partially uncapusulated portion. 5) The intrinsic and the extrinsic laryngeal muscles are activated with a highly constant pattern in each deglutition. 6) Subglottal pressure rises before laryngeal elevation, temporarily drops during laryngeal ele vation and rises again during downwards movement of the larynx. This pattern is not affected by resection of the unilateral recurrent laryngeal nerve.

Closure of the laryngeal vestibule during deglutition.

With the aid of high-speed cineradiography (up to 100 frames per second) the closure of the laryngeal vestibule during deglutition was studied in 150 volunteers free from swallowing complaints. The closure was observed to be effected by a peristaltic-like wave from below. This was accomplished in two steps. First the caudal segment of the vestibule, the supraglottic space, was closed by an apposition of the side walls. Then the cranial segment of the vestibule, the supraglottic space, was closed by an apposition of the fixed part of the epiglottis to the arytenoid region. The subdivision of the vestibule was made by an imaginary plane between the interarytenoid incisure and incisure of the thyroid cartilage. This subdivision corresponds to the location of the thyroarytenoid muscles lateral to the supraglottic space and the thyroepiglottic muscles lateral to the subepiglottic space. In this way the two muscle pairs contribute indifferent and distinct ways to the closure of the vestibule during deglutition.

Cancer of the Endolarynx

CANCER of the endolarynx is not common, but neither is it rare. Of the tobacco-induced malignant neoplasms, 12 pulmonary carcinomas to one cancer of the endolarynx are encountered. However, unlike cancer of the lung, laryngeal carcinoma is not only treatable but highly curable. The common sites of origin of carcinoma of the endolarynx include the supraglottic region (above the vocal cords), the glottic region (at the vocal cords), and the subglottic region (below the vocal cords). The endolarynx is divided into the following anatomic sites: laryngeal surface of the epiglottis, laryngeal surface of the arytenoid region, false cord, ventricle, true cord, and subglottis. Early lesions involve one or two sites and are designated T1 or T2, respectively. An example is a carcinoma confined to one vocal cord for Tl, or vocal cord carcinoma with either false cord or subglottic involvement for T2; T3 or T4 lesions are advanced tumors and

Function of the laryngeal muscles on the position and shape of the vocal cord (author's transl)

The purpose of the present study is to investigate how the position and the shape of the vocal cord are altered by contraction of the laryngeal muscles, and thus to determine the role of each laryngeal muscle in adjusting the vibrator, i. e. the vocal cord.In excised canine larynges, the changes in position and shape of the vocal cord when each muscle was electrically stimulated were observed and photographed from above as well as from the inner side. Then the larynges were rapidly immersed in cold alcohol solution of -30°C and fixed in the stimulated condition. They were dehydrated with u freeze substitution method, and later seved for histological examinations.The results obtained are the followings:1. Whe the the cricothyroid muscle is stimulated, the vocal cord is stretched, elongated and slightly adducted to paramedian position. The edge of the vocal cord becomes thin.2. Contraction of the posterior cricoarytenoid muscle results in abduction of the vocal cord to lateral position and the glottis is widely opened. The edge of the vocal cord becomes slightly thick, however, it becomes thin in the width of the entire vocal cord.3. Among the adductor muscles, there are significant differences in regulating shape of the vocal cord. When the thyroarytenoid muscle is stimulated, the vocal cord is markedly shortened and thickened and the middle part of the vocal cord is bulged. On the other hand, the cord is slightly elongated and becomes slightly thin at the edge when the lateral cricoarytenoid muscle is stimulated.4. On the histological examination of frontal section of the vocal cord, size and shape of the subepithelial layer, i. e. lamina propria is changed by contraction of each muscle.Contraction of the thyroarytenoid muscle results in an increase in cross sectional area whereas a decrease in the area results from contraction of the other three muscles.5. Contraction of the arytenoid muscle causes adduction of the arytenoid region, however, it does not affect shape of the membranous portion of the vccal cord markedly.6. From the findings described above, it appears that the laryngeal muscles play important roles to change the shape of the vocal cord, as well as to determine the position of the vocal cord.This gives us the bases to discuss laryngeal adjustments which produce different patterns of vocal cord vibration in various ways of phonation.

A case of laryngeal chondroma

A rare case of chondroma of the larynx is herein reported in which the neoplasma originated in the cricoid cartilage extended to left arytenoid region, and it obstructed severly the laryngeal cavity. Total laryngectomy was necessary in this case.Some problems on diagnosis and therapy of this desease are discussed in refering the bibliographies.

Myoblastoma of the Larynx

Myoblastoma of the larynx is a benign, rare tumour. Previously, only 32 cases have been described. An account is given here of a 9-year-old boy with a myoblastoma of the left half of the larynx, where the only symptom was slight hoarseness. By means of indirect laryngoscopy an elevation of the left arytenoid region was visible together with a reduced mobility of the left vocal cord. An attempt was made to excise the tumour through laryngofissure, but, on account of the tumorous remnants and continued constriction of the larynx, total laryngectomy had to be performed. Macro-scopically, the tumour was radically excised, but histologic investigations showed that tumorous stripes are present in one of the edges towards the oesophagus. Two years after the operation the boy is in good condition and no increase in the tumour has been observed.

Socalled Associated Laryngeal Paralysis

Recently experienced seven cases of socalled associated laryngeal paralysis were reported. They were 4 unilateral paralysis, 2 mixed bilateral paralysis and a bilateral paralysis.With the electromyographic examinations for 3 cases of them, it was investigated for the cases to be in the condition of paresis and to show various and complicated muscle action potential in the abnormal forms in spite of accompanying with the fixations of the vocal cords.Moreover, the questions of the laryngoscopic findings in the vocal cordparalysis were alluded to: especially on the fixed position of the paralysed vocal cord and the strange change of the arytenoid region at the paralytic side.

CYST OF THE LARYNX

In general, the occurrence of cysts in the larynx is rare. Beschorner1in 1877 saw 45 cysts among 693 polypoid growths. Of more than 722 benign tumors of the larynx seen at the Mayo Clinic, only 35 have been diagnosed as cysts.2Of these, only 3 have involved the appendix of the ventricle, like the one we are reporting. In scanning the literature, a survey reveals that the number of cysts of this type is relatively limited. As far back as 1860, Ulrich3collected a number of cases in which the cysts included 50 on the vocal cords, 8 in the sinus of Morgagni and 8 in the arytenoid region. Moure,4in 1880, had observed 68 cases and Wolfenden5165. Since that time, a great number of publications of case reports accompanied by drawings have found their way into print, and several theories about the origin of cysts have been

CYSTOMA OF THE ARYTENOID REGION OF THE LARYNX, WITH THE REPORT OF A CASE.Read before the Section of Laryngology of the Tenth International Medical Congress, Berlin, 1890.

Under this title it is proper to include only cysts, or neoplasms of predominating cystic formation, which originate from the immediate vicinity of one or other arytenoid eminence, including the neighboring part of the inter-arytenoid fold and of the ary-epiglottic fold. Recent literature has contained numerous reports of cystomata occurring elsewhere in the larynx. Schwartz, cited by Garel, places the proportion of cysts among laryngeal neoplasms in general at 3 per cent., whilst Garel himself, out of a total of sixty cases, has met with cysts of the larynx sixteen times—an unusually large proportion of 25 per cent. Most of these were situated near the anterior third of the vocal cords, and not one was in the arytenoid region. Massei, of Naples, found among his 200 cases of laryngeal neoplasms thirteen cysts—6.5 per cent. Cohen, in Sajous' Annual for 1889, cites five cases reported during the year; one of