Laryngeal Area Research Articles

Atypical Granular Cell Tumor of the Larynx: Report of an Unusually Aggressive Tumor

Introduction: Granular cell tumors are uncommon benign neoplasms. The head and neck is the most common site, usually localized to the anterior tongue. The larynx is rarely involved, representing 1.6% to 3.7%. Case report: We present the case of a 31-year-old, non-smoking female, with a history of recurrent cysts in the pyriform sinus. She consulted for dyspnea. By physical exam, there were no specific findings in head and neck area. Cervical computed tomography demonstrated a tissular mass in the laryngeal area. Laryngoscopy showed a submucosal tumor of the aryepiglottic fold. A biopsy was performed. Histopathological examination revealed round or oval-shaped tumor cells with abundant eosinophilic granular cytoplasm. The nuclei are sometimes small and regular and sometimes hyperchromatic and pleomorphic. The tumor cells showed immunoreactivity for S100 protein and vimentin. The tumor was diagnosed as an atypical granular cell tumor. Conclusion: Pathologists should be aware of this exceptional lesion. So, that the patient could have appropriate treatment.

Vocal Tract Adjustments of Dysphonic and Non-Dysphonic Women Pre- and Post-Flexible Resonance Tube in Water Exercise: A Quantitative MRI Study

To compare vocal tract (VT) adjustments of dysphonic and non-dysphonic women before and after flexible resonance tube in water exercise (FRTWE) at rest and during phonation using magnetic resonance imaging. Prospective study. Twenty women, aged 20-40 years, 10 dysphonic with vocal nodules (VNG) and 10 controls (CG), underwent four sets of sagittal VT MRI: two pre-FRTWE, at rest and during phonation, and two post-FRTWE, during phonation and at rest. The subjects performed 3 minutes of exercise. Nine parameters at rest and 21 during phonation were performed. Pre-FRTWE, eight significant differences were found, three at rest and five during phonation: at rest - laryngeal vestibule area, distance from epiglottis to pharyngeal posterior wall (PPW) and interarytenoid complex length were smaller in the VNG; during phonation - laryngeal vestibule area, angle between PPW and vocal fold (VF), epiglottis to PPW, and anterior commissure of the larynx to laryngeal posterior wall were smaller in the VNG; tongue area was larger in the VNG. Post-FRTWE, only three significant differences were found, two during phonation and one at rest: during phonation - angle between PPW and VF and the membranous portion of the VF length were smaller in the VNG; at rest - distance from epiglottis to PPW was smaller in the VNG. Results suggest that the habitual VT adjustments of dysphonic and non-dysphonic women are different at rest and during phonation. The FRTWE promoted positive VT changes in the VNG, reducing the intergroup differences.

Long-term follow-up after surgery in localized laryngeal amyloidosis.

To study effectiveness of surgery and watchful waiting in localized laryngeal amyloidosis, retrospective case series. This retrospective study comprises all consecutive patients with localized laryngeal amyloidosis surgically treated in a tertiary hospital between 1994 and February 2016. Recurrence rate, revision surgery, progression to systemic amyloidosis, and changes in voice were monitored yearly. Eighteen patients were included. Seven women and eleven men had a median age 50 years (range 21–77 years) and median follow-up 6.4 years (2.4–17 years). Amyloid was located in subglottis (5), glottis (8), false vocal folds (8) and other supraglottic areas (5), in more than one laryngeal region (13) and bilaterally (12). Cold steel excision was used at the glottis; CO2 laser excision, sometimes assisted by microdebrider, at other laryngeal areas. Eleven patients needed revision surgery, ten within the first 4 years after surgical treatment. One patient needed his first revision surgery after 11 years. Five patients needed a second revision within 6 years after initial diagnosis. Two patients needed a third revision. Indications for first revision surgery were progression (8) with dysphonia (7), dyspnea (2), dysphagia (1), exclusion of malignancy (1), and aphonia (1). No patient developed systemic amyloidosis during follow-up. Although local progression of amyloid necessitates revision surgery once or twice in the first 4–6 years, progression slows down thereafter. Late progression, however, remains possible.

Structural Organization of the Laryngeal Motor Cortical Network and Its Implication for Evolution of Speech Production.

The role of the primary motor cortex in the formation of a comprehensive network controlling speech and language has been long underestimated and poorly studied. Here, we provide comparative and quantitative evidence for the significance of this region in the control of a highly learned and uniquely human behavior: speech production. From the viewpoint of structural network organization, we discuss potential evolutionary advances of enhanced temporoparietal cortical connections with the laryngeal motor cortex in humans compared with nonhuman primates that may have contributed to the development of finer vocal motor control necessary for speech production.

Isolated Tracheobronchial Hyperkeratosis

SESSION TITLE: Bronchology SESSION TYPE: Case Report Slide PRESENTED ON: Sunday, April 17, 2016 at 02:15 PM - 03:45 PM INTRODUCTION: Airway hyperkeratosis is uncommon and affects upper airway, such as the laryngeal area in most cases. Tracheobronchial involvement is very rarely reported, and here we report a case of isolated tracheobronchial hyperkeratosis. CASE PRESENTATION: An otherwise healthy 32-year-old man presented with recurrent cough, sputum production and intermittent low-grade fever over three years. He had been treated as bronchitis with antibiotics, and the above symptoms could be relieved temporarily. He had a 5 pack year history of smoking and had quit 3 years ago. He worked in an open-air steel market with heavy ground dust pollution. Physical examination revealed no significant abnormalities. His tuberculin skin test and T-spot. TB blood test were both negative. Pseudomonas aeruginosa were seen in sputum cultures. Spirometry showed mild airflow obstruction. Chest CT scan showed no significant abnormalities. Bronchoscopy revealed diffuse white nodules like paving stone changes in the tracheobronchial mucosa with no laryngeal area involvement (Panel A, B and C). The results of tissue stains and cultures for acid-fast bacilli and fungal organisms were negative. Multiple tracheobronchial mucosa biopsy showed squamous cell metaplasia and hyperkeratosis, with no dysplasia or malignancy (Panel D). DISCUSSION: Lower airway hyperkeratosis is very rare and isolated tracheobronchial involvement has not been documented before. The cause of airway hyperkeratosis is not clear and maybe related with chronic inflammatory stimulus, air pollution, inhalation of poisonous gases, occupational dust exposure or trace element deficiency. The tracheobronchial hyperkeratosis may occur as a result of smoking and chronic dust exposure in this patient who maybe genetically predisposed to such lesions. The relationship between chronic airway infection and hyperkeratosis has not been determined. Does chronic airway infection serve as an incentive for hyperkeratosis? Or loss of normal clean function of airway secondary to hyperkeratosis, induced recurrent infection. Tracheobronchial hyperkeratosis should be differentially diagnosed from bronchial tuberculosis and fungus infection. There is no specific treatment for airway hyperkeratosis yet. The primary concern for the management of airway hyperkeratosis is the potential for malignant conversion. The risk is increased by the presence of dysplasia, since increasing severity of dysplasia appears to increase the risk of malignant conversion. Hence close follow-up with surveillance bronchoscopy is ongoing for this subject. CONCLUSIONS: Lower airway hyperkeratosis has no specific clinical characteristics. Broncoscopy with multiple-section histopathological analysis is necessary for accurate diagnosis. Close follow-up is mandatory due to its potential for malignant conversion. Reference #1: Isenberg et al. Institutional and Comprehensive Review of Laryngeal Leukoplakia. Annals of Ototogy, Rhinology & laryngology. 117(l);74-79. DISCLOSURE: The following authors have nothing to disclose: Xiaolei Zhang No Product/Research Disclosure Information

Hypopharyngeal, Supraglottic and Subglottic Stenosis after 1 Week Intubation

Hypopharyngeal, Supraglottic and Subglottic Stenosis after 1 Week Intubation

Risk factors for head and neck squamous cell carcinomas amongst patients attending a tertiary care centre of Assam

Problem consideredHead and neck cancer in India accounts for 30% of all cancer associated with distinct demographic profile, risk factors, food habits and personnel and family history. MethodsA case–control study with 87 patients with head and neck squamous cell carcinoma (HNSCC) with age and sex matched controls were evaluated for possible risk factors in a tertiary care hospital. A total of 87 cases with diagnosed HNSCC underwent structured questioning using predesigned pretested schedule. Patients with cancers in oral cavity, oropharynx, nasopharynx, hypopharynx and laryngeal areas were included. Patients from outside the state of Assam were excluded. Statistical speculations were done by using univariate and multivariate analyses. ResultsIlliteracy [OR 20.88, 95% CI 1.73–251, p=0.017], use of mosquito coil [OR 5.53, 95% CI 1.93–15.79, p=0.001], betel nut quid retention in mouth for more than 10min [OR 27.01, 95% CI 1.39–521.40, p=0.029] and use of biomass fuel [OR 5.31, 95% CI 2.12–13.31, p=0.000] had significant positive association with HNSCC. ConclusionsPreventable risk factor needs to be addressed. Counselling all patients and screening of high risk group along with health awareness creation may be effective in risk reduction.

Proton pump (H+/K+-ATPase) expression in human larynx.

The goal of our study was to investigate and to identify the existence of proton pump in different parts of larynx. The presence of acidic content in this area is known to be connected to several laryngeal diseases. It is mostly developed by upward recurrence of acidic gastric content, but there are some signs that the acid can be produced in the larynx as well, because of the proton pump activity in laryngeal mucosa. The study was performed on two types of specimens: (1) 50 cadaver larynges and (2) 11 surgical larynges obtained after laryngectomy. Samples were taken from supraglottis, glottis and subglottic areas and immunohistochemistry for the beta subunit of the proton pump was done. The presence of proton pump was proved in seromucous glands in laryngeal supraglottic area, but it was also, for the first time, found in human chondrocytes in the thyroid and epiglottic cartilage. These new findings could encourage further research that would illuminate better the etiopathogenesis not only of laryngopharyngeal reflux, but also the pathophysiology of cartilaginous disorders.

MASSIVE TONGUE EDEMA FROM AN ALLERGIC REACTION TO AN ANTIBIOTIC: EPINEPHRINE MAY AVERT NEED FOR ENDOTRACHEAL INTUBATION

Massive tongue edema from allergic reaction to medications raises a serious concern for maintaining adequate respiration as well as establishing endotracheal intubation. The necessity for airway intervention depends on the extent of airway edema, particularly the involvement to the laryngeal areas. Administration of subcutaneous epinephrine may rapidly decrease swelling of the tongue and may avert complications of airway intervention.

Incidence and mortality of laryngeal cancer in China, 2011.

Laryngeal cancer is the common cancer of the upper aerodigestive tract. We aimed to use the national cancer registration data in 2011 to estimate the incidence and mortality of laryngeal cancer within China. Comparable, high-quality data from 177 population-based cancer registries were qualified for analysis. The pooled data were stratified by area, sex and age group. National new cases and deaths of laryngeal cancer were estimated using age-specific rates and national population in 2010. All incidence and death rates were age-standardized to the 2000 Chinese standard population and Segi's population, which were expressed per 100,000 populations. All 177 cancer registries covered a total of 175,310,169 population (98,341,507 in urban and 76,968,662 in rural areas), accounting for 13.01% of the national population. The data quality indicators of proportion of morphological verification (MV%), percentage of cancer cases identified with death certification only (DCO%) and mortality to incidence ratio (M/I) were 77.98%, 2.62% and 0.55, respectively. Estimated 20,875 new cases of laryngeal cancer were diagnosed and 11,488 deaths from laryngeal cancer occurred in China in 2011. The crude incidence rate of laryngeal cancer was 1.55/100,000 (2.69/100,000 in males and 0.35/100,000 in females). Age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 1.13/100,000 and 1.14/100,000, respectively. Laryngeal cancer is much rarer in females than in males. The incidence rate was higher in urban areas than that in rural areas. The crude mortality rate of laryngeal cancer was 0.85/100,000 (1.42/100,000 in males and 0.25/100,000 in females). Age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population (ASMRW) were both 0.61/100,000. The mortality rate in males was much higher than that in females. There was no definite difference in mortality rates of laryngeal cancer between urban and rural areas. Larynx is a specialized area and cancer of larynx significantly affects the quality of life for the patients. Comprehensive measures should be carried out to prevent the ascent of laryngeal cancer.

Keratin 5 expression in squamocellular carcinoma of the head and neck.

Keratin 5 (K5) is present in the basal layer of a stratified squamous keratinized and non-keratinized epithelium. K5 and K14 have been demonstrated in the mucosa and tumors of the oral cavity, oropharynx, hypopharynx and larynx, and in the mitotic active basal cells of a stratified squamous epithelium. The aim of the present study was to assess K5 expression in squamocellular carcinoma with various localizations in the head and neck. A total of 13 biopsy fragments were included from patients diagnosed with squamocellular carcinoma of the larynx area (n=2), pharynx (n=2), hard palate (n=1), tongue (n=2), submandibular (n=1), lip (n=1), gingival sulcus (n=1), nasal pyramid (n=1), maxilla (n=1) and zygomatic (n=1). The immunohistochemical staining for K5 was evaluated according to the following score criteria: 0 (0% positive cells); 1 (<10% positive cells); 2 (10–30% positive cells); and 3 (>30% positive cells). K5 expression was observed in all squamocellular carcinomas included in the present study with scores between 1 and 3. For well- and moderately-differentiated histopathological types, a maximum score of 3 was recorded for all of the cases, not including the laryngeal area, which presented a score of 2. The following scores were identified in the regions of the poorly differentiated carcinomas: Jaw, 3; gingival sulcus, 2; and tongue and submandibular area, 1. These observations may aid with an improved stratification of head and neck squamocellular carcinoma, thus improving the diagnosis and treatment strategies for this type of cancer.

Comments on the dilemma in the March issue:‘Looking a store horse in the mouth’

The dilemma in the March issue concerned a well-bred, four-year-old, National Hunt filly, to be vetted before the premier sales (In Practice, March 2014, volume 36, pages 158-156). The horse...

Turban pin: an unusual cause of foreign body aspiration in young islamic adult.

Turban pin: an unusual cause of foreign body aspiration in young islamic adult.

Ontogeny of Sexual Dimorphism in the Larynx of the Túngara Frog,Physalaemus pustulosus

In the majority of frogs, males but not females produce vocalizations to attract mates. Sexual selection can influence the evolution of these vocalizations by modifying the frog's morphology. The larynx is the main organ responsible for sound production; thus, it constitutes a target of selection. The goal of this study was to determine qualitatively and quantitatively the sexual differences in the developmental sequence of larynges of Physalaemus pustulosus ( = Engystomops pustulosus). We examined larynges of individuals ranging from recent metamorphs to adults. We provide quantitative measurements of laryngeal area and volume, vocal cords, and fibrous mass 1 (FM1), as well as qualitative descriptions of the developmental origin of vocal cords and FM1. Larynges of small male and female juveniles (less than 16 mm SVL) are similar, both externally and internally. The area of these larynges is no more than 1 mm2; no vocal cords or FM1 are present in either sex at this developmental stage. In individuals lar...

Death Caused by Honey Bee Stings: Case Report

A bee sting is always potentially serious. The severity and duration of a reaction can vary from one person to another. In addition, one's own reaction to a bee sting may differ between occurrences. Most persons experience a local non-serious allergic reaction to bee venom. However, depending on the location and number of bee stings received, as well as the ever-present possibility of a severe allergic reaction to bee venom, a serious reaction can be precipitated that can be life-threatening. A 49 years old man having a history of allergic reaction to bee sting was found dead near to 9 nests. There were many dead honey bees on him. External examination of the body showed more than 50 stings all over the body. Upon medico-legal autopsy, pulmonary edema and swelling in laryngeal area were the internal findings. History of allergy, autopsy findings and findings obtained from crime scene investigation were evaluated together and the cause of death was concluded to be anaphylactic shock resulted from bee stings.

Immunohistochemical Examination of E-Cadherin in the Head and Neck Squamocellular Carcinomas

E-cadherin is present in the epithelial cells and its aberrant expression is correlated with different kinds of head and neck squamocellular carcinomas. The purpose of the present study was to identify the expression particularities of analyzed E-cadherin in rapport with the localization and the differentiation of various head and neck squamocellular carcinomas. 18 biopsy fragments obtained by squamocellular carcinoma patients (larynx, pharynx, hard palate, tongue, submandibular, lip, gingival sulcus, nasal pyramid, maxillary, zygomatic) were processed by immunohistochemical staining. Immunoreactions for E-cadherin in the tumoral cells were examined according to the score: 0 (0% positive cells of specimen); 1 (30% of specimen). The immunohistochemical staining indicated the presence of 12 cases of well-differentiated squamocellular carcinoma (7 cases with score 3, 3 cases with score 2 and 1 case with score 1). Moderately-differentiated carcinomas were observed in the 3 cases (2 with score 2 and 1 with score 1). The poorly-differentiated histopathological type was present in 3 cases (all with score 1). Three types of E-cadherin distribution patterns were found: cytoplasmatic; cytoplasmatic and membranar; membranar. The presence of maximum score (value 3) of E-cadherin was found in well-differentiated squamocellular carcinomas of laryngeal, tongue, lip, nasal pyramid, and zygomatic area origin. A lower value of the score was present in the less differentiated histopathological type.

Effects of different head–neck positions on the larynges of ridden horses

Hyperflexion, that is the strong deflection of the horse's head, poll and neck, is a prevalent training technique in equitation. Hyperflexion has come under criticism in recent years for being suspected of affecting the horses' well-being contrary to animal welfare. The goal of the present study is a comparison between the impacts of different poll-neck positions on findings in the upper respiratory tract of ridden horses. For this purpose, video recordings of the larynges of 14 horses were taken using an overground endoscope. The videos were recorded at rest and during three different riding phases: firstly, in a stretching posture, secondly, in a working position and, thirdly, in hyperflexion. A comparison between the analyses of the working position and hyperflexion phases revealed a significant reduction in the laryngeal opening area (p=0.001) with a value of 8.2±5.0%. Furthermore, other parameters of the larynx evaluated also showed a significant diminishment. These changes did not correlate with the age of the horses or their level of education, and they were independent of the individual anatomical conditions of the poll-neck region. In summary, it can be stated that hyperflexion causes a considerable compression of the larynx.

The glottaltopogram: A method of analyzing high-speed images of the vocal folds

Laryngeal high-speed videoendoscopy is a state-of-the-art technique to examine physiological vibrational patterns of the vocal folds. With sampling rates of thousands of frames per second, high-speed videoendoscopy produces a large amount of data that is difficult to analyze subjectively. In order to visualize high-speed video in a straightforward and intuitive way, many methods have been proposed to condense the three-dimensional data into a few static images that preserve characteristics of the underlying vocal fold vibratory patterns. In this paper, we propose the “glottaltopogram,” which is based on principal component analysis of changes over time in the brightness of each pixel in consecutive video images. This method reveals the overall synchronization of the vibrational patterns of the vocal folds over the entire laryngeal area. Experimental results showed that this method is effective in visualizing pathological and normal vocal fold vibratory patterns.

Neuromagnetic detection of the laryngeal area: Sensory-evoked fields to air-puff stimulation

The sensory projections from the oral cavity, pharynx, and larynx are crucial in assuring safe deglutition, coughing, breathing, and voice production/speaking. Although several studies using neuroimaging techniques have demonstrated cortical activation related to pharyngeal and laryngeal functions, little is known regarding sensory projections from the laryngeal area to the somatosensory cortex. The purpose of this study was to establish the cortical activity evoked by somatic air-puff stimulation at the laryngeal mucosa using magnetoencephalography. Twelve healthy volunteers were trained to inhibit swallowing in response to air stimuli delivered to the larynx. Minimum norm estimates was performed on the laryngeal somatosensory evoked fields (LSEFs) to best differentiate the target activations from non-task-related activations. Evoked magnetic fields were recorded with acceptable reproducibility in the left hemisphere, with a peak latency of approximately 100ms in 10 subjects. Peak activation was estimated at the caudolateral region of the primary somatosensory area (S1). These results establish the ability to detect LSEFs with an acceptable reproducibility within a single subject and among subjects. These results also suggest the existence of laryngeal somatic afferent input to the caudolateral region of S1 in human. Our findings indicate that further investigation in this area is needed, and should focus on laryngeal lateralization, swallowing, and speech processing.

Pregnancy is associated with a decrease in pharyngeal but not tracheal or laryngeal cross-sectional area: a pilot study using the acoustic reflection method

BackgroundThe risk of difficult upper airway access is increased during pregnancy, especially in labor. Changes in upper airway calibre have been poorly studied during pregnancy. The acoustic reflection method is a non-invasive technique that allows a longitudinal assessment of the cross-sectional area of the upper airway from the mouth to carina. We used this technique to evaluate upper airway calibre during normal pregnancy. MethodsWe conducted a prospective, single centre, observational study with a clinical and upper airway acoustic reflection method evaluation of healthy women during the first, second and third trimesters of pregnancy, and up to two days and one month after delivery. ResultsFifty women participated to the study. The mean pharyngeal cross-sectional area decreased between the first and third trimesters (P<0.001) with no significant change of the minimal and mean tracheal cross-sectional areas. The Mallampati score increased during pregnancy between the first and third trimesters (P<0.001). ConclusionUsing measurements with the acoustic reflection method, normal pregnancy is associated with a significant reduction in the cross-sectional area of the pharynx and a concomitant increase in the Mallampati score. No change was observed in the minimal and mean tracheal cross-sectional areas.