Reinke's Space Research Articles

Conservative Management of Early Grade Unilateral Reinke's Edema with Laryngopharyngeal Reflux

Reinke's edema is described as fluid-filled vocal folds in the Reinke's space. Unilateral cases are uncommon and might caused by gastrointestinal reflux. We report a 61-year-old man with complaints of hoarseness since one year ago, which was getting worse for the past two months. Examination of the reflux symptom index (RSI) obtained a score of 23 and reflux finding score (RFS) score of 11. Examination of the flexible fiber laryngoscopy showed that the right vocal fold size was thicker than the contralateral side, greyish in color, soft, and did not bleed easily. The patient was then given conservative therapy with proton pump inhibitors (PPIs), corticosteroids, and mucolytics, accompanied by lifestyle modifications. Clinical improvement was found at four weeks of evaluation. In conclusion, the response to conservative therapy and elimination of risk factors for early-stage Reinke's edema contributes well to disease recovery, particularly those caused by laryngopharyngeal reflux.

Expression of chemotaxis in regulators of tissues of exudative lesions of Reinke’s space

Exudative tumor-like neoplasms of the Reinke space in vocal folds are widespread in the population, more often among representatives of vocal professions, e.g., actors, singers, teachers, lecturers and represent a serious medical and social problem. In pathogenesis of such neoplasms, a key role is given to chronic phonotrauma, intoxication during smoking against the background of the nearly complete absence of lymphatic drainage in the Reinke space. Cellular factors of tissue and immune homeostasis are of great importance in morphogenesis of this disorder. Switching of immune responses aimed at maintaining tissue homeostasis is accompanied by increased production of pro-inflammatory cytokines, as well as chemotaxis regulators and growth factors. The aim of our work was to study the levels of chemokines (MIP-1, MIP-1, MIP-3, fractalkine, IL-8, I-TAC) in the tissues of exudative lesions from the Reinkes space (EPPR).
 Forty tissue samples of exudative lesions from Reinkes space, in particular, vocal fold polyps, vocal nodules and neoplasms presenting as Reinkes edema were taken as biological material for the study. The samples were taken intraoperatively when the neoplasm was removed, using an Olympus TYPE 150 fiber bronchoscope (Germany) using an integrated Lumenis Acu Pulse CO2 laser (Israel). The content of chemokines was determined in the supernatants of the tissues homogenates, using multiplex analysis with MAGPIX-100 immunoanalyzer (Bio-Rad, USA). Statistical processing was carried out using Statistica 10.0 for Windows software package. The results are presented as medians (Q0.25-Q0.75).
 Chronic phonotrauma and/or exposure to toxic factors leads to increased permeability of the vascular endothelium, tissue edema and activation of cells involved in tissue and immune homeostasis, e.g., fibroblasts, monocytes, endotheliocytes. The study of the chemokine expression in the tissues of various exudative lesions of Reinkes space enabled us to reveal the following features: (1) predominance of the CXC-chemokine content produced mainly by fibroblasts in dense neoplastic tissues, thus reflecting participation of the latter in the genesis of this pathology. (2) In the tissues of soft neoplasms with large proportion of liquid component, we have revealed increased concentrations of SS-chemokines and fractalkine. The latters are produced mainly by macrophages and endotheliocytes, thus, probably, reflecting a predominant role of these cells in development of myxoid polyps and Reinkes edema.

Histopathological characteristics of larynx in hypothyroidism in an experimental rabbit model.

ObjectiveHypothyroidism has a significant effect on the patients' voices. This study evaluated the histopathological characteristics of larynx following hypothyroidism in an experimental rabbit model.MethodsEleven male Dutch rabbits were included. Methimazole‐induced hypothyroidism was done for nine rabbits. The remaining two rabbits were assigned as controls. Six weeks after starting methimazole, a histological examination was performed with parameters of inflammation, ulceration, hemorrhage, and thickness of epithelium, Reinke's space, vocal ligament, thyroarytenoid muscle, collagen deposition, and periodic acid‐Schiff (PAS)‐positive materials, as well as confirmation of hypothyroidism by T4 measurement.ResultsHistologic examination showed a significant thickening of epithelium, Reinke's space, vocal ligament, and collagen PAS‐positive materials deposition in hypothyroid rabbits (p < .05). There was significant reduction in thyroarytenid muscle thickness (p < .05). Inflammation, ulceration, and bleeding were not significantly different between hypothyroid and control rabbits' laryngeal specimens.ConclusionHypothyroidism causes significant changes in the laryngeal tissues. Thickening of epithelium, Reinke's space, vocal ligament, collagen, PAS‐positive materials, and reduced thickness of thyroarytenoid muscle are the major findings of this study.

Voice Quality Analysis of Reinke's Edema According to Recent New Classification

Reinke's edema is a benign laryngeal disease characterized by inflammation and swelling of the superficial layer of the lamina propria of the vocal fold, known as Reinke's space. The aim of this study was to evaluate the quality of voice by quantitative acoustic measurements in patients affected by RE according to new classification proposed by de Vincentiis. Prospective case-control. We enrolled 76 consecutive patients with RE: eight type 1, 36 type 2, four type 3. and 28 type 4. A population of 30 healthy subjects was enrolled too. A voice recording for each subject was performed and the analysis were performed using the Multi-Dimensional Voice Program. The parameters considered were: fundamental frequency (F0), Jitter% (Jitt%), Shimmer% (Shim%), and Noise Harmonics to Ratio (NHR). Statistical analyses were performed using GraphPad Prism 8 software. A level of significance of P < 0.05 was used. The mean values and standard deviation for each parameter for the male group of patients affected by RE are: F0 101.06 (± 9.56) Hz, Jitt% 2.254 (±0.93), Shim% 9,037 (±2.21) and NHR 0.235 (±0.099). About the female group, the mean values are: F0 147,58 (±13.68) Hz, Jitt% 3,733 (±1.12), Shim% 11.172 (±3.54) and NHR 0.278 (±0.12). The difference between the types of RE and reference sample people in male and female groups are statistically significative (P < 0.05) for each parameter. In the female group all outcomes are statistically different except the F0 and NHR between healthy people and type III RE patients. RE is one of the most common diseases of true vocal folds and the classification proposed by de Vincentiis is a synthesis of endoscopic findings. In this paper we underline the change in vocal quality before surgery according a new type of RE classification.

Methods of sparing surgical treatment of chronic edematous-polypous laryngitis, edema Reinke

Introduction. Laryngeal pathology occupies a leading place in the general structure of diseases of the upper respiratory tract, chronic edematous-polypous laryngitis, Reinke-Gayek edema accounts for 5.5% of all benign diseases of the vocal folds. The main method of treating Reinke-Gayek's disease is surgical treatment, which consists in removing excess mucosa, or “stripping” - tearing a strip of mucosa with forceps from the vocal fold. One of the main principles of laryngeal surgery is the maximum preservation of the structures of the vocal fold, obtaining a flexible vibration of the muscular-membranous part and the mucous membrane of the vocal fold.Purpose. The purpose of our work is to improve the effectiveness of treatment of chronic edematous-polypous laryngitis using a CO2 laser.Tasks. To develop a differentiated approach to the surgical treatment of chronic edematous-polypous laryngitis using a carbon dioxide laser.Materials and Methods. We treated 46 patients with Reinke-Gayek disease, including 35 women and 11 men. The age of the patients ranged from 40 to 67 years. Preoperative examination included endoscopic examination, laryngostroboscopy. The type was determined according to the classification of H. Yonekawa, for the choice of further surgical tactics. In type II, an incision of the mucosa, aspiration of gelatinous matter from the Reinke space, and laying of the mucosa were performed. With type III, it is made by forming M-shaped flap to close the defect.Results. All patients in the preoperative period were surveyed with the VOICE HANDICAP INDEX(VHI-30) questionnaire, laryn-gostroboscopy, and maximum phonation time. In the postoperative period, the examination was performed twice, 1 month after the operation and 3 months after the operation. There is a significant increase in indicators, an increase in the maximum phonation time, a decrease in VHI-30 points.Conclusion. The use of this technique allowed to significantly accelerate the recovery of the voice, reduce the time spent in the hospital, minimally damaging the structure of the mucous membrane of the vocal folds.

Autologous Tragal Perichondrium Graft for Vocal Fold Scar and Sulcus Vocalis

Between 2006 and 2016 in a Tertiary Academic Center, 11 patients underwent phonomicrosurgery with tragal perichondrium graft placement in Reinke's space for the treatment of sulcus (Ford type 2) and vocal fold scar. A total of six patients out of 11 had an additional autologous fat implantation in order to improve the glottic closure. We evaluated the functional outcome using the Spanish validated version of the VHI- 30 before and 6 months after the surgery. We also measured the subjective appreciation of the obtained outcome, a perceptual voice evaluation using GRBAS scale, and changes in videostroboscopy examinations concerning mucosal wave and glottic closure. In the VHI-30 questionnaire, we observed an improvement in all patients (six of which showed an improvement of 50% or more) with statistically significant results (P=0.003), and no significant differences between sulcus (Ford type 2) and vocal cord scar patients (P=0.7579). The results obtained from the single question assessing changes in voice quality showed a high improvement in seven patients. According to the GRBAS scale, all cases improved. Concerning the results of the videostroboscopy, two patients obtained very favorable results, eight of them presented a moderate recovery and only one improved slightly. The following complications were identified: two granulomas, a graft extrusion and a tragal infection. The tragal perichondrium used as an autograft in Reinke's space appears to be a safe and satisfactory choice, comparable to other grafts such as temporalis fascia or autologous fat.

Office-Based Steroid Injection in Benign Vocal Fold Lesions

Background: Benign vocal fold lesions (BVFLs) are usually caused by vocal abuse or misuse. Conservative treatment and micro laryngeal surgery (MLS) are recommended in the treatment. However, conservative measures are usually difficult to perform and some patients are contraindicated for general anesthesia.Objective: This study is designed to assess the practical application, effectiveness, and side effects of office-based steriod injection via a transnasal route.Patients and Methods: This study included 29 patients with BVFLs. Transnasal endoscopic steroid injection (TESI) was performed via operating channel for all patients. Local anesthesia was used to inject betamethasone into Reinke's space at the base of the lesion. Acoustic analysis, including fundamental frequency (F0), jitter, shimmer, noise to a harmonic ratio (NHR), aerodynamic analysis (MPT), auditory perceptual assessment using modified GRBAS scale, videolaryngostroboscopy (VLS) evaluations, and voice handicap index (VHI), was done before and three months after TESI.Results: Three months after injection, the VLS demonstrated that remission in size or lesions improvement was observed in 20 patients, total disappearance in 4 patients, and no improvement in 5 patients. The summation of the modified GRBAS scale also indicated highly significant improvement after TESI (P < 0.01). MPT showed a highly significant increase post-injection. VHI showed a highly significant reduction post-injection. Acoustic analysis revealed significant improvements in F0, jitter, shimmer, and NHR (P <0.05).Conclusion : Office-based TESI is an effective, safe, easy, and feasible alternative treatment method in some BVFLs

Epithelium of the human vocal fold as a vibrating tissue

ObjectivesThe human adult vocal fold mucosa, especially, superficial layer of the lamina propria (Reinke's space) has attracted notice as an important vibrating structure. However, fine structures of the stratified squamous epithelium of the human adult vocal fold, which is another histological component of the mucosa, remain enigmatic. MethodsThree normal human adult vocal folds and epiglottises and three newborn vocal folds were investigated. Observations using transmission electron microscopy and light microscopy including immunohistochemistry were performed. ResultsThe most obvious feature of the epithelium of the human adult vocal folds was that the intercellular spaces between adjacent epithelial cells were large (984 ± 186 nm) compared with the stratified squamous epithelium of the human adult epiglottis and the human newborn vocal fold.Even though intercellular spaces between adjacent epithelial cells of the human adult vocal fold were large, desmosomes at the junctions of two adjacent epithelial cells made firm intercellular adhesion. Tonofilaments composed of the bundles of intermediate filaments anchored to the desmosomes. Desmosomes formed a continuous cytoskeletal network throughout the epithelial cells and epithelium of the human adult vocal fold. In addition, a great deal of E-cadherin (adhesive glycoprotein) was present between epithelial cells especially the lower half of the stratified squamous epithelium of the human adult vocal fold. ConclusionsFrom the functional morphological point of view, stratified squamous epithelium of the human adult vocal fold seems to form a structural framework of tensile strength with pliability suitable structure for vibration.

Dilated Minute Chambers in Laryngeal Vocal Fold Polyps: Histopathological and Ultrastructural Features

In Reinke's space of human vocal fold, type III collagen forms a three dimensional network and this contains numerous minute chambers in between these fibers. These compartments are occupied by glycosaminoglycans and glycoproteins. In laryngeal fold lesions, such as Reinke's edema and vocal fold polyps, proteoglycan (PG)/hyaluronic acid (HA) components of extracellular matrix increased. We investigated the size and quantity of the minute chambers within Reinke's space, filled with PG/HA with the aid of transmission electron microscopy. Eight vocal fold polyps and 10 mucosal biopsies (as control group) were all evaluated by light microscopy and electron microscopy. We detected that PG/HA in extracellular matrix had been increased in vocal fold lesions when compared with control group, by Alcian Blue-pH 2.5 stain. The mean volume of the chambers in Reinke's space of normal larynx was measured as 0.040233 µm2 whereas the mean volume of these chambers in vocal fold polyps was measured as 6.420221 µm2. The difference between the volumes of these chambers in vocal fold polyps and in control group was statistically significant (P = 0.001). Within these chambers PG/HA were found and PG/HA filling these chambers were increased in vocal fold polyps. We think proteoglycan and glycosaminoglycans, especially HA, play an important role in determining biochemical properties of vocal fold lesions.

Laryngopharyngeal reflux disease in singers: Pathophysiology, clinical findings and perspectives of a new patient-reported outcome instrument

Purpose of reviewLaryngopharyngeal reflux (LPR) is an inflammatory disease associated with the development of voice disorder and vocal fold lesions. The occurrence of LPR in professional voice users as singers can have a dramatic impact of daily life. The aims of this paper is to review the current literature about the pathophysiological mechanisms underlying the development of voice disorder, especially in singers, and to propose a new patient-reported outcome instrument to assess complaints of these patients. Recent findingsMany clinical and experimental studies reported that LPR leads to the development of significant macroscopic and microscopic histological changes in the mucosa of the vibratory margin of the vocal folds. Epithelial cell dehiscence, microtraumas, Reinke's space modifications, inflammatory infiltrates, mucosal drying, and epithelial thickening are associated with LPR. These histological changes may modify the biomechanical properties of the vocal fold tissue leading to hoarseness. In practice, singers with LPR may have normal or discretely pathological speaking voice but impaired singing voice (vocal fatigue, hoarseness, and loss of range). To date, the literature about the specific LPR signs and symptoms in singers is almost non-existent. However, singers are at high risk to present LPR because of necessary air support involving higher intra-abdominal pressure, increased stress due to career management and uncomfortable schedules, late meals just before sleep, bad nutrition habits like increased intake of citrus products, fats foods and spicy foods. PerspectivesThe lack of clinical singer-reported outcome instrument may decrease the management of LPR in singers. In this context, the LPR Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) developed a new instrument to precisely assess symptoms related to LPR in singing voice. This instrument will be validated and could be used in clinical practice in voice centers.

Permeability and Weibel-Palade Bodies of the Blood Vessels in the Human Vocal Fold Mucosa.

Transendothelial exchange and permeability of the capillaries in Reinke space (the superficial layer of the lamina propria) of the vocal fold mucosa affect physiological and pathological conditions of the human vocal fold mucosa. The mechanism of permeability and Weibel-Palade bodies of the blood vessels in the human vocal fold mucosa were investigated using electron microscopy. Histologic analysis of the human vocal fold. Six normal human vocal folds (three adults and three newborns) obtained from autopsy cases and three human vocal folds with Reinke edema from surgical specimens were investigated under transmission electron microscopy. There were three possible capillary wall transport systems related to the permeability of the blood vessels in the vocal fold mucosa: 1) Fenestra transport, plasma exuded from the capillaries into surrounding tissue via the fenestration with or without a diaphragm; 2) vesicular transport (transcellular transport via vesicles), the use of vesicles to ferry fluid and solutes across endothelial cells; and 3) junctional transport (intercellular transport), molecules passed through intercellular gaps between endothelial cells. Weibel-Palade bodies were present in the cytoplasm of endothelial cells both in adults and newborns. They were present in high numbers in the cytoplasm of endothelial cells, with intercellular transport in the vocal folds with Reinke edema. There were three types of mechanisms for the permeability of the blood vessels in the human vocal fold mucosa. Some physiologically active substances, such as histamine produced by Weibel-Palade bodies, may adversely influence the permeability of the blood vessels. NA. Laryngoscope, 2588-2592, 2018.

Pericytes in the Human Vocal Fold Mucosa.

1. The human vocal fold is a vibrating tissue and vascular structures in organs which have the capacity to vibrate require a specific structure suitable for vibration. 2. The structure of the blood vessels is unique at the vocal fold edge as a vibrating tissue, where only small vessels, including arterioles, venules, and capillaries, are present. The capillaries are distributed in the superficial layer of the lamina propria (Reinke's space). 3. The blood vessels enter the vocal fold edge from the anterior or posterior end of the membranous vocal fold and run essentially parallel to the vocal fold edge. 4. Many pericytes can be seen around the capillaries in the human vocal fold mucosa. The cell bodies of the pericytes attach to capillary endothelial cells, and the branching processes encircle the capillaries and attach to the capillary endothelial cells at the tips. The processes of pericytes are in close contact with endothelial cells, sharing a common basement membrane with them. The tips of the processes form intercellular tight junctions with endothelial cells. 5. The pericytes in the vocal fold mucosa appear to provide mechanical support and protection to the capillary walls, particularly during phonation. The pericytes also appear to regulate the diameter of the capillary during and after phonation. Pericytes are also thought to be critical cells in vascular biology and angiogenesis, especially in revascularization following vocal fold tissue injury. 6. At birth, pericytes have already encircled the capillaries in the newborn vocal fold mucosa. The pericytes appear ready to provide support and protection of the blood vessels just after birth. 7. Vascular structures and their permeability are related to the specific structures and specific diseases of the human vocal fold mucosa as a vibrating tissue.

Reinke ödeminde enflamatuvar hücre tipleri

Objective: To evaluate the histopathological findings in Reinke's edema and correlate them with otorhinolaryngologic symptoms other than dysphonia. Methods: Patients diagnosed with Reinke's edema as the source of dysphonia from January to December 2016 were included in this retrospective study. The histopathological findings in Reinke's edema and the correlation with otorhinolaryngologic symptoms other than dysphonia were evaluated. Results: A total of 13 patients (3 females, 10 males) with Reinke's edema all of whom were smokers underwent surgery. In all of the specimens, the main histopathological finding was edema in the lamina propria of the vocal folds. The dominant inflammatory cell type in the stroma was determined by evaluating the whole microscopic subepithelial zone. The cell types included plasma cells, lymphocytes, monocytes, and neutrophils. Conclusion: In Reinke's edema the main pathologic finding is the collection of edematous fluid in Reinke's space. As our study was limited by the small number of cases, we could not find any statistically significant correlation between the inflammatory cell types and clinical characteristics of Reinke's edema.

Friedrich Berthold Reinke (1862–1919): brilliant yet troubled anatomist of the vocal fold

Reinke's space is a critical laryngeal structure, and the eponym remains in current use in both clinical and research settings. However, little is known about the life of the German anatomist Friedrich Berthold Reinke. His name is missing from the otolaryngological histories, despite his work on the structure he described being responsible for a fundamental advance in our understanding of the larynx. Although brilliant, Reinke was described as impetuous and coarse by his colleagues, resulting in his academic career being cut short. Reinke's relative anonymity is thought to derive from the fact that he never defined himself as a laryngologist. Without question, Reinke's observations of the human vocal fold are substantive contributions, without which modern laryngology could not have evolved. This article aimed to summarise this brilliant yet troubled man's life and achievements, allowing appreciation for his singular genius and fundamental contribution to laryngology.

Hyaluronan in Human Vocal Folds in Smokers and Nonsmokers—A Histochemical Study

To study the hyaluronan occurrence in human vocal folds, with special regards to gender and smoking and to discuss the implications of findings. This is a descriptive/morphologic study. Sixteen cadaveric vocal folds from eight individuals between 58 and 90years old (six women and two men) were removed and studied morphologically. Three of the individuals had been cigarette smokers. A direct method for hyaluronan histochemistry using a hyaluronan-binding protein probe (HABP) was used to visualize the polysaccharide. Five examiners performed an analysis of the intensities of hyaluronan staining, independently. We observed intense hyaluronan staining of the vocal folds of which those from women stained considerably stronger than those from men. Stratified squamous epithelium stained for hyaluronan in all sections, whereas respiratory epithelium only stained weakly or not at all. The highest accumulation of hyaluronan occurred subepithelially in the lamina propria, corresponding to Reinke's space. It was observed that vocal folds from smokers were more intensively stained than those from nonsmokers. Hyaluronan is found in all layers of the human vocal fold. Contradictory to earlier studies, hyaluronan was visualized in squamous epithelium, where it may function as an impact protector. The occurrence of hyaluronan in smokers may have implications in the development of vocal fold inflammation and tumor initiation as hyaluronan is an important molecule in these processes.

Transillumination for needle localization in the larynx

Transillumination through laryngeal soft tissue may be used to direct percutaneous transcricothyroid membrane subepithelial needle placement in the larynx. Cadaver simulation (canine and human). Lighted devices, including sialendoscopes and fiberoptic cables, were tested as transilluminating obturators in trocars and needles through multiple studies to identify appropriate illumination, monitoring, and equipment for successful localization of needle/trocar tips placed within laryngeal tissue. Lighted 250-micron fiberoptic cables within 23-gauge needles were successfully placed percutaneously through the cricothyroid membrane and maneuvered submucosally into Reinke's space, the midlateral vocal fold, and through the thyroarytenoid gap with monitoring via flexible transnasal laryngoscopy. Technical adaptations in the course of study permitted successful simulation of clinical use in full cadaver study for accurate injection laryngoplasty, confirmed by laryngeal dissection following collagen injection. Small caliber fiberoptic cables are useful as transilluminating obturators to accurately direct needle position within laryngeal tissue. Clinical application of this new technique is anticipated to improve the accuracy of percutaneous needle localization in the larynx, as well as to assist in directed instrumentation of the larynx from an external approach. N/A.

Using Hyaluronic Acid for Improving Vocal Function in a Prepubescent Boy With an Atrophied Right Vocal Fold

A single case study is reported of a child who underwent several surgical procedures as result of congenital grade III subglottic stenosis. The anterior aspect of the right vocal cord was damaged and underwent atrophy during one of these procedures. Now, an active 10-year-old, the patient has become increasingly aware of his vocal limitations on functional activities. Injection of hyaluronic acid into the vocal folds has been known to provide improved voice quality in adults although there are no known cases reported of this procedure in children. This article reports voice outcomes after injection of hyaluronic acid into the Reinke's space in a single case study. Voice recordings were made before, after, and 1month after injection. The voice recordings were subject to acoustic and perceptual analysis. Post and follow-up voice recordings demonstrate decreased jitter, shimmer, and harmonics-to-noise ratio. Perceptual evaluation indicates improved voice quality. Injection of hyaluronic acid in children who require voice augmentation is possible and may contribute to increased vocal function and improved voice outcomes.

The morphology of vocal fold polyps and mucosa in Reinke's edema

To investigate the morphogenesis of vocal fold polyps and Reinke's edema on the basis of clinical and morphological analyses of the histological and immunohistochemical data characterizing the state of the local microcirculatory bed and the mechanisms of its permeability impairment. Polyps of the vocal folds and their mucosal tissue samples in Reinke's edema mucosa, which had been obtained after microsurgical treatment of 31 patients (13 men and 18 women) aged 23 to 75 years, were studied using a wide panel of peroxidase-labeled monoclonal and polyclonal antibodies (DAB chromogen), including T and B cell differentiation markers, Toll-like receptors (TLR2, TLR4, and TLR9), the costimulatory molecule CD80 (B7- 1), and markers for angiogenesis (CD34), vascular and tissue permeability (matrix metalloproteinases (MMP-1 and MMP-9)), and vascular cell adhesion molecule-1 (VCAM-1). Results. All types of the examined polypoid hyperplasia were ascertained to realize through the impaired permeability of the wall of microcirculatory vessels in the membranous vocal fold portion called Reinke's space. The expression of molecules, such as CD34, VCAM-1, MMP-1 and MMP-9, as well as TLR4 and TLR9 was revealed on the endothelial cells of microcirculatory vessels. The epithelial lining cells simultaneously expressed the above-mentioned Toll-like receptors and the costimulatory molecule CD80 (B7-1) that modulated T cell lymphocyte activity (through CD28) or attenuation (through CTLA-4), ensuring the interaction of structures of innate and adaptive immunity. The morphogenesis of polypoid hyperplasia of the vocal folds is a result of an epithelial stromal interaction under poor etiological factors, such as high vocal loads, exogenic intoxications, and viral infections. The integumentary lining cells carrying Toll-like receptors initiate reactive alterations in Reinke's space.

The stratigraphical organisation of the microvascular systems of the porcine vocal folds.

The cranial and caudal vocal folds (CraF, CauF) of the glottis of adult minipigs (11-27 months; n = 12) were examined after immunohistochemical application of polyclonal anti-von-Willebrand-Factor and anti-Smooth-Muscle-Actin in serial paraffin sections. This examination aimed at a stratigraphical analysis of microvessels; data were compared with findings in humans which had been reported in the literature. (1) The distribution of the microvessels was very heterogeneous in the CraF and in the CauF, but a common pattern existed in both. (2) Characteristic vascular zones and rows were detected; each of them displayed a specific distribution and density of blood capillaries, arterioles, venules, lymphatic capillaries, and lymphatic precollectors. (3) A striking feature was the presence of a subepithelial Avascular Band and of a focal Avascular Area within the lamina propria of the fold's crests. (4) The vascular zones, the rows, the Avascular Band, and the Avascular Area could be allocated to specific layers of the lamina propria: subepithelial, superficial, intermediate, deep layer. (5) The loose Avascular Area at the level of the superficial layer of the lamina propria (in both CraF and CauF) corresponded to Reinke's space in humans in terms of structure and location. (6) The direction/course of blood and lymphatic microvessels shared common features with that of the human vocal fold.

Histomorphometric analysis of collagen and elastic fibres in the cranial and caudal fold of the porcine glottis.

The porcine glottis differs from the human glottis in its cranial and caudal vocal folds (CraF, CauF). The fibre apparatus of these folds was studied histomorphometrically in adult minipigs. For object definition and quantification, the colour-selection tools of the Adobe-Photoshop program were used. Another key feature was the subdivision of the cross-sections of the folds into proportional subunits. This allowed a statistical analysis irrespective of differences in thickness of the folds. Both folds had a distinct, dense subepithelial layer equivalent to the basement membrane zone in humans. The subsequent, loose layer was interpreted - in principle - as being equivalent to Reinke's space of the human vocal fold. The next two layers were not clearly separated. Due to this, the concept of a true vocal ligament did not appear applicable to neither CauF nor CraF. Instead, the body-cover model was emphasized by our findings. The missing vocalis muscle in the CraF is substituted by large collagen fibre bundles in a proportional depth corresponding to the position of the muscle of the CauF. The distribution of elastic fibres made the CraF rather than the CauF more similar to the human vocal fold. We suggest that these data are useful for those wishing to use the porcine glottis as a model for studying oscillatory properties during phonation.