[Laryngeal squamous cell carcinoma in a 12-year-old boy]. / Plattenepithelkarzinom des Larynx bei einem 12-jährigen Jungen.

This is a case report on a middle grade differentiated keratinized squamous cell carcinoma of the larynx in a 12-year-old boy. Squamous cell carcinoma of the larynx is very rare in children and adolescents and in older literature studies less than 70 cases have been reported in children. Histologically the same variants are present as in adults. The way to the final diagnosis of laryngeal carcinoma often takes longer in children because dysphonia or dyspnoe are often caused by other pediatric diseases, risk factors such as those found in adults cannot be elucidated and many symptoms can be due to incomplete development of the laryngeal skeleton. Generally speaking, prior radiation therapy of the neck region and papillomatosis have been described as risk factors. In rare cases translocations or mutations can play a causative role.

Integration of human papilloma virus type 26 in laryngeal cancer of a child.

Squamous cell carcinoma (SCC) in larynx is rare with children and adolescents. Usually larynx cancer is common with male smokers in the 7th decade. Among patients with no history of tobacco and/or alcohol consumption several factors have can play a role in the outbreak of laryngeal cancer: such as individual predisposition, radiation, gastroesophageal reflux, viral infection, dietary factors and environmental influences. In literature only few cases of laryngeal cancer with children are reported. Recent studies show that the most frequent laryngeal malignancy is the embryonal rhabdomyosarcoma. Besides the recurrent respiratory papillomatosis (RRP) based on an infection with human papilloma virus (HPV) types 6 and 11 (low risk) and types 16 and 18 (high risk) is known for a possible malignant transformation towards a SCC. HPV type 26 is only reported as low risk type HPV associated with cervical cancer. Final diagnosis often takes a long time. Initial symptoms such as hoarseness, cough or shortness of breath are often referred to more typical pediatric diseases or laryngeal development.

[Functional anatomy of the larynx from clinical points of view: part II: Laryngeal mucous membrane, blood supply, innervation, lymphatic drainage, age-related changes]. / Update Larynx: funktionelle Anatomie unter klinischen Gesichtspunkten: Teil II: Kehlkopfschleimhaut, Blutgefässversorgung, Innervation, Lymphabfluss, Altersveränderungen.

Diseases of the larynx are of concern not only for ear, nose, and throat physicians and phoniatricians but also for other clinicians who treat the larynx either conservatively or surgically, including speech therapists, pediatricians, anesthetists, oncologists, pulmonologists, radiologists, and general practitioners. Based on today's state of knowledge and taking into account our own research results of the last years as well as clinical points of view, the present contribution gives a short overview of the anatomy and physiology of the larynx. Part 2 discusses the functional anatomy of the laryngeal mucous membrane (glycoconjugates, mucins, trefoil factor family peptides, antimicrobial substances, larynx-associated lymphoid tissue), the vascular supply, innervation, and lymphatic drainage, as well as age-related laryngeal changes and their effects on swallowing, breathing, and phonation.

[Functional anatomy of the larynx from clinical viewpoints. Part I: development, laryngeal skeleton, joints, insertion structures, musculature]. / Update Larynx: funktionelle Anatomie unter klinischen Gesichtspunkten. Teil I: Entwicklung, Kehlkopfskelett, Gelenke, Stimmlippenansatz, Muskulatur.

ENT specialist and phoniatricians are not the only professionals for whom diseases of the larynx occupy centre stage; this applies to those in all fields involving conservative or surgical treatment of the larynx, such as speech therapists, paediatricians, anaesthetists, oncologists, pulmonologists, radiologists and general practitioners. On the basis of current knowledge and taking account of results yielded by their own research in recent years and of clinical aspects, in this paper the authors give a short overview of basic knowledge on the anatomy and physiology of the larynx. Part 1 deals with its development and division, the laryngeal skeleton and joints, the insertion structures of the vocal folds and the laryngeal musculature and describes new insights into the mineralization and ossification of the laryngeal skeleton and their implications for phonation, arytenoid subluxation, degenerative joint changes and the biomechanics of vocal cord insertion.

[Ultrastructural analysis of secretion-transport through the parotid duct]. / Ultrastukturelle Analysen zum Sekrettransport im Ductus parotideus.

BACKGROUND: Mechanisms of secretion transport through the parotid duct (stenon's duct) and their influence on diseases of the parotid gland have not been investigated sufficiently until today. METHODS: According to this background we performed histologic and scanning electron microscopical investigations of 23 parotid ducts in order to investigate the arrangement of fibrillar structures of the duct as well as get deeper insights into the physiology of secretion transport mechanisms. RESULTS: The subepithelial soft tissue of the parotid duct could be divided into two layers. The inner layer measured about 100-200 microm and consisted of collagen and elastic fibres running in a spiral arrangement. The outer layer varied in its thickness and was composed of collageous fibres, which were mostly arranged longitudinally. CONCLUSIONS: The arrangement of collagen fibrils in the wall of the parotid duct seems to influence secretion transport. Due to the spiral organization of collagen fibrils, distension of the duct is likely to be associated with a "wring-out" mechanism leading to unidirectional transport of saliva into the oral cavity. A muscular sphincter at the outlet of the parotid duct did not exist. The duct pierced the buccinatory muscle. Here, it was surrounded by sceletal muscle fibres that lead to a functional closure during contraction. Our results indicate that an active transport of saliva through the parotid duct--as so far assumed--is unlikely.

Antimicrobial defence mechanisms of the human parotid duct.

The parotid duct transports saliva from the gland into the oral cavity. However, its immune response properties, along with the secretion and moistening principles of the duct, have not yet been fully investigated. These properties may play an important role in protecting the parotid gland from infection and also prevent development of sialodocholithiasis, as the parotid duct -- in contrast to the submandibular salivary duct -- is often free of duct concrements. Up to now, only the parotid gland has been investigated, without regard to its duct. The present study analyses the structures of the parotid duct in their relations to antimicrobial defence mechanisms and rheological properties. Investigations were performed on 23 parotid ducts using histological, histochemical and immunohistochemical methods. Epithelial and goblet cells of the parotid duct synthesize a complex mucous layer that covers the epithelium. The viscosity is influenced by secreted mucins and TFF peptides. This layer contains carbohydrates including N-acetyl-glucosamine, N-acetyl-galactosamine, galactose, mannose, fucose and sialic acids. The lamina propria contains granulocytes, T lymphocytes and macrophages. IgA, produced by plasma cells in the subepithelial layer, is frequently integrated in the secretory product. Synthesized mucins, TFF peptides, carbohydrates and immunoglobulins form a complex layer that can be expected to prohibit infection and enables salivary flow. Our study demonstrates that the steady secretion of the parotid gland, together with the ductal cellular and biochemical immune protection system, is likely to thwart ascending infections in the parotid duct and gland.

[Influence of the head position in laryngoscopy]. / Einfluss der Kopfposition auf den laryngoskopischen Bildbefund.

INTRODUCTION: The aim of this study was to determine the optimal position of the head during larygoscopy. MATERIAL AND METHODS: During fiberoptic evaluation of the larynx, the head position of eight subjects (5 male, 3 female) was changed systematically. The influence of reclining and anteversion, tilting and rotation of the head on the quality of the endoscopic images was determined. RESULTS: The vocal tract became wider and the view onto the glottis could be improved by reclining the head and anteversion of the chin. On rotation of the head, the hypopharynx of the same side became narrower. This is well known and is used worldwide in the therapy of dysphagia. DISCUSSION: Positioning of the patient is important in laryngoscopy. Reclining the head and forward inclination of the trunk (horizontal axis of the mouth) seems to be the best position for obtaining an optimal view onto the glottis.