Morphological Characteristics of the Oropharyngeal Cavity (Tongue, Palate and Laryngeal Entrance) in the Eurasian Coot (Fulica atra, Linnaeus, 1758).

The present study represents the first definitive anatomical description of the oropharyngeal cavity of the coot Fulica atra. For this purpose, the organs of six birds were prepared to examine grossly and by SEM and stereomicroscope. The oval lingual apex had multiple overlapping branched acicular processes on its anterior and lateral border. The lingual apex and body had multiple caudally directed filiform-like papillae. By stereomicroscopy, the lingual root had a characteristic appearance and consisted of four parts. The openings of the anterior glands were present on the dorsal lingual surface of the body, while the projected papillae with wide openings of the posterior glands were present on the dorsal surface of lingual root. There was a row of caudally directed pharyngeal papillae at the caudal border of the laryngeal mound. Grossly, the pharyngeal papillae arrangement took a W-shape, while by stereomicroscopy was observed to be heart shape. The palate was divided into two regions: a small rostral non-papillary and a large caudal papillary region, but the rostral region was characterized by the presence of three longitudinal ridges. The papillary crest had two paramedian longitudinal papillary rows, which continued caudally until the beginning of the third median row. The freely distributed papillae took a caudolateral direction, while the papillae encircling the rostral part of choanal cleft took a caudomedial direction. There was a transverse papillary row between the two parts of choanal cleft. There was a transverse papillary row between the caudal border of the infundibular cleft and oesophagus.

Perceptual consequences of changes in epilaryngeal area and shape.

The influence of epilaryngeal area on glottal flow and the acoustic signal has been described [Titze, J. Acoust. Soc. Am. 123, 2733-2749 (2008)], but it is not known how (or whether) changes in epilaryngeal area influence perceived voice quality. This study examined these relationships in a kinematic vocal tract model. Epilaryngeal constrictions and expansions were simulated at the levels of the aryepiglottic folds and the ventricular folds in the context of four glottal configurations representing normal vibration to severe vocal fold paralysis, for the three corner vowels /a/, /i/, and /u/. Minimum and maximum glottal flow, maximum flow declination rate, spectral slope, cepstral peak prominence, and the harmonics-to-noise ratio were measured, and listeners completed a perceptual sort-and-rate task for all samples. Epilaryngeal constriction and expansion caused salient differences in voice quality. The location of constriction was also perceivable. Vowels simulated with aryepiglottic constriction demonstrated lower maximum airflow and less noise than the other epilaryngeal shapes, and listeners consistently perceived them as distinct from other stimuli. Acoustic differences decreased with increasing severity of simulated paralysis. Results of epilaryngeal constriction and expansion were similar for /a/ and /i/, and produced slightly different patterns for /u/.

Ultrastructural evaluation of 585-nm pulsed-dye laser-treated glottal dysplasia.

OBJECTIVE/HYPOTHESIS: To describe the ultrastructural changes occurring within pulsed-dye laser (PDL)-treated glottal tissues. STUDY DESIGN: Prospective. METHODS: Nine patients presenting with glottal dysplasia requiring biopsy to rule out microinvasive carcinoma were enrolled in this prospective study. At least two samples were obtained in each case: one from a PDL-treated area and another from a non-PDL-treated area (obtained from a nonphonatory region as an internal control). In some cases, a third sample was obtained from the junction between PDL- and non-PDL-treated areas. All samples were examined with light microscopy (H and E stain) and transmission electron microscopy. Observations were made of morphological changes within the epithelium, epithelial/ superficial lamina propria (SLP) junction, and the lamina propria of tissues treated with the PDL. Eight of nine patients were followed for a period of 9-25 months (mean, 18 months) with two recurrences that were retreated with awake-PDL and followed for an additional 8.3 and 9.5 months without recurrence. Vocal fold appearance returned to normal within 3-4 weeks posttreatment. RESULTS: Intraepithelial desmosome junctions were preferentially destroyed, and regional blood vessels were coagulated. The PDL consistently caused a separation of epithelial cells away from the basement membrane. CONCLUSIONS: The PDL allowed for both a surgical and a nonsurgical multimodality method for treatment of precancerous lesions with minimal effects on the SLP.

Anatomical definition of the subglottic region.

BACKGROUND: Due to laryngeal neoplasia, as well as infectious and autoimmune diseases, the subglottic region is of great clinical relevance. However, descriptions of the subglottic structures are inconsistent. The aim of our study was to present a precise analysis of the subglottic region and derive functional and clinical conclusions. METHODS: Histological, histochemical and immunohistochemical investigations as well as scanning electron microscopy were performed and combined with injection techniques applied to the subglottic region of the larynges of 33 body donors. RESULTS: The three-dimensional extensions of the subglottic region were newly defined: the inferior arcuate line of the vocal cord was defined as the cranial border. The lower margin of the cricoid is the caudal border. Craniolaterally, the elastic cone and, further caudally, the cricoid form the border. Therefore, the definition presented comprises heretofore unnamed ventral and dorsal parts of the lower larynx. The subglottic region can be described as cylindrical, becoming smaller in the cranial direction, following the elastic cone. The ventral boundary is formed by the median part of the cricothyroid ligament (ligamentum conicum), the dorsal part by the cricoid cartilage. The walls of the subglottis are divided into three or four layers composed of collagenous and elastic fibres in which seromucous glands are embedded. Subglottic blood vessels including a tight subepithelial capillary plexus were delineated. CONCLUSION: The new definition of the subglottic extensions presented is helpful and essential for precise laryngeal tumour classification. The results indicate that the boundaries are unlikely to counteract tumour progression in the subglottis. Furthermore, the findings suggest that these structures contribute to temperature regulation of breath, protection against inflammation as well as breath frequency and depth-dependent mucus secretion.

Fetal airway wound repair: a new frontier.

PURPOSE: Fetal dermal repair is regenerative and scarless until middle to late gestation, when there is a transition to fibrotic repair. Fetal skeletal muscle and tendon undergo repair with fibrosis similar to the process in adults. This study addresses whether fetal mucosal healing is regenerative and scarless. METHODS: Anesthetized pregnant rabbits underwent laparotomy and controlled hysterotomy at 21 to 23 days' gestation (term is 31 days). A midline thyrotomy was made, followed by cricoidotomy and circumferential cauterization of the subglottic mucosa. A similar insult was applied to weanlings. The data were collected in 2 groups. One group was followed to term and killed at 4 weeks. A second group was killed after 6 days (30 days' gestation). The weanlings were killed at similar points. The larynges were harvested and processed for histological and morphometric analysis. RESULTS: Three litters were followed to term. Of these, 1 was not recovered; in the other two, 7 of 8 manipulated fetuses were found and 3 of 8 were viable. The fourth litter was harvested after 6 days; all 4 injured fetuses were recovered and viable. All animals in the fetal injury groups healed with complete regeneration of the airway mucosa. In contrast, weanlings injured post partum had mucosal inflammation, necrosis, and ulceration; squamous metaplasia and basal cell hyperplasia were also found. There were fibrosis, granulation tissue, and inflammation in the lamina propria; chondritis, cartilaginous necrosis, chondrolysis, and perichondritis were also found. CONCLUSIONS: Fetal airway mucosal healing is regenerative and, thus, scarless. This study provides further support for the thesis that skin and mucosa respond to injury similarly in both the developmental and postpartum stages, and that subglottic stenosis is reasonably thought of as the "hyperplastic scar" of the airway. These results have potential therapeutic applications for mucosal wound management.

[The anterior commissure of the larynx in the subperichondral functional surgery of the glottic plane: critical evaluation on the basis of a serial section study in normal and neoplastic laryngeal specimens]. / La commissura anteriore della laringe nella chirurgia funzionale sottopericondrale del piano glottico: considerazioni critiche sulla base di uno studio istologico seriato in laringi normali e neoplastiche.

It is a well-known fact that the clinical growth of laryngeal cancer varies according to the site of its origin. A number of macro and microscopy studies have attempted to explain the various routes it follows in spreading. The anatomical features of the anterior commissure, the conus elasticus and posterior commissure condition the direction and extent of tumour spreading as do the blood supply in the glottis and the distribution of mucous glands in the glottis and subglottis. Of the various regions of the larynx, the anterior commissure has provided perhaps the greatest challenge to investigators in that its boundaries as well as its morphology are still not clear. The possible spreading of glottic cancers exceeding these anatomic structures is very difficult to evaluate using two dimensional picture given by laryngoscopy as well as the images provided by TC and NMR which justifies a different behavior of same stage. Therefore these elements, in addition to the absence of a universally accepted clinical definition of the boundaries of AC, justify the diagnostic, pathologic, and therapeutic problems linked to AC carcinoma. Eight normal adult larynges were studied by microdissection and serial section after fixation in 10 percent formalin followed by decalcification. These specimens were dissected according to the stages of "evisceratio laryngis" performed in our Department for the treatment of T1a, T1b tumors. Our observations confirm that the island located at the anterior insertion of the thyroarytenoid muscle, easy reached during subperichondral dissection, cannot be identified with the so-called tendon described by Broyles. The specimens shown circumstantiate the fact that this fibrous-cartilagineous island act as a barrier and that when the neoplasia does start to spread into this segment, this fibrous area forces it to spread mainly along the surface. Our observations were confirmed by histologic examination of 6 surgical specimens after "evisceratio laryngis" performed on T1a, T1b tumors. Clinical positive results in subjects treated employing "evisceratio laryngis" appear to further confirm of our interpretation to these morphological observations.

Endoscopic laser management of supraglottic cancer.

Current concepts of endoscopic management of supraglottic cancer are an extension of precepts fostered by Jackson. The current approach has been facilitated by a half century of technological developments: the surgical microscope, the CO2 laser, improved laryngoscopes, and general endotracheal anesthesia. Selected small-volume cancers can be curatively resected, whereas excisional biopsy can be performed on larger neoplasms. With this cost effective minimally-invasive surgical approach, there is less disturbance of normal tissue, thereby minimizing morbidity rate and hospitalization. If the transoral excision is inadequate, radiotherapy can not be depended on to eradicate known residual disease. Endoscopic resection of supraglottic cancer should not alter the surgeon's standard management of the neck.

Nucleolar organizer regions in glottic carcinomas: comparison of DNA cytofluorometry and clinicopathological analysis.

The significance of nucleolar organizer regions (NORs) and nuclear DNA content in 73 glottic carcinomas was assessed for proliferative activity and tumor progression. NORs stained with silver colloid were counted, and nuclear DNA content was assayed by cytofluorometry. The cytofluorometric study demonstrated that the percentage of tumors with aneuploidy tended to increase as histological differentiation decreased. Survival rates of patients with diploid and aneuploid tumors were not significantly different. AgNOR staining revealed that mean AgNOR numbers rose as histological differentiation of tumors decreased. Moreover, as T and N categories and stages showed advancing malignancy, mean AgNOR numbers tended to rise. However, there was no significant difference in survival rates between tumors with low and with high AgNOR counts. These studies indicate that while AgNOR staining is better than DNA cytofluorometry for determining histological differentiation of glottic carcinoma, neither is of prognostic value at the present time.

The posterior glottis.

The posterior glottis is an area of the larynx previously referred to by the terms 'posterior commissure' and 'interarytenoid'; these are poorly defined and a new definition of this unique area of the larynx is provided. Within the text is a series of experiments performed on nearly 300 larynges. The posterior glottis was examined in relation to the following: the embryology, the epithelium, mathematical dimensions, gross anatomy, microanatomical structures, submucosal spaces and the spread of carcinoma related to this area. Various significant findings were made. There exists a pharyngoglottic duct which divides the embryonic larynx into anterior (membranous) and posterior (cartilaginous) parts. The epithelium of the posterior glottis in neonates and non-smokers is respiratory in nature and the notion of a laryngeal respiratory function is reinforced by a mathematical analysis of the cross sectional areas of the larynx during inspiration. The presence of a posterior cricoarytenoid ligament which stabilizes the arytenoid is confirmed. The spread of carcinoma to the posterior glottis from the different primary laryngeal and pyriform fossa sites shows differing modes of invasion but in particular a direct extension and connection with the subglottis. The most significant conclusion from these studies is that the posterior glottis is so intimately related to the subglottis that it must be considered as part of the subglottis. The acceptance of this fact, however, requires a new definition of the larynx from that given by the American Joint Committee on Cancer Staging and that of U.I.C.C. The posterior glottis considered as part of the subglottis requires a review of our present understanding of the structure and function of the larynx and in particular the spread of cancer posteriorly.