This study was carried out to determine the ultrastructure of the mucous membrane of vocal folds of human newborns. Excised larynges of newborns were observed with a transmission electron microscope.
The results obtained are summarized as follows: 1) The epithelium of the edge of the vocal folds consisted of stratified squamous epithelium. It was thin but numerous desmosomes showed firm attachment between cells. 2) The basement membrane zone had the same structure as that of adults. 3) The lamina propria of the vocal fold mucosa was loose in structure and there was no vocal ligament. 4) Fibroblasts were sparse and in the resting phase. 5) Collagenous and elastic fibers were sparse in the lamina propria. Structures of the collagenous fibers were mature but those of elastic fibers, were immature morphologically. 6) Ground substance was abundant in the lamina propria. 7) The newborn vocal fold mucosa lacked not only a vocal ligament but also adequate viscoelasticity for vibration.

View full abstract

We studied the clinical and histopathological characteristics of granular cell tumor (GCT) of the tongue in 5 cases (2 males and 3 females) over a period of 25 years. The patients ranged in age from 8 to 44 years old. In 4 cases, the site of origin in the tongue was the anterior two thirds of the lateral border (UICC). In the remaining case, the tumor originated on the dorsal surface of the tongue (UICC). The tumor was 3-10 mm long and had an average diameter of 6mm. The lesions were painless. The cellular granules in all the tumors reacted positively to PAS regent and S-100 protein using immunohistological methods. Other immunohistological staining using antiactin antibody showed cellular granules beneath the epithelium. In one case, these findings were especially marked in the portion that exhibited peudo-epitheliomatous hyperplasia. There was a mixture of both positive and negative cells in the deep layer of the epithelium. Not all tumor cells stained with anti-desmin antibody, however, there appeared to be a direct transitions from stained striated muscle fibers to the tumor cells. Staining with antivimentin antibody was positive at the boundaries between cells and the positive granules in cells appeared in the dots. Two of the five, tumors were unencapsulated, and the other 3 were partially encapsulated. The constituent fibers of the capsule consisted of collagen fibers alone. Thus, the former 2 cases should be regarded as proliferative in nature, and the latter 3 as benign. These tumor cells were potentially very active beneath the epithelium.
From the results of our immunohistological stainings, we concluded that myoepithelial cells might also be the source of GCT cells, although GCT cells have generally been reported to originate from muscle and nerve cells.
We maintain that care must be taken when removing GCTs because there may be proliferative growth along the epithelium.

View full abstract

Neurovascular compression syndrome of the 5th and 7th cranial nerves has been recognized as the cause of trigeminal neuralgia and hemifacial spasm. On the other hand, it is still difficult to diagnose vertigo as neurovascular compression syndrome of the 8th cranial nerve. To detect some specific finding in this syndrome of the 8th cranial nerve, 5 patients with vertigo with hemifacial spasm were examined for the clinical course and neurootological features. In all patients MRI and/or angiography suggested vascular compression against the 8th cranial nerve. The clinical courses of these patients revealed various symptoms resembling benign paroxysmal positional vertigo, vestibular neuronitis and Meniere's disease. Audiograms showed two normal hearing patterns, bilateral high frequency hearing loss probably due to aging in one case, bilateral C5-dip in one and fluctuating unilateral hearing loss like Meniere's disease in one. The prolongation of IPL I-III on auditory brainstem response proposed as a criterion by Møller was detected in one case. No response in the caloric test was found in two cases. These abnormalities in the auditory brainstem response and caloric test appeared to be useful for diagnosis but were uncommon findings in all cases. Electronystagmographic examinations including the eye tracking test, optokinetic nystagmus and optokinetic pattern were all normal. We could not find any specific clinical findings valuable for diagnosis of neurovascular compression syndrome of the 8th cranial nerve. It is proposed that the indication of microvascular decompression should be decided carefully.

View full abstract

The lamina propria of the human vocal fold consists of a superficial, intermediate, and deep layer. This stratified structure is thought to facilitate phonation. Each layer has different physical properties based on different alignment and distibution of collagen and elastic fibers. In the present study, developmental changes in vocal fold structure were studied in human fetuses, infants, and children, with special reference to the pattern of distribution of collagen and elastic fibers.
Vocal fold specimens were obtained at autopsy from 5 fetuses, 7 neonates, 3 infants, 3 children at the age of 1 year, 3 children at 3 years, 3 children at 5 years, 3 children at 12 years, and 5 subjects at ages ranging from 15 to 22 years.
Prior to the examination of collagen fibers, elastic fibers and cells were dissolved with 10% sodium hydroxide treatment. Prior to the examination of elastic fibers, collagen fibers and cells were dissolved by treatment with 90% formic acid. The specimens were then dehydrated, dried, ion-coated with platinum, and examined with a scanning electron microscope.
In fetuses and infants, thin, coiled fibers were found distributed densely in the anterior, posterior, and deep parts of the lamina propria, while irregular thick fibers were sparsely seen in the superficial layer of the vocal fold.
In children aged 1 to 3 years, the dense fibers in the deep part decreased, and the longitudinal fibers in the superficial layer increased.
In children at 5 years of age, longitudinal collagen and elastic fibers were noted in all of the layers of the vocal fold. The distribution of fibers was uniform irrespective of the depth.
At 12 years of age, thin, coiled fibers were noted in the superficial layer, while thin, irregular fibers were found in the deep layer.
At 17 years, differentiation of the superficial and deep layers was more evident.
In male subjects after adolescence the curvature of curly collagen fibers decreased, and the diameter of fibers increased.
The present findings suggest that the development of the vocal fold in childhood occurs in two steps.
In the first step, dense fibers in the anterior, posterior, and deep parts of the lamina propria found in fetuses and infants shift to the anterior and posterior ends of the vocal fold, between which longitudinal fibers appear. During this step only simple phonation is possible.
In the second step, differentiation of the superficial and deep layers occurs, and the stratified structure of the vocal fold appears in the teens. This step is probably related to the complicated modality of phonation in this age group.
In males, the development of the vocal fold is completed after changes in collagen fibers during the mutation.

View full abstract

The distribution of γδ-T cells (γδ-TCR positive cells) in nasal mucosa and polyps was studied in patients with nasal allergy and non-allergic patients. The biopsy specimens from the inferior turbinate and resected polyps were frozen at -70°C and sliced at a thickness of 4μm with a cryostat. Monoclonal antibodies (CD3 and TCR-γδ-1) and the Labelled Streptavidin Biotin method were used to detect T lymphocytes and γδ-T cells. The results were as follows: 1) The rate of γδ-T cells in the epithelium is higher than that in the lamina propria in patients with nasal allergy. 2) In non-allergic patients, on the other hand, the rate of γδ-T cells was almost the same in these layers. 3) The distribution of γδ-T cells in nasal polyps was uniform and their rate was relatively high. It has been reported that γδ-T cells can recognize a stress antigen such as heat shock protein. These cells are thought to play an important role in non-specific immunoreactions. This study suggests that γδ-T cells in the nasal mucosa play an important role also in specific immunoreactions.

View full abstract

Adult supraglottitis is an acute inflammation of the supraglottic structures first reported by Shapiro et al. While multiple anatomical sites in the larynx and oropharynx are inflamed, the epiglottis is not always the most involved area. In this paper, we refer to “adult supraglottitis” as “acute supraglottitis” because pediatric supraglottitis is rare in Japan.
There have been no reports of acute supraglottitis in Japan to date. We report a clinical study of 15 cases of acute supraglottitis. In addition, we investigated whether acute supraglottitis can be recognized as a special form of acute laryngitis, the same as epiglottitis. Thirteen of 15 patients had severe sore throat or pain on swallowing. Oropharyngeal and laryngeal examinations revealed that the most involved area in the oropharynx and larynx was the aryepiglottic folds and the arytenoids. Five patients with edema extending from the aryepiglottic folds to the arytenoids complained of referred otalgia on swallowing. Strep. pyogenes, Strep. pneumoniae, α-strep., and Staph. aureus were isolated from the oropharynx. All patients were hospitalized because of severe presenting symptoms. Treatment consisted of intravenous antibiotics, including piperacillin, clindamycin, flomoxef, aspoxicillin, and cefotiam. Nine patients also received intravenous steroids. Signs and symptoms of supraglottitis resolved within 10 days in every case. No patient required airway intervention.
Acute supraglottitis manifested more severe clinical symptoms than acute laryngitis. The local inflammatory findings of this disease were different from those of acute laryngitis and epiglottitis. Therefore, we propose that acute supraglottitis is a special form of acute laryngitis.

View full abstract

We investigated the p53 expression and the presence of HPV DNA in 90 patients with squamous cell carcinomas (SCCs) of the head and neck and the relation to clinicopathological parameters and patients' prognosis. Immunohistochemical analysis of p53 protein was conducted by using monoclonal anti-p53 antibody, clone 1801 and clone 240. The relationship between the overexpression of p53 and the duration of survival of patients was analyzed. The polymerase chain reaction (PCR) was carried out with consensus primers capable of detecting HPV16, 18, 31, 33, 52b and 58. In situ hybridization was performed in the mesopharyngeal carcinoma to confirm the presence of HPV genomes in cancer cells with a wide-spectrum cDNA probe capable of detecting HPV6, 11, 16, 18, 30, 31, 33, 35, 45, 51, 52. Forty-five tissue samples (50%) were immunohistochemically positive for p53. T-category, N-category, primary site of tumor, clinical stage and tumor differentiation did not correlate with p53 expression. Our finding that p53 overexpression occurred in 50% of head and neck tumor samples is similar to the frequency of p53 overexpression reported for both lung and esophageal cancer. The common risk factor is the same in these neoplasmas, and therefore it is not surprising to find a similar percentage of p53 overexpression. The prevalence of metastasis was higher in the patients with p53-positive staining than in those with p53-negative staining (p<0.10). Analysis of cumulative survival rates of patients by the Kaplan-Meier method showed a close correlation between p53 expression and survival time. The survival differences according to p53 immunostaining were significant (p<0.05). Our results indicate that p53 immunohistochemical evaluation may be useful as one of the new prognostic parameters in head and neck cancer patients. The HPV genomes were detected in 9 of 90 patients (10.0%); 8 of 9 patients with mesopharyngeal cancer and one with maxillary cancer, namely, 29.6% of mesopharyngeal cancers and 6.7% of maxillary cancer contained HPV DNA sequences. Seven of 8 patients had SCCs of tonsil origin. Almost all of the HPV infections in our study occurred in patients with mesopharyngeal cancer, and it has been suggested that this anatomic subsite may be more frequently infected by HPV than other sites within the head and neck region. Among the 27 patients with mesopharyngeal cancer, HPV DNA-positive patients experienced a higher incidence of complete remission than HPV DNA-negative patients (87.5% vs. 26.3%, p<0.05).

View full abstract