Although phonosurgery has resolved various aspects of voice disorders, it still remains difficult to regenerate the tissue properties of the stiffened or degenerated vocal fold mucosa. Recent advancements in molecular biology, tissue engineering and regenerative medicine has shed a light on overcoming this challenge. Since the myriad distribution of extracellular matrix (ECM) components defines the viscoelasticity of the vocal fold, it is important to well characterize the location and function of each molecule in the vocal folds, as well as to develop some strategies to restore the ECM distribution in order to regenerate the tissue properties. Several investigations have revealed histologic and genetic features of normal, scarred, and aged vocal folds. Innovative treatments targeting key molecules have been researched using animal models and human cases. These treatments included an implant of hyaluronic acid and growth factor therapy. Further studies are required for the development of a molecular approach to the restoration of vocal fold mucosa.
Utilizing laryngeal tissue removed from glottic-type laryngeal cancer patients, immunohistopathologic evidence of invasion into surrounding cartilage was examined. The 40 subjects of this study were glottic carcinoma patients who had undergone total laryngectomies at the Kurume University Hospital between 1988 and 2002. Laryngeal cartilage invasion was observed in 22 of the 40 subjects. The cause of death by primary disease was observed predominantly in patients with cartilage invasion. Using immunohistochemical techniques, it became evident that the perichondrium of normal laryngeal cartilage was constructed of type 1 and type 3 collagens. In some glottic carcinomas, immunohistochemical positive staining of types 1 and 3 collagenases detected expression of matrix metalloproteinases [MMPs] 1, 3 and 8. These findings suggest the possibility that glottic carcinomas secrete MMP, damage the membranous portion of cartilage and, as a result, facilitate the invasion of cancer cells. Analyses of consecutive sections revealed the distribution of S-100 protein positive (Langerhans) cells. These results also demonstrate that MMP-2 and S-100 positive cells are useful as markers for indicating invasion of glottic carcinomas into laryngeal cartilage.
Episodes of acute epiglottitis in 18 patients, including 6 cases with epiglottic abscess were analyzed retrospectively. None of the acute epiglottitis cases had airway obstructions that necessitated airway management. With the epiglottic abscess cases, however, tracheal intubations or tracheostomies were performed. Cultures retrieved from the abscess cavities revealed normal pharyngeal flora and anaerophytes. Except for one case, all cases with epiglottic abscesses were accompanied by inflammation at the inferior pole of palatine tonsil. Pharyngeal inflammation was seen in all cases of epiglottitis with bilateral arythenoid swelling. Acute epiglottitis with pharyngeal inflammation seems to have a high risk of progressive upper airway obstruction.
A rare case of adductor spasmodic dysphonia treated with a botulinum toxin injection after a bilateral thyroarytenoid myectomy is reported. We discuss the difficulty of diagnosis and therapy of spasmodic dysphonia. The patient was a 60 year-old male, whose profession depended on his voice. He had felt dysphonia over 20 year period. He had tried voice therapies and folk remedies at otolaryngological and psychopathological hospitals; however, the symptom had not improved. Later he read an article regarding spasmodic disphonia in a newspaper and subsequently visited Osaka University Hospital. He was then diagnosed with adductor spasmodic dysphonia. A bilateral thyroarytenoid myectomy was performed in March of 2001. After the operation, the dysphonia had improved and he was able to spend dairy life with better vocalization. Although it initially appered that there would be no recurrence, he gradually came to sense dysphonia slightly. This dysphonia however was to a degree that couldn't be objectively recognizeed. He hoped this symptom could be remedied because of his occupation as a Buddhist priest and singer of Japanese court music. Boturinum toxin injection therapy was recommended to him. After this treatment, the symptom improved. He presently continues this therapy.
The decline of tuberculosis has resulted in laryngeal tuberculosis becoming rare. We observed only two cases of laryngeal tuberculosis during the past 10 years. A chief complaint of this malady was hoarseness. The patients' chest x-rays showed abnormality. One case had an ulcer lesion in the false vocal fold, and the other had white and granulomatous lesions in the vocal fold and epiglottis. A stroboscopic examination was performed on the case which had a pathological change in their vocal cords. Stroboscopic finding were useful in assessing the presence of laryngeal cancer. Mycobacterium tuberculosis was discharged in the phlegm of one of the cases. As a result, tuberculosis infection in our hospital became a concerm. From experience of two cases, strategies were given consideration to prevent such an infection from spreading through the hospital when a case of laryngeal tuberculosis was suspected. A patient who has a pathological change to their larynx and has a cough is recommended to take a chest x-ray at an early stage. Medical practitioners should presently refresh their knowledge about tubercular diagnosis and prevention.
Neuroendocrine carcinoma is an uncommon disease in the larynx. We had two cases of laryngeal neuroendocrine carcinoma. Both patients had a laryngeal tumor in the epiglottis. Case 1, a 55-year-old male, was diagnosed with small cell carcinoma according to light microscopic and immunohistochemical findings. Because he did not have cervical neck metastasis, he was treated with a partial laryngectomy and postoperative radiotherapy. When postoperative cervical metastasis occurred after initial treatment, he underwent radical neck dissection. He died of multiple bone metastasis 2 years after diagnosis. Case 2, a 68-year-old female, was diagnosed with an atypical carcinoid. She was treated with a horizontal partial laryngectomy. She is alive without recurrence 21 months after the operation.
It is comparatively rare that Spindle cell carcinoma occurs in the larynx, amounting to around 1% of malignant larynx tumors. We reported on the therapeutic experience of one Spindle cell carcinoma case. Our case, a 56 year-old male, had fallen down due to dyspnea at a subway station and was transported by ambulance to the hospital. During the initial diagnostic phase, while conducting a fiberscopic examination, it was found that the larynx lumen was full of the tumors which were presented as a flat, dark redness on the surface of the larynx. We performed an emergency tracheostomy for airway maintenance. A biopsy led to the diagnosis of low specialization type squamous cell carcinoma. The treatment required a total laryngectomy and neck dissection on both sides as the glottic carcinoma was at an advanced stage, T4N0M0. Histopathologic examination of the extracted specimen determined that the growth was specifically Spindle cell carcinoma.
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