RESUMEN

OBJECTIVE: To describe the findings on the presbylarynx under scanning electron microscopy. STUDY DESIGN: Cadaver study. SETTING: Universidade Estadual Paulista (Botucatu, São Paulo, Brazil). SUBJECTS AND METHODS: Sixteen vocal folds were removed during necropsies and distributed into 2 age groups: control (n = 8; aged 30-50 years) and elderly (n = 8; aged 75-92 years). The right vocal fold was dissected, fixed in glutaraldehyde 2.5%, and prepared for scanning electron microscopy. The thickness of the epithelium was measured using a scandium morphometric digital program. RESULTS: In the control group, the epithelium had 5 to 7 overlapped cell layers, rare desquamation cells, and little undulation with protruding intercellular junctions. The lamina propria showed a uniform network of collagen and elastic fibers in the superficial layer. A dense network of collagen was identified in the deeper layer. In the elderly group, the epithelium was atrophic (2-3 cells), with more desquamation cells and intercellular junctions delimited by deep sulci. The epithelial thickness was lower in elderly than in controls (mean [SD], 221.64 [145.90] µm vs 41.79 [21.40] µm, respectively). The lamina propria had a dense and irregular distribution of collagen and elastic fibers in the superficial layer. In the deep layers, the collagen fibers formed a true fibrotic and rigid skeleton. CONCLUSION: Scanning electron microscopy identified several changes in the elderly larynx, differentiating it from the controls. These alterations are probably related to the aging process of the vocal folds. However, the exact interpretation of these findings requires additional studies, even to the molecular level, having the fibroblasts as targets.

Asunto(s)

Microscopía Electrónica de Rastreo , Pliegues Vocales/ultraestructura , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Cadáver , Humanos , Persona de Mediana Edad

RESUMEN

The objective of this study was to investigate the morphological and immunohistochemical characteristics of vocal fold nodules. The study design was prospective and retrospective. For the histological study, we reviewed 15 slides from the surgical cases of vocal fold nodules, in which we analyzed epithelium, basal membrane (bm), and lamina propria. For the transmission and scanning electron microscopy (TEM, SEM) studies, five new cases on vocal fold nodules were included. Immunohistochemistry study was carried out in the 15 specimens, using antifibronectin, antilaminin, and anticollagen IV antibodies. The main histological alterations were epithelial hyperplasia (73.33%), basement membrane thickening (86.66%), edema, and fibrosis (93.33%). SEM--reduction in mucous lacing and increase in the desquamating cells, without epithelial erosion. TEM--hyperplasia of the epithelium, enlargement of the intercellular junctions, which was filled by fluid, subepithelial thickening of the lamina reticularis, and break points in the basal membrane. Immunohistochemistry--we identified greater immunoexpression of fibronectin on the basal membrane, on the lamina propria, and around the vessels. Antilaminin and anticollagen IV antibodies showed higher pigmentation on the endothelium of the vessels than that on the basal membrane. In vocal fold nodules, combined assessment using light microscopy, electron microscopy, and immunohistochemistry can reveal important morphological details useful in characterizing these lesions.

Asunto(s)

Inmunohistoquímica , Pliegues Vocales/química , Pliegues Vocales/patología , Trastornos de la Voz/diagnóstico , Membrana Basal/química , Membrana Basal/patología , Brasil , Colágeno Tipo IV/análisis , Células Epiteliales/química , Células Epiteliales/patología , Fibronectinas/análisis , Fibrosis , Humanos , Hiperplasia , Laminina/análisis , Microscopía Electrónica de Rastreo , Microscopía Electrónica de Transmisión , Membrana Mucosa/química , Membrana Mucosa/patología , Estudios Prospectivos , Estudios Retrospectivos , Pliegues Vocales/ultraestructura , Trastornos de la Voz/metabolismo , Trastornos de la Voz/patología

RESUMEN

Although it is currently believed that the vocal ligament of humans undergoes considerable development postnatally, there is no consensus as to the age at which it first emerges. In the newborn infant, the lamina propria has been described as containing a sparse collection of relatively unorganized fibres. In this study we obtained larynges from autopsy of human fetuses aged 7-9 months and used light and electron microscopy to study the collagenous and elastic system fibres in the lamina propria of the vocal fold. Collagen fibres were viewed using the Picrosirius polarization method and elastic system fibres were stained using Weigert's resorcin-fuchsin after oxidation with oxone. The histochemical and electron microscopic observations were consistent, showing collagen populations with an asymmetric distribution across different compartments of the lamina propria. In the central region, the collagen appeared as thin, weakly birefringent, greenish fibres when viewed using the Picrosirius polarization method, whereas the superficial and deep regions contained thick collagen fibres that displayed a strong red or yellow birefringence. These findings suggest that the thin fibres in the central region consist mainly of type III collagen, whereas type I collagen predominates in the superficial and deep regions, as has been reported in studies of adult vocal folds. Similarly, elastic system fibres showed a differential distribution throughout the lamina propria. Their distribution pattern was complementary to that of collagen fibres, with a much greater density of elastic fibres apparent in the central region than in the superficial and deep regions. This distribution of collagen and elastic fibres in the fetal vocal fold mirrors that classically described for the adult vocal ligament, suggesting that a vocal ligament has already begun to develop by the time of birth. The apparently high level of organization of connective tissue components in the newborn is in contrast to current hypotheses that argue that the mechanical stimuli of phonation are essential to the determination of the layered structure of the lamina propria and suggests that genetic factors may play a more significant role in the development of the vocal ligament than previously believed.

Asunto(s)

Pliegues Vocales/embriología , Colágeno/ultraestructura , Tejido Elástico/embriología , Tejido Elástico/ultraestructura , Femenino , Edad Gestacional , Humanos , Masculino , Membrana Mucosa/química , Membrana Mucosa/embriología , Membrana Mucosa/ultraestructura , Pliegues Vocales/química , Pliegues Vocales/ultraestructura

RESUMEN

UNLABELLED: Granulomas are bilateral and pediculated lesions of the vocal apophysis. Etiologies: intubation, reflux, trauma, vocal abuse, idiopathic origin. AIM: To analyze the clinical and morphological aspects of post intubation granulomas. METHODS: retrospective study of patients submitted to microsurgery for post intubation laryngeal granulomas seen at our Medical School starting in 2002. We analyzed: age, gender, indication and time of intubation, symptoms, videolaryngoscopic diagnosis and biopsy findings. Light microscopy was performed on all specimens, and electron microscopy on three of them. RESULTS: ten patients (7 females and 3 males), between the ages of 2 and 72 years, intubation time between 4h and 21 days. Hoarseness was a frequent symptom, starting in the first week following extubation. Histology shows mild epithelial hyperplasia, severe inflammation and vessel proliferation in the corion. Under SEM, the epithelium presented mild superficial desquamation. Under TEM, intracellular junctions showed widening with structural changes in the desmosomes. In the corion there were vessel proliferations, inflammation and fibroblasts with structural alterations. CONCLUSIONS: post intubation granulomas appear in any age and hoarseness is a frequent symptom. Morphological alterations occur in the corion as vessel proliferations, inflammation, and intracytoplasmatic alterations in fibroblasts suggesting cellular dysfunction and damage.

Asunto(s)

Granuloma Laríngeo/patología , Intubación Intratraqueal/efectos adversos , Pliegues Vocales/ultraestructura , Adolescente , Adulto , Anciano , Preescolar , Femenino , Granuloma Laríngeo/etiología , Granuloma Laríngeo/cirugía , Humanos , Masculino , Microscopía Electrónica , Persona de Mediana Edad , Estudios Retrospectivos , Pliegues Vocales/cirugía , Adulto Joven

RESUMEN

Granulomas são lesões bilaterais e pediculadas das apófises vocais. Etiologias: intubação, refluxo, traumatismos, fonotraumatismo e idiopática. OBJETIVO: Analisar aspectos clínicos e morfológicos dos granulomas de intubação. MATERIAL E MÉTODOS: Estudo retrospectivo dos pacientes submetidos à microcirurgia por granulomas de intubação, atendidos na Instituição onde foi realizado, a partir de 2002. Analisaram-se: idade, sexo, indicação e tempo da intubação, sintomas, laudos de videolaringoscopia e número de biópsia. Realizou-se estudo histológico em todos os casos e de microscopia eletrônica em três deles. RESULTADOS: 10 pacientes (7 F e 3 M), idade entre 2 anos e 72 anos e tempo de intubação entre 4 horas e 21 dias. Rouquidão foi o principal sintoma. A histologia mostrou hiperplasia epitelial, intenso inflamação importante no corion e proliferação vascular. Na MEV observou-se epitélio escamoso com escassa descamação. À MET, junções intercelulares alargadas e desmossomos alterados. No corion havia lagos sanguíneos, intensa inflamação, e fibroblastos com alterações estruturais como núcleos irregulares e cisternas dilatadas. CONCLUSÕES: Granulomas pós-intubação aparecem em qualquer idade, mesmo em intubação por curto período, e causam rouquidão precocemente. As principais alterações morfológicas são observadas no corion, como proliferação vascular, inflamação e alterações estruturais em fibroblastos indicando disfunção e dano celular.

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Granulomas are bilateral and pediculated lesions of the vocal apophysis. Etiologies: intubation, reflux, trauma, vocal abuse, idiopathic origin. AIM: To analyze the clinical and morphological aspects of post intubation granulomas. METHODS: retrospective study of patients submitted to microsurgery for post intubation laryngeal granulomas seen at our Medical School starting in 2002. We analyzed: age, gender, indication and time of intubation, symptoms, videolaryngoscopic diagnosis and biopsy findings. Light microscopy was performed on all specimens, and electron microscopy on three of them. RESULTS: ten patients (7 females and 3 males), between the ages of 2 and 72 years, intubation time between 4h and 21 days. Hoarseness was a frequent symptom, starting in the first week following extubation. Histology shows mild epithelial hyperplasia, severe inflammation and vessel proliferation in the corion. Under SEM, the epithelium presented mild superficial desquamation. Under TEM, intracellular junctions showed widening with structural changes in the desmosomes. In the corion there were vessel proliferations, inflammation and fibroblasts with structural alterations. CONCLUSIONS: post intubation granulomas appear in any age and hoarseness is a frequent symptom. Morphological alterations occur in the corion as vessel proliferations, inflammation, and intracytoplasmatic alterations in fibroblasts suggesting cellular dysfunction and damage.

Asunto(s)

Adolescente , Adulto , Anciano , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Granuloma Laríngeo/patología , Intubación Intratraqueal/efectos adversos , Pliegues Vocales/ultraestructura , Granuloma Laríngeo/etiología , Granuloma Laríngeo/cirugía , Microscopía Electrónica , Estudios Retrospectivos , Pliegues Vocales/cirugía , Adulto Joven

RESUMEN

Various authors have published results related to the ultrastructure of vocal folds in specific areas proceeding from human cadavers. Nevertheless, starting from the premise that a fundamental principle of sampling and the samples should be a true representative of the whole, the authors decided to examine vocal folds from human cadavers and compare them to normal vocal folds from the guinea pig (Cavia porcellus). The findings of these authors demonstrated clearly that the conclusion of Rhodin (1954) is correct, that a biological sample must be preserved immediately after blood circulation ceases, and that the intermediary time between biopsy and fixation cannot be more than 3 minutes. Cells fixed a few hours after death appeared disaggregated, and many of their endocellular components were profoundly altered. The results obtained by the authors suggests that ultrastructural studies with cadaverous material may lead to serious risks or doubts about the accuracy of the results and consequently result in dubious interpretations.

Asunto(s)

Cambios Post Mortem , Pliegues Vocales/ultraestructura , Adulto , Animales , Cadáver , Cobayas , Humanos , Recién Nacido , Músculos Laríngeos/patología , Músculos Laríngeos/ultraestructura , Masculino , Microscopía Electrónica , Factores de Tiempo , Pliegues Vocales/patología

RESUMEN

Realizamos un estudio sobre aspectos morfológicos de la laringe de la chinchilla. La laringe está compuesta por las porciones muscular, membranosa y cartilaginosa y tiene en promedio 9mm de longitud. En la pared lateral se localizan los plieges vocales y vestibulares; el ventrículo laríngeo es una pequeña depresión localizada entre estos pliegues. El epitelio laríngeo fue estudiado a travéz de la microscopía fotónica y electrónica de barrido. La superficie del espacio supraglótico está cubierto predominantemente por epitelio estratificado con aspecto de adoquín, mientras que, puede observarse un típico epitelio seudoestratificado compuesto por células ciliadas y no ciliadas en el área de la subglotis. Sin embargo, cerca de la parte caudal del pliegue vocal el epitelio cambia gradualmente de escamoso estratificado al tipo intermedio demostrando un aspecto de guardacantón. La capa subepitelial estaba compuesta por fibras elásticas y colágenas que contituían una intrincada malla

Asunto(s)

Animales , Masculino , Femenino , Chinchilla/anatomía & histología , Laringe/ultraestructura , Microscopía Electrónica de Rastreo , Pliegues Vocales/ultraestructura