Surgical management of calcium hydroxyapatite in the superficial lamina propria of the vocal fold

Reinke's edema (RE) has been associated typically with smoking and sometimes with vocal abuse, but aspects of the pathophysiology of RE remain unclear. To gain new insights into phonatory mechanisms associated with RE pathophysiology, weused an integrated battery of objective vocal function tests to analyze 20 patients (19 women) who underwent phonomicrosurgical resection. Preoperative stroboscopic examinations demonstrated that the superficial lamina propria is distended primarily on the superior vocal fold surface. Acoustically, these individuals have an abnormally low average speaking fundamental frequency (123 Hz), and they generate abnormally high average subglottal pressures (9.7 cm H20). The presence of elevated aerodynamic driving pressures reflects difficulties in producing vocal fold vibration that are most likely the result of mass loading associated with RE, and possibly vocal hyperfunction. Furthermore, it is hypothesized that in the environment of chronic glottal mucositis secondary to smoking and reflux, the cephalad force on the vocal folds by the subglottal driving pressure contributes to the superior distention of the superficial lamina propria. Surgical reduction of the volume of the superficial lamina propria resulted in a significant elevation in fundamental frequency (154 Hz) and improvement in perturbation measures. In almost all instances, both the clinician and the patient perceived the voice as improved. However, these patients continued to generate elevated subglottal pressure (probably a sign of persistent hyperfunction) that was accompanied by visually observed supraglottal strain despite the normalsized vocal folds. This finding suggests that persistent hyperfunctional vocal behaviors may contribute to postsurgical RE recurrence if therapeutic strategies are not instituted to modify such behavior.

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Vocal Fold Submucosal Infusion Technique in Phonomicrosurgery

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949610500503 ◽

1996 ◽

Vol 105 (5) ◽

pp. 341-347 ◽

Cited By ~ 45

Author(s):

Erik S. Kass ◽

Robert E. Hillman ◽

Steven M. Zeitels

Keyword(s):

Lamina Propria ◽

Retrospective Review ◽

Vocal Fold ◽

Malignant Lesions ◽

Sulcus Vocalis ◽

Infusion Technique ◽

Superficial Lamina

Phonomicrosurgery is optimized by maximally preserving the vocal fold's layered microstructure (laminae propriae). The technique of submucosal infusion of saline and epinephrine into the superficial lamina propria (SLP) was examined to delineate how, when, and why it was helpful toward this surgical goal. A retrospective review revealed that the submucosal infusion technique was used to enhance the surgery in 75 of 152 vocal fold procedures that were performed over the last 2 years. The vocal fold epithelium was noted to be adherent to the vocal ligament in 29 of the 75 cases: 19 from previous surgical scarring, 4 from cancer, 3 from sulcus vocalis, 2 from chronic hemorrhage, and 1 from radiotherapy. The submucosal infusion technique was most helpful when the vocal fold epithelium required resection and/or when extensive dissection in the SLP was necessary. The infusion enhanced the surgery by vasoconstriction of the microvasculature in the SLP, which improved visualization during cold-instrument tangential dissection. Improved visualization facilitated maximal preservation of the SLP, which is necessary for optimal pliability of the overlying epithelium. The infusion also improved the placement of incisions at the perimeter of benign, premalignant, and malignant lesions, and thereby helped preserve epithelium uninvolved by the disorder.

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Sulcus Vocalis: A Rational Analytical Approach to Diagnosis and Management

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949610500304 ◽

1996 ◽

Vol 105 (3) ◽

pp. 189-200 ◽

Cited By ~ 108

Author(s):

Charles N. Ford ◽

Katsuhide Inagi ◽

Aliaa Khidr ◽

Diane M. Bless ◽

Kennedy W. Gilchrist

Keyword(s):

Lamina Propria ◽

Vocal Fold ◽

Rational Approach ◽

Common Pathway ◽

Scar Contracture ◽

Benign Vocal Fold Lesions ◽

Sulcus Vocalis ◽

Histopathologic Analysis ◽

Superficial Lamina

The term sulcus vocalis has been applied to a spectrum of disorders ranging from minor vocal fold indentations to destructive lesions causing severe dysphonia. To clarify the pathophysiology and to develop a more rational approach to treatment, we report a series of sulcus patients including 20 surgical cases. Clinical and histopathologic analysis produced a clinically useful classification: type 1 is a physiologic variant accentuated by atrophy but with intact lamina propria; types 2 (sulcus vergeture) and 3 (sulcus vocalis) are characterized by severe dysphonia, loss of vibratory activity, and destruction of the functional superficial lamina propria. These latter cases respond favorably to microsurgery designed to remove destroyed tissue, release scar contracture, and promote mucosal redraping by regional undermining. Further study of the extracellular matrix of the superficial lamina propria (Reinke's space) might indicate a common pathway in the pathogenesis of sulcus deformities and other related benign vocal fold lesions.

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Small Intestinal Submucosa Implantation for the Possible Treatment of Vocal Fold Scar, Sulcus, and Superficial Lamina Propria Atrophy

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489415601685 ◽

2015 ◽

Vol 125 (2) ◽

pp. 137-144 ◽

Cited By ~ 10

Author(s):

Michael J. Pitman ◽

Jonathan A. Cabin ◽

Codrin E. Iacob

Keyword(s):

Lamina Propria ◽

Vocal Fold ◽

Small Intestinal Submucosa ◽

Vocal Fold Scar ◽

Small Intestinal ◽

Intestinal Submucosa ◽

Superficial Lamina

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Imaging the Mucosa of the Human Vocal Fold with Optical Coherence Tomography

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940511400903 ◽

2005 ◽

Vol 114 (9) ◽

pp. 671-676 ◽

Cited By ~ 41

Author(s):

James A. Burns ◽

Steven M. Zeitels ◽

R. Rox Anderson ◽

James B. Kobler ◽

Mark C. Pierce ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Lamina Propria ◽

Vocal Fold ◽

Imaging Techniques ◽

Vocal Folds ◽

Superficial Layer ◽

Optical Coherence ◽

Cross Sectional ◽

Superficial Lamina

Objectives: Discerning the layered microstructure of the vocal folds is critical for effective phonomicrosurgery. Optical coherence tomography (OCT), a noncontact, noninvasive technology that provides cross-sectional images by means of backscattered light, offers the potential for delineating these layers in vivo. Methods: The glottal mucosa of 3 human cadaver larynges was imaged with conventional OCT and polarization-sensitive OCT (PS-OCT). Images were obtained through the epithelium and lamina propria. Results: Although the superficial layer of the lamina propria appeared quite homogeneous, the outer surface of the superficial lamina propria was correlated with an increase in backscatter with OCT. The superficial lamina propria and vocal ligament were correlated with a marked increase in tissue birefringence with PS-OCT. Conclusions: This preliminary study demonstrates the capacity of OCT and PS-OCT for visualizing the layered microstructure of the vocal fold mucosa. We believe that these imaging techniques will have applications in the exploration of solutions to vocal fold scarring and in imaging vocal fold disorders in the clinic and operating room.

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Cogels of Hyaluronic Acid and Acellular Matrix for Cultivation of Adipose-Derived Stem Cells: Potential Application for Vocal Fold Tissue Engineering

BioMed Research International ◽

10.1155/2016/6584054 ◽

2016 ◽

Vol 2016 ◽

pp. 1-10 ◽

Cited By ~ 3

Author(s):

Dongyan Huang ◽

Rongguang Wang ◽

Shiming Yang

Keyword(s):

Tissue Engineering ◽

Stem Cells ◽

Extracellular Matrix ◽

Hyaluronic Acid ◽

Lamina Propria ◽

Vocal Fold ◽

Adipose Derived Stem Cells ◽

Acellular Matrix ◽

Decellularized Extracellular Matrix ◽

Superficial Lamina

Stem cells based tissue engineering has been one of the potential promising therapies in the research on the repair of tissue diseases including the vocal fold. Decellularized extracellular matrix (DCM) as a promising scaffold has be used widely in tissue engineering; however, it remained to be an important issue in vocal fold regeneration. Here, we applied the hydrogels (hyaluronic acid [HA], HA-collagen [HA-Col], and HA-DCM) to determine the effects of hydrogel on the growth and differentiation of human adipose-derived stem cells (hADSCs) into superficial lamina propria fibroblasts. hADSCs were isolated and characterized by fluorescence-activated cell sorting. The results indicated that HA-DCM hydrogel enhanced cell proliferation and prolonged cell morphology significantly compared to HA and HA-Col hydrogel. Importantly, the differentiation of hADSCs into fibroblasts was also promoted by cogels of HA-Col and HA-DCM significantly. The differentiation of hADSCs towards superficial lamina propria fibroblasts was accelerated by the secretion of HGF, IL-8, and VEGF, the decorin and elastin expression, and the synthesis of chondroitin sulfate significantly. Therefore, the cogel of HA-DCM hydrogel was shown to be outstanding in apparent stimulation of hADSCs proliferation and differentiation to vocal fold fibroblasts through secretion of important growth factors and synthesis of extracellular matrix.

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Immunocytochemical Study of Proteoglycans in Vocal Folds

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949610500102 ◽

1996 ◽

Vol 105 (1) ◽

pp. 6-11 ◽

Cited By ~ 72

Author(s):

Agnieszka S. Pawlak ◽

Elizabeth Hammond ◽

Thomas Hammond ◽

Steven D. Gray

Keyword(s):

Chondroitin Sulfate ◽

Lamina Propria ◽

Vocal Fold ◽

Keratan Sulfate ◽

Vocal Folds ◽

Basement Membrane Zone ◽

Immunocytochemical Study ◽

Frozen Sections ◽

Intense Staining ◽

Immunocytochemical Techniques

We evaluated the proteoglycan composition of normal vocal folds using immunocytochemical techniques. Frozen sections of 14 normal cadaveric vocal folds were obtained within 12 hours of death and sectioned immediately. Vocal fold sections were stained with antibodies against keratan sulfate, chondroitin sulfate, heparan sulfate proteoglycan (HSPG), decorin, and hyaluronate receptor. We found that the lamina propria has diffuse staining of fibrillar components with keratan sulfate and decorin. Intense staining was observed in the vocal ligament area with keratan sulfate. The HSPG was localized to the basement membrane zone. Chondroitin sulfate, HSPG, and hyaluronate receptor were detected in the cytoplasm of interstitial cells with immunocytochemical characteristics of macrophages. The keratan sulfate distribution suggests that fibromodulin may be significant in normal vocal folds. Production of HSPG and probably versican occurs in macrophages and fibroblasts in the lamina propria.

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