Apoptosis in the developing human cricoid cartilage: a pilot study

Apoptosis is widely recognized as a major phenomenon in normal development. Deficiencies in this process may lead to developmental abnormalities such as congenital subglottic stenosis. We studied apoptosis using in situ end labeling of the 3'-OH ends of fragmented DNA in 5 progressively older, normal, human cricoid cartilage specimens. Results show that apoptosis is a very active process in fetal and neonatal tissue. The process gradually slows with advancing age. In the 4- and 13-year-old specimens, minimal to no apoptosis was seen. We conclude that apoptosis plays a critical role in the intraluminal and extraluminal expansion of the cricoid cartilage.

Osteoarthritis in cricoarytenoid joint

OBJECTIVE

Occurrence of osteoarthritis is a frequent event of limb joints in people over 40 years of age. The human cricoarytenoid joint is comparable with the joints of the limbs despite its structure and extracellular matrix composition. To date, little is known about the occurrence of osteoarthritis in the human cricoarytenoid joint.

METHODS

Sixty-eight cricoarytenoid joints (42 male and 26 female, age 25-98 years) were analysed by means of histology, lectin histochemistry, immunohistochemistry as well as scanning and transmission electron microscopy.

RESULTS

About 50% of the investigated cricoarytenoid joints aged over 40 years show degenerative changes in their joint surface structure at varying levels of intensity. The articular cartilage surface is fibrillated in some places and sometimes shows fissures. A demascing of collagen fibrils next to the joint surface and a loss of proteoglycans in the upper cartilage layers can be observed. Chondrocytes near the joint surface appear as voluminous chondrocyte clusters. The clusters and the superficial cartilage layer show a positive reaction to type VI collagen antibodies. The distribution patterns of lectins are completely changed in fibrillated cartilage areas.

CONCLUSION

Degenerative alterations in diarthrodial joints resembling osteoarthritis can occur in the joints of the larynx. These structural changes of the articular cartilage are comparable to osteoarthritis of the limb joints. Osteoarthritis in the cricoarytenoid joint may lead to impaired movements of the arytenoid cartilages. Functionally the structural changes may lead to negative consequences during vocal production, such as impaired vocal quality and reduced vocal intensity.

Composition of the extracellular matrix in human cricoarytenoid joint articular cartilage

The extracellular matrix of the human cricoarytenoid joint articular cartilage is involved in different pathological changes. Interestingly, in contrast to the limb joints, the extracellular matrix composition of the healthy cricoarytenoid joint articular cartilage has not yet been elucidated except by some light microscopical investigations. The present study investigates the extracellular matrix components of the cricoarytenoid joint articular cartilage by means of light microscopy, immunohistochemistry, transmission electron microscopy and scanning electron microscopy and compares them with the limb joints for a better understanding of their involvement in joint disease. Chondrocytes near the joint surface of the cricoid and arytenoid cartilage differ from chondrocytes of deeper cartilage layers. The extracellular matrix of the articular cartilage contains chondroitin-4-sulfate, chondroitin-6-sulfate and keratansulfate as well as collagen types II, III, VI, IX and XI. Type-III-collagen shows a special distribution throughout the joint cartilage. In deeper cartilage layers, type-III-collagen occurs only pericellularly; in higher cartilage layers type-III-collagen is also located territorially and interterritorialy in small amounts. Scanning and transmission electron microscopy have revealed the articular surface of the cricoid and arytenoid cartilage to consist of a network of irregularly organized collagen fibrils, which are lined by a layer of electron dense material. The network coats subjacent collagen bundles which descend obliquely downward and intermingle at right angles in the middle part of the articular cartilage with collagen bundles of the deeper cartilage zones. The articular cartilage surface shows structural characteristics which differ from the underlying cartilage. The superficial electron dense layer possibly plays a role in the lubrication of the articular cartilage surface. The alignment of the fibrillar structures in the articular cartilage of the cricoarytenoid joint varies from those of the limb joints based on the different strain occurring during arytenoid movement. Nevertheless, the human cricoarytenoid joint articular cartilage can be compared with the joints of the limbs despite its extracellular matrix composition and its involvement in joint pathology. Evidence of type III collagen in the outermost layer of the articular cartilage of the cricoarytenoid joint presents a peculiarity, which has yet not be demonstrated in the articular cartilage of limb joints.

Degenerative changes in the human cricoarytenoid joint

OBJECTIVE

Changes in the human voice occur during the natural aging process. Occurrence of compromising alterations in the cricoarytenoid joint has been hypothesized as a possible reason for voice changes seen in advanced age and has been discussed controversially until today.

METHODS

The present study analyzes degenerative changes in 42 cricoarytenoid joints from 21 body donors (13 men and 8 women; age range, 42-98 years) by means of histological, immunohistochemical, and scanning electron microscopic methods.

RESULTS

Many patients older than 40 years show distinctly altered joint surfaces at varying levels of intensity. The articular cartilage surface is fibrillated in some places. Chondrocytes near the joint surface appear as voluminous chondrocyte clusters. The superficial cartilage layer shows a positive reaction to type III and type I collagen antibodies.

CONCLUSIONS

Chondrocyte proliferation next to the joint surface, changed collagen synthesis, and fibrillation of the joint surface indicate degenerative alterations. Such changes are well known in cases of limb diarthroses. The changes may impair gross positional or postural movements of the arytenoid cartilages and reduce the degree and extent of vocal ligament closure. The structural changes may also lead to negative functional consequences during vocal production, such as impaired vocal quality and reduced vocal intensity due to air leakage through incompletely or loosely approximated vocal ligaments.

Injury- and age-linked differences in wound healing and stenosis formation in the subglottis

We studied the effects of superficial and deep endolaryngeal trauma of the subglottic airway in young and adult rabbits. In both age groups a soft stenosis was formed as long as the cartilaginous cricoid ring is not involved. This stenosis comprised a thickened subepithelial zone of scar tissue, separated from the cricoid cartilage by a layer of fatty tissue. Injury of the internal side of the cricoid cartilage induced a compact mass of scar tissue with local differentiation into fibrocartilage. In young animals only, injury of the cartilage led to remodelling of the cricoid ring (indentation or collapse of the traumatized sectors). On the basis of the differentiating effects of age and depth of the lesion, three histopathological types of subglottic stenosis were distinguished. The experimental results provide an explanation for the variability in the histopathological features of the wall of the stenotic subglottic airway, as observed in biopsies and postmortem specimens.

Application of pulsed and continuous wave 1.32 and 1.06 microns wavelengths of the Nd:YAG laser in the canine tracheobronchial tree: a comparative study

Previous investigations have shown good clinical potential for the use of the 1.32 microns wavelength Nd:YAG laser because its soft tissue absorption is better than that of the 1.06 microns wavelength Nd:YAG laser. The 1.32 microns wavelength Nd:YAG laser has an absorption coefficient in water that is 10 times higher than the 1.06 microns wavelength Nd:YAG laser. A comparative in vivo study of laser soft tissue effects was performed by using the 1.32 microns wavelength and the 1.06 microns wavelength Nd:YAG lasers in a pulsed wave (PW) mode and continuous wave (CW) mode using a non-contact endoscopic delivery system. A standard 5 mm mucosal lesion was made in the canine tracheobronchial tree down to the level of the perichondrium. Soft tissue and cartilage effects were examined by light and scanning electron microscopy, acutely, 1 week and 2 weeks after operation, and a comparison was made between the different laser modalities. To create similar lesions, higher energy was required when using the 1.06 microns wavelength Nd:YAG laser. Soft tissue injury was greater with the 1.06 microns wavelength in CW mode, and no cartilage damage occurred in the PW mode. Soft tissue and cartilage repair after 1 and 2 weeks was better with the 1.32 microns wavelength laser. In comparison, the CO2 laser and the contact Nd:YAG laser proved to be more precise cutting tools than the 1.32 microns wavelength or the 1.06 microns wavelength Nd:YAG lasers. Both Nd:YAG laser wavelengths were useful for coagulation and vaporization of tissues and blood vessels. More studies are needed to determine the effect of the new 1.32 microns wavelengths on endotracheal tumors.

Observations on the structure and the biomechanics of the cricothyroid articulation

We examined quantitatively the ventrodorsal gliding occurring along a sagittal plane in the cricothyroid articulation. For this purpose we used 10 fresh excised human larynges taken at autopsy. Furthermore we examined the morphology, the hydroxyproline content and collagen types of the ligaments and the articular capsule of the cricothyroid articulation. This articulation appeared to be a synovial joint, supported by two ligaments: the lateral and posterior ceratocricoid ligament and articular capsule. The ligaments and the capsule contained both type I and type III collagen fibres and they were rich in elastin fibres 1-2.5 microns in diameter. Ventrodorsal gliding was generally possible when the joint was not rotated to its extremes. The marked individual variation was not essentially affected by sex or age. The collagen content of the lateral ceratocricoid ligament showed a statistically significant negative correlation with the gliding. The articular facet of the cricoid cartilage, which was not usually well-shaped, limits the gliding. A force of +/- 1.0 N caused on the average a change of +/- 1.0 mm in the length of the vocal cord. Further research is needed to evaluate the physiological importance of these findings.

Nemaline rods in cricopharyngeal dysphagia

Cricopharyngeal dysphagia, a disorder of uncertain pathogenesis, is most frequently found in patients with associated gastroesophageal reflux. Seven patients who had dominant cricopharyngeal dysphagia were evaluated. Manometry showed characteristic motor incoordination. Biochemical profiles and endoscopy were normal. Electronmicroscopic examination of the cricopharyngeal muscle biopsy specimens obtained during myotomy showed significant ultrastructural abnormalities. These included numerous and aberrant mitochondria, increased glycogen, lipid inclusions, and phagolysozomes. A striking finding was the presence of numerous nemaline rods in five of seven biopsy specimens examined. The pathologic changes in this muscle in cryopharyngeal dysphagia have not been reported previously. Structural changes are thought to be a secondary response to reflux injury. Nemaline rods form part of the structural abnormality of muscle in patients who have cricopharyngeal dysphasia with no evidence of underlying generalized disease or myopathy.