BACKGROUND: Many head and neck surgeons preferred the radiotherapy as a first choice in treating early laryngeal carcinoma(T1, T2) to surgical operation because of the relatively high curability(80-90%), organ preservation and better quality of life. If radiotherapy failed, some surgeons perform total laryngectomy as salvage operation, but others prefer to perform partial laryngectomy, which is increasing in tendency. OBJECTIVE: To investigate the pattern of cancer invasion to the laryngeal cartilages using salvage laryngectomized cancer specimens which had recurred after radiotherapy. MATERIALS & METHOD: Preoperative computerized tomograpy images were retrospectively compared to postoperative salvage laryngectomized cancer specimens which had recurred after radiotherapy 13 cases from March, 1985 to February, 1994. RESULTS: 1) In laryngeal cacer recurred after radiotherapy, incidence of cartilage invasion was not in early supragolttic cancer. but all in advanced supraglottic cancer, and 3cases of 5 cases(60.0%) in early glottic cancer, 4cases of 5 cases(80.0%) in advanced glottic cancer. 2) The order of laryngeal cartilage invasion was the first thyroid cartilage(61.5%), the second arytenoid cartilage(30.7%), and the third cricoid cartilage(23.1%). 3) The diagnostic accuracy of preoperative CT scan for laryngeal cartilage invasion was 66.7% in thyroid cartilage, 55.6% in arytenoid cartilage, 55.6% in cricoid cartilage, and 100% in epiglottis. CONCLUSION: Selection of partial laryngectomy as salvage operation should be considered carefully.
Arytenoid Cartilage ; Cartilage ; Cricoid Cartilage ; Epiglottis ; Head ; Incidence ; Laryngeal Cartilages* ; Laryngectomy* ; Neck ; Organ Preservation ; Quality of Life ; Radiotherapy ; Retrospective Studies ; Thyroid Cartilage ; Thyroid Gland ; Tomography, X-Ray Computed

In man the epiglottis is a thin lamella of yellow elastic cartilage. The upper part is free and is known asleaf and lower part participates in the formation of the anterior wall of the vestibule of the larynx. Theipithelial covering extends forwards onto the base of the tongue over the medial glossoepiglottic folds. The sidesof epiglottis are connected with the cartilages of Wrisberg and arytenoid cartilage by the aryepiglottic fold. Inview of these anatomical complexities, the function and physiology of the epiglottis have been debated sinceMagendi(1815), who proposed the theory that the epiglottis acts as a flap valve to prevent food entering thewindpipe, and who found that he could remove the free part of the epiglottis in dog without spoiling the dog.Follwoing the introduction of laryngoscopy(Garcia, 1815; Liston, 1840; Czermark, 1861) and modern cineradiographicequipments in 1950's, the anatomy and physiology of epiglottis has become much clearrer. Age as it is seen on thelateral x-ray of the neck. In the present study we have made an attempt to systematically analyze aging changes ofthe epiglottis in the lateral x-ray of the neck in 245 healthy adults. The age ranged from 16 to 65 years old.Based on our observation the epiglottis was classified into type A, B, and C according to their curvatures. Thus,type A represented those with posterior curvature, type B those with straight epiglottis and type C anteriorcurvature. Type C was sudivided into I, II and III according to the degree of curvature. Thus, type C-I, C-II andC-III represented mild, moderated and marked anterior curvature, respectively. Type A epiglottis was found in thesecond, third and fourth decades and type C-III in the older age group. Type A was least comon and type C mostprevalent. It seems that the epiglottis inclines anteriorly with backward curvature with age (p<0.0001).
Adult ; Aging ; Animals ; Arytenoid Cartilage ; Cartilage ; Dogs ; Elastic Cartilage ; Epiglottis ; Humans ; Larynx ; Neck ; Physiology ; Tongue

BACKGROUND AND OBJECTIVES: Cancer invasion of the laryngeal cartilage is mainly found in the ossified portion of cartilage and contraindication for conservation surgery of laryngopharyngeal cancer. Thus, it is an important factor to consider in planning the management of laryngopharyngeal cancer. Computed tomographic (CT) scan is an useful tool for the evaluation of laryngopharyngeal cancer, but it is difficult to distinguish cancer invasion from non-ossified cartilage regions by the CT scan. Knowledge of the precise ossification pattern will be useful to determine the cancer invasion of laryngeal cartilage. The purposes of this study include ossi6cation pattern according to age, symmetry of ossification and incidence of bone marrow formation. MATERIALS AND METHODS: Fifty-three cases of normal laryngeal CT scans which were reviewed by two radiologists. They were all males, ranging in the ages from 40 to 69 (mean age 53). Ossification degree (%) was measured from the inferior cornu in the thyroid cartilage and the superior border of the posterior lamina in the cricoid cartilage. Age relation and symmetry of ossification and incidence of bone marrow formation were evaluated. RESULTS: There were no correlation between age and degree of laryngeal cartilage ossification (p> 0.05). But there was symmetry and definite pattern of ossification. Symmetry of ossification was 84.9% in the thyroid cartilage. Incidence of bone marrow formation was 60.6% in the thyroid cartilage and 82.8% in the cricoid cartilage. CONCLUSION: This study reveals that there is no ossification-age relationship, but the symmetry and the definite pattern of ossification in the laryngeal cartilage are useful clues in determining the cancer invasion on CT scan.
Bone Marrow ; Cartilage ; Cricoid Cartilage ; Humans ; Incidence ; Laryngeal Cartilages* ; Male ; Thyroid Cartilage ; Tomography, X-Ray Computed*

There is little or no information about the distribution of elastic fibers in the human fetal head. We examined this issue in 15 late-stage fetuses (crown-rump length, 220-320 mm) using aldehyde-fuchsin and elastica-Masson staining, and we used the arterial wall elastic laminae and external ear cartilages as positive staining controls. The posterior pharyngeal wall, as well as the ligaments connecting the laryngeal cartilages, contained abundant elastic fibers. In contrast with the sphenomandibular ligament and the temporomandibular joint disk, in which elastic fibers were partly present, the discomalleolar ligament and the fascial structures around the pterygoid muscles did not have any elastic fibers. In addition, the posterior marginal fascia of the prestyloid space did contain such fibers. Notably, in the middle ear, elastic fibers accumulated along the tendons of the tensor tympani and stapedius muscles and in the joint capsules of the ear ossicle articulations. Elastic fibers were not seen in any other muscle tendons or vertebral facet capsules in the head and neck. Despite being composed of smooth muscle, the orbitalis muscle did not contain any elastic fibers. The elastic fibers in the sphenomandibular ligament seemed to correspond to an intermediate step of development between Meckel's cartilage and the final ligament. Overall, there seemed to be a mini-version of elastic fiber distribution compared to that in adults and a different specific developmental pattern of connective tissues. The latter morphology might be a result of an adaptation to hypoxic conditions during development.
Adult ; Capsules ; Cartilage ; Connective Tissue ; Ear Cartilage ; Ear Ossicles ; Ear, Middle ; Elastic Tissue ; Fascia ; Fetus ; Head ; Humans ; Joint Capsule ; Laryngeal Cartilages ; Ligaments ; Muscle, Smooth ; Muscles ; Neck ; Pterygoid Muscles ; Stapedius ; Temporomandibular Joint Disc ; Tendons ; Tensor Tympani

BACKGROUND: The ear is composed of elastic cartilage as its framework, and is covered with a thin layer of skin. Auricular reconstruction using autogenous cartilage in microtia patients requires delicacy. This paper reports clinical experiences related to elevation of reconstructed ear in the last 11 years. METHODS: This study was based on 68 congenital microtia patients who underwent auricular elevation in our hospital. Among these 68 patients, 47 patients were recruited. We compared the differences in the ear size, auriculocephalic angle, and conchal depth with those in the opposite ear, and the patients' satisfaction levels were investigated using a survey. RESULTS: The difference in the sizes of the two ears was less than or equal to 5 mm in 32 patients, 5 to 10 mm in 10 patients, and greater than or equal to 10 mm in 5 patients. The difference in the auriculocephalic angles of the two ears was less than or equal to 10 degrees in 14 patients, 10 to 20 degrees in 26 patients, and greater than or equal to 20 degrees in 7 patients. The difference in the conchal depths of the two ears was less than or equal to 5 mm in 24 patients, 5 to 10 mm in 19 patients, and greater than or equal to 10 mm in 4 patients. The average grade of 3.9 points out of 5 points was obtained by the patients with satisfactory surveys. CONCLUSION: We could make enough protrusion and maintain the three-dimensional shape for a long time to satisfy our patients.
Cartilage ; Ear ; Ear Auricle ; Elastic Cartilage ; Humans ; Skin ; Transplantation

PURPOSE: The focal ossification of auricular cartilage is an unusual clinical entity in which the ear becomes partially or totally rigid and immalleable. This condition may result from cold injury, local trauma, inflammation, or various systemic diseases. Patients may feel mild discomfort, but there are usually no other serious symptoms. We present a case of focal ossification of auricular cartilage in which the cause is unknown. METHODS: A healthy 58-year-old man presented with a 2-year history of hard mass of right posterior auricular area. He denied any precipitating historical events like cold injury and inflammation. Routine testing did not demonstrate systemic abnormalities. Ultrasonographic examination revealed a 22 x 10 x 11 mm sized heterogenous isoechoic mass showing an acoustic shadow. RESULTS: Excisional biopsy was performed under local anesthesia. Histological examination revealed the ossification with deposition of trabecular bone in normal elastic cartilage. The patient was healed without any problems and satisfied with the result. CONCLUSION: We report clinical experience of focal ossification of auricular cartilage, which is quite a rare clinical entity. It should be considered that there is the possibility of ossification of cartilage when it meets the benign mass of the ear.
Acoustics ; Anesthesia, Local ; Biopsy ; Cartilage ; Cold Temperature ; Ear ; Ear Cartilage ; Elastic Cartilage ; Humans ; Inflammation ; Middle Aged

We compared the age-related morphology of the cricothyroid (CT) joint with that of the cricoarytenoid (CA) joint using 18 specimens from elderly cadavers in terms of their elastic fiber contents as well as the cells composing the joint capsule and synovial tissues. In contrast to an almost flat-flat interface in the CT joint, the CA joint was similar to a saddle joint. The CA joint capsule was thin and contained few elastic fibers, and in contrast to the CT joint, external fibrous tissues were not exposed to the joint cavity, there being no injury to the CA joint capsule. The lateral and posterior aspects of the CA joint were covered by the lateral and posterior CA muscles, respectively, and the fascia of the latter muscle was sometimes thick with abundant elastic fibers. However, due to possible muscle degeneration, loose connective tissue was often interposed between the fascia and the capsule. The medial and anterior aspects of the CA joint faced loose tissue that was continuous with the laryngeal submucosal tissue. Therefore, in contrast to the CT joint, a definite supporting ligament was usually absent in the CA joint. Synovial folds were always seen in the CA joint, comprising a short triangular mass on the posterior side and long laminar folds on the anterior side. The synovial folds usually contained multiple capillaries and a few CD68-positive macrophages. High congruity of the CA joint surfaces as well as strong muscle support to the arytenoid cartilage appeared to provide the specific synovial morphology.
Aged* ; Arytenoid Cartilage ; Cadaver ; Capillaries ; Connective Tissue ; Elastic Tissue ; Fascia ; Humans ; Joint Capsule ; Joints* ; Ligaments ; Macrophages ; Muscles

Ectopic ossification refers to the process of new bone formation in sites that normally do not ossify. The auricle is composed of elastic cartilage, and hence is a pliable structure. Auricular ossification is a rare condition that might be caused by injurious processes, including frostbite, physical trauma, and inflammation as well as processes related to metabolic or endocrine disorders. Here, we report a case of unilateral auricular ossification in a 53-year-old Korean man who had previously rubbed his ear repeatedly with his hand.
Cartilage ; Ear ; Elastic Cartilage ; Frostbite ; Hand ; Humans ; Inflammation ; Middle Aged ; Ossification, Heterotopic ; Osteogenesis

Among several techniques to maintain the lengthened cartilagenous tip structure, septal extension graft with septal cartilage or rib cartilage is most widely used. But in many cases, nasal tip rigidity with unnatural appearance on smiling is one of the major drawbacks of septal extension graft. The authors used a piece of elastic cartilage graft harvested form ear that can act as a cushion buffer between alar cartilage and septum instead of directly fixing the alar cartilage to extended septum for obtaining a less stiff nasal tip with sufficient nasal tip elongation. We called this graft "derotation graft". Derotation graft was performed in 1197 patients via the open nasal approach. Among them, 432(36%) patients had preoperative short nose deformity and 765(64%) patients developed intraoperative cephalic rotation of the tip resulting from procedures for tip projection such as columellar strut. Excellent results were achieved in 1110(93%) patients. 87(7%) patients had unsatisfactory results requiring a revision surgery because of overcorrection or undercorrection of tip rotation, poor tip projection and visible graft on supratip. Derotation graft is a simple, and effective procedure for short nose correction preventing with less post-operative nasal tip rigidity.
Cartilage ; Congenital Abnormalities ; Ear ; Ear Cartilage ; Elastic Cartilage ; Humans ; Nose ; Nose Deformities, Acquired ; Rhinoplasty ; Ribs ; Smiling ; Succinates ; Transplants

The purpose of this study was to evaluate the influence of different types of PLGA scaffolds on the formation of human auricular and septal cartilages. The scaffolds were formed in tubular shape from 110,000 g/mol PLGA (poly lactic glycolic acid) and 220,000 g/mol one. Elastic cartilage was taken from the ear of a patient aged under 20 years old and hyaline cartilage from the nasal septum. The chondrocytes cells were then isolated by Klausburn method. After second passages, the chondrocytes were seeded on the PLGA scaffolds followed by in vitro culture for one week. The cells-PLGA scaffold complex was implanted at the back of nude mouses for 8 weeks. The tissue engineered cartilages were separated from nude mouse and examined histologically after staining with the Hematoxylin Eosin and Verhoeff. The formation of extracellular matrix and the porosity of the scaffolds were examined by scanning electron microscopy. The pores were well formed and uniformly distributed in both 110,000 g/mol and 220,000 g/mol PLGA scaffolds. The extracellular matrix was formed better in 110,000 g/mol PLGA compared to 220,000 g/mol one. And hyaline cartilage was proliferated better in vitro culture than elastic cartilage. After 8 weeks in vivo culture, cartilage was well formed with 110,000 g/mol PLGA, however lumen was collapsed. In contrast with 220,000 g/mol PLGA scaffold, neocartilage was formed in minimal amount while the architecture of scaffold was well preserved. Elastic cartilage seems to be better than hyaline one in terms of neocartilage formation. From the analysis after Verhoeff staining the cartilages, the neocartilage from elastic cartilage was proved to be elastic cartilage. In summary, there was no significant difference between elastic cartilage and hyaline cartilage in their morphologies, proliferation rates and the degree of cartilage formation since they were tissue engineered, however marked difference was found in neocartilage formation and preservation of scaffold architecture between 110,000 g/mol PLGA scaffold and 220,000 one. From the present findings, it is concluded that the influence of scaffold materials is significantly higher than that of different types of cells on the formation of new tissues.
Animals ; Cartilage* ; Chondrocytes* ; Ear ; Elastic Cartilage ; Eosine Yellowish-(YS) ; Extracellular Matrix ; Hematoxylin ; Humans* ; Hyalin* ; Hyaline Cartilage ; Mice ; Mice, Nude ; Microscopy, Electron, Scanning ; Nasal Septum ; Porosity ; Young Adult