Efecto inmediato de dos ejercicios con tracto vocal semiocluido en el contacto glótico de usuarios ocupacionales de la voz / Immediate effect of two semi-occluded vocal tract exercises in glottal contact of occupational voice users

Introducción. Los docentes son usuarios ocupacionales de la voz con alto riesgo de desarrollar patologías vocales a causa de su labor. Para enfrentar esta proble-mática, suelen usarse ejercicios con tracto vocal semiocluido (TVSO), estrategia de educación/rehabilitación empleada para generar un cambio en el patrón de vibración de los pliegues vocales, minimizando el riesgo de lesión vocal al reducir el estrés de colisión al que se someten los tejidos. Diversos reportes han indicado que este tratamiento tiene efectos en el cociente de cierre (CQ), medida indirecta del estrés de colisión.Objetivo. Examinar el efecto fisiológico de dos ejercicios con TVSO en la actividad laríngea de profesores con esfuerzo vocal constante pero sin patología vocal. Metodología. Se registraron muestras de 43 profesores antes, durante y después de la realización de dos ejercicios con TVSO (vibración lingual y fonación en tubos). Las muestras de electroglotografía se analizaron para obtener el CQ. Resultados y conclusión. Se observó una diferencia significativa al comparar los valores del CQ antes y durante la realización de ambos ejercicios. No se encontraron cambios en este parámetro después de ejecutar la actividad. Estos hallazgos concuer-dan con reportes previos en los cuales el CQ tiende a aumentar durante la fonación en tubos; contrariamente, la realización de la vibración lingual tiende a decrecer el valor del CQ. Es posible que este comportamiento se deba a los mecanismos biome-cánicos particulares de cada ejercicio

Introduction. Teachers are occupational voice users with high risk of developing vocal pathologies due to their work. To face this situation, it is common the use of semi-occluded vocal tract (SOVT) exercises, a strategy of voice education/rehabil-itation implemented to induce a change in the vibration pattern of the vocal folds, mitigating, therefore, the risk of vocal lesion by reducing the collision stress applied to tissues. A variety of reports have indicated that this treatment has effects in the closed quotient (CQ), an indirect measure of collision stress. Aim. The purpose of this study was to examine the physiological effect of two dif-ferent SOVT exercises in larynx activity of teachers with constant vocal effort but without vocal pathology. Methods. 43 samples of teachers were recorded before, during and after executing two SOVT exercises (tongue trill and tube phonation). Electroglottographic samples were analyzed in order to obtain CQ. Results and conclusion. Both exercises had a significant difference of CQ scores when before and during conditions were compared. Any difference was found on this parameter after executing the activity. These findings agree with previous reports where CQ tends to increase during phonation through resonance tubes; on the con-trary, execution of tongue trill tends to decrease CQ values. This behavior might be because of the particular biomechanical mechanisms of each exercise

Laryngeal granulomas in patients after two-jaw surgery: Four cases report

BACKGROUND: Endotracheal intubation can cause focal ischemia, damage or edema to the laryngeal mucosa, and may be followed by serious complications such as vocal cord paralysis, ulcers, and granulation tissue formation. Laryngeal granuloma is rare but also a significant late complication of endotracheal intubation, and anesthesiologists should be concerned about it.CASE: We experienced four cases of laryngeal granuloma that developed after two-jaw surgery January 2017–December 2018 in our hospital and would like to report these cases with brief review of literature.CONCLUSIONS: There are frequent movements on the head and neck in maxillofacial surgery and the nasotracheal intubation should be prolonged after bimaxillary osteotomy surgery because of post-operative airway problems. This may be why two-jaw surgery may have higher occurrence of laryngeal granuloma than others.

The Correlation between Benign Laryngeal Mucosal Disease and Metabolic Syndrome

BACKGROUND AND OBJECTIVES: The aim of this study is verify the correlation between benign laryngeal mucosal disease and metabolic syndrome. MATERIALS AND METHOD: Data for patients diagnosed with benign laryngeal mucosal disease and metabolic syndrome from 2006 to 2015 were selected for analysis from the National Health Insurance Service database. RESULTS: The prevalence of Metabolic syndrome was 2,179,785 out of 6,437,051 patients (33.86%). The prevalence of benign laryngeal mucosal disease was 516,594 out of 6,437,051 patients (8.03%). Metabolic syndrome was a risk factor for benign laryngeal mucosal disease [hazard ratio: 0.99, 95% confidence interval: 0.984–0.997] after adjusting for age and other variables including age, gender, smoking status, alcohol intake, exercise, body mass index, and diabetes. The number of metabolic syndrome components was also risk factor. CONCLUSION: Metabolic syndrome was related to the incidence of benign laryngeal mucosal disease. However this correlation did not seem to be high.

A Case of Unexpected Clinostomum complanatum Infection Initially Presenting as Foreign Body in Pharynx

A 46-year old man visited our outpatient clinic with complaint of foreign body sensation in throat after consuming raw freshwater fish 5 days ago. Laryngoscopic examination revealed a motile worm attached on posterior pharyngeal wall. The worm was removed using biopsy forceps under transnasal endoscopy and evidently identified as Clinostomum complanatum after microscopic examination. Patient’s subjective foreign body sensation of throat and hyperemia of laryngeal mucosa remained for approximately 2 weeks post-removal, which were eventually resolved after administration of non-steroidal anti-inflammatory drug and anti-refluxant drug for 2 weeks. Treatment was ended at three weeks since the first visit. C. complanatum infections in humans are rare, and only four cases have been reported in Korea. Symptoms resembling pharyngitis or laryngitis occurs by consumption of raw, infected freshwater fish and treatment is done by mechanically removing the parasite.

Lesão de mucosa laringotraqueal e fatores associados após extubação endotraqueal: estudo piloto / Laryngotracheal mucosa injury and associated factors after endotracheal extubation: a pilot study

Resumo Objetivo Descrever os sinais clínicos de lesão de mucosa laringotraqueal e seus fatores associados. Métodos Estudo observacional, longitudinal, em pacientes intubados por ocasião da anestesia geral. Foram realizadas avaliações no pré-operatório, transoperatório, e nas 24, 48 e 72 horas após extubação. Para análise, utilizaram-se estatísticas descritiva e exploratória, e também foi verificada a razão de chances. Resultados Dentre os pacientes, 53,3% apresentaram pelo menos um sinal clínico de lesão de mucosa laringotraqueal, sendo predominantes: rouquidão (43,3%), disfagia (40%) e odinofagia (33,3%). Estiveram associados aos seguintes fatores: pressão intra-cuff acima de 25cmH2O, intubação por mais de 120 minutos e uso de tubos maiores que 7,5mm. Conclusão Os sinais clínicos de lesão de mucosa laringotraqueal mais frequentes na população deste estudo foram rouquidão, disfagia e odinofagia, associados à pressão do cuff acima de 25 cmH2O, seguido do tempo de intubação e tamanho inadequado de tubos endotraqueais.

Abstract Objective To describe the clinical signs of laryngotracheal mucosal injuries and associated factors. Methods This was an observational longitudinal study conducted with patients intubated due to general anesthesia. Assessment was carried out in the preoperative period, intraoperative period and at 24, 48, and 72 hours after extubation. Descriptive and exploratory statistics were used for analysis, in addition to odds ratio. Results 53.3% of the sample presented at least one clinical sign of laryngotracheal mucosal injury, mainly: hoarseness (43.3%), dysphagia (40%), and odynophagia (33.3%). The following factors were associated: intracuff pressure above 25 cmH2O, intubation longer than 120 minutes, and the use of tubes larger than 7.5mm. Conclusion The most common clinical signs of laryngotracheal mucosal injury among the studied population were hoarseness, dysphagia, and odynophagia, associated with cuff pressure above 25 cmH2O, followed by duration of intubation and inadequate endotracheal tube size.

A Case of Malignant Transformation of Layngeal Mucosa after Inhalation Injury 25 Years Ago

Laryngeal neoplasm is the second most common malignancy of the upper aerodigestive tract. About 85% to 95% of laryngeal malignancies are squamous cell carcinoma that arises from the epithelial lining of the larynx. The exact cause of laryngeal neoplasm is unknown, but certain risk factors can affect the chances of developing it. Chronic inflammation is a mutagen factor confirmed in the carcinogenesis of various tumor. Inhalation injuries cause histopathologic damage to laryngeal mucosa and inflammation change. This long term inflammation may leads to the development of dysplasia and malignant transformation. Recently, we experienced a case of malignant transformation of laryngeal mucosa after inhalation injury patient 25 years ago. Herein, we reported this rare case and review the relevant literature.

Variations in the origin of superior laryngeal artery / 대한해부학회지

The superior laryngeal artery is the principal artery supplying the laryngeal mucosa, musculature, and glands. Knowledge of variations in the origin of superior laryngeal artery could prove to be very useful during reconstructive surgeries of the larynx, partial laryngectomy, laryngeal transplantation, and also during procedures like super-selective intra-arterial chemotherapy for laryngeal and hypolaryngeal cancers. However, relatively few studies have been done on the superior laryngeal artery in comparison to its clinical importance. The present study was aimed at documenting the prevalence of variable origin of the superior laryngeal artery within the carotid triangle. Sixty hemi-necks obtained from 30 South Indian cadavers were dissected and studied for variations in the origin of superior laryngeal artery. It was observed that the superior laryngeal artery took origin from superior thyroid in 91.7% cases. Variable origin from the external carotid artery was noted in 5% cases. The superior laryngeal artery was found to arise from the lingual artery in one case alone (1.7%). In addition to the above findings, a very rare variation of superior laryngeal artery arising from the ascending pharyngeal (1.7%) was also observed in the hemi-neck of one cadaver. All the variations that were observed were unilateral and on the left side. These findings may help provide further insight to the anatomists, radiologists and surgeons and can help improve performances during surgical manipulations of the larynx.

Surgical excision and botulinum toxin A injection for vocal process granuloma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the efficacy of treatment with microsurgery in combination with local injection of type A botulinum toxin for vocal process granuloma.@*METHOD@#28 patients with vocal process granuloma received endotracheal intubation under general anesthesia. The lesion was removed with micro-scissor and CO2 laster under a self-retaining laryngoscope and microscope. The incision and mucous membrane surrounding the wound was closed with 8-0 absorbable suture. 4-point injection of botulinum toxin type A 8-15 u was then performed along the thyroarytenoid muscle and arytenoid muscle of the same side. Postoperative medication was administered based on disease causes.@*RESULT@#All patients experienced vocal cord dyskinesia of the injected side 2-3 days after surgery. At 1 month after the surgery, wound healing was good in all the 28 patients, and the vocal cord movement was limited at the injected side. At 3 months, movement of the bilateral vocal cords was normal, and the vocal cord process mucosa was smooth. Patients were followed up for more than a year, and only one patient had recurrence in 2 months after surgery. The cure rate was 96. 4%.@*CONCLUSION@#Combination of laryngeal microsurgery and type A botulinum toxin local injection can shorten the treatment course of vocal process granuloma.

Expression of BTG1 protein in laryngeal squamous cell carcinoma and its clinical significance / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression of B-cell translocation gene 1 (BTG1) and to determine the relationship between BTG1 expression and clinicopathological features, biological behaviors in laryngeal squamous cell carcinoma.@*METHOD@#Immunohistochemistry and Western blot were used to analyze BTG1 protein expression in 70 cases of laryngeal cancer and 35 cases of adjacent corresponding laryngeal mucosal tissues to illuminate the relationship between BTG1 expression and clinical factors.@*RESULT@#The positive rate of BTG1 protein expression was 31.43% in laryngeal carcinoma tissues, significantly lower than 91.43% in the adjacent laryngeal tissues (P 0.05) of patients with laryngeal cancer.@*CONCLUSION@#The expression of BTG1 protein was decreased in laryngeal squamous cell carcinoma, suggesting that BTG1 gene may be closely associated with the carcinogenesis and the degree of malignancy. Detection of BTG1 expression may be useful in diagnosis, treatment and prognosis of laryngeal carcinoma.

A Case of Pharyngitis Caused by Clinostomum complanatum / 대한이비인후과학회지

A 13-year-old female patient visited the otolaryngology clinic with complaints of a moving foreign body sensation in her throat. The patient used to eat raw fish and she had eaten mullet sashimi a week before. During laryngoscopy for the pharynx and larynx, a motile fluke was found attached to the posterolateral nasopharyngeal wall. The worm was easily removed and identified as Clinostomum complanatum (C. complanatum) after morphological observation. C. complanatum is a digenetic trematode which usually infects fish-eating birds. Human infection by C. complanatum is very rare, and if a human eats infected raw fish, the worm can be on the pharyngeal or laryngeal mucosa. Human cases of parasitic C. complanatum infection have been reported twice in Korea, with the present report being the first case in the otolaryngology field.

Myogenic differentiation of laryngeal mucosal mesenchymal stem cells / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the myogenic differentiation of laryngeal mucosal mesenchymal stem cells (LM-MSCs) and the possibility of LM-MSCs as new alternative seed cells for laryngeal tissue engineering.</p><p><b>METHODS</b>LM-MSCs were separated from normal epiglottis mucosa and the cell surface markers including CD44, CD105, CD90, CD29, CD34 and CD45 were analyzed through flow cytometry. The osteogenesis and adipogenesis differentiation of LM-MSCs were investigated by oil red staining and alizarin red S staining. Immunofluorescence staining and RT-PCR were used to detect the expressions of myogenic differentiation markers including Myod1, Myogenin and myosin heavy chain (MyHc).</p><p><b>RESULTS</b>The separated LM-MSCs were in a fibrocyte-like form with long fusiform shape and grew adherent. The expression rates of cell surface markers LM-MSCs were CD44 (100.0%), CD105 (90.4%), CD90(99.9%), CD29 (93.0%), CD34 (0.4%) and CD45(1.3%) respectively. A number of beaded lipid drops and mineral deposition were observed after 14 days of adipogenesis differentiation and 21 days of osteogenesis differentiation. Myod1, Myogenin and MyHc genes appeared after 1 week and 3 weeks of myogenesis differentiation respectively.</p><p><b>CONCLUSIONS</b>The LM-MSCs have the properties of mesenchymal stem cells and could be differentiated into myoblasts, providing with the possibility to repair the damaged vocal cords with LM-MSCs through tissue engineering techniques.</p>

Expression of cancer stem cell marker USP22 in laryngeal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the expression of cancer stem cell marker USP22 in laryngeal squamous cell carcinoma (LSCC) and clinical implications.</p><p><b>METHODS</b>The expression of USP22 was detected by immunohistochemistry in LSCC tissues of 64 cases and squamous epithelium tissues beside carcinoma of 26 cases (control). The correlation of USP22 expression with various clinicopathologic factors was evaluated with the single factor analysis.</p><p><b>RESULTS</b>The expression levels of USP22 in LSCC and control were 57.8% and 19.2% (P < 0.05). Clinicopathological analysis showed that USP22 expression level had a relationship with clinical stage, T stage, and lymph node metastasis (P < 0.05), but not with gender, age, smoking and differentiation (P > 0.05). Survival analysis showed that patients with high USP22 expression had significantly poorer outcome compared with patients with low USP22 expression. The survival was related to clinical stage, T stage, and lymph node metastasis, but not with age, sex, and smoking (P > 0.05).</p><p><b>CONCLUSIONS</b>The expression of USP22 is significantly increased in LSCC, which correlates with the malignant degree, invasion, metastasis and prognosis of LSCC. USP22 may be served as a new candidate molecular marker and therapeutic target of LSCC.</p>

Aberrant expression of CyclinE and p27 in laryngeal squamous cell carcinoma and the clinical significance / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore new hallmarks affecting the prognosis of patients with laryngeal squamous cell carcinoma (LSCC) via investigating the expression of CyclinE and p27 in LSCC tissues.@*METHOD@#The expression of CyclinE and p27 was detected via Elivision immunohistochemical staining in 160 LSCC tissues and 20 normal laryngeal tissues (NLT). The relationship between CyclinE/ p27 and LSCC/ NLT was analyzed via Log-rank analysis. The relationship of CyclinE and p27 protein was statistically analyzed by spearman correlation analysis. The relationship between CyclinE/p27 and clinical-pathology-factors of patients with LSCC, such as age, gender, tumor site, diameter, differentiation, lymph node metastasis and PTNM stage were analyzed by Chi-square test. The relationship between clinical-pathology-factors, CyclinE, p27 and overall survival time of patients with LSCC was analyzed via Cox multiplicity and Kaplan-Meier survival analysis. A significant difference was recognized by P0.05 for all). A negative correlation was found between the expression of CyclinE and p27 protein, r= -0.767(P<0.05). Kaplan-Meier survival analysis showed that the overall survival rate of patients with LSCC was 36.9% (P<0.05). The 5-year survival rate in positive group of CyclinE was 8%, in negative group was 80% (P<0.05). On the contrary, the 5-year survival rate of patients with LSCC in positive group of p27 protein was 77.27%, the rate was 5.32% in negative group (P<0.05). Cox multivariate regression analysis revealed that lymph node metastasis, PTNM stage, CyclinE and p27 were independent risk factors of prognosis for patients with LSCC.@*CONCLUSION@#It is the molecular basis underlying the development and invasion/ metastasis of LSCC that activation of CyclinE gene accompanying inactivation of p27 gene. It is very important of co-detecting CyclinE and p27 protein to predict the prognosis of patients with LSCC.

Expression and significance of DNA-dependent protein kinase in human laryngeal squamous cell carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the expression of DNA-dependent protein kinase (DNA-PK) in human laryngeal squamous cell carcinoma (LSCC) and normal laryngeal mucosa (NLM), and to analysize the relationship between the expression and the clinicopathologic parameters of LSCC.@*METHOD@#Immunohistochemical technique (Envision) was used to detect the expression of DNA-PK in 64 cases of LSCC and 15 cases of NLM. To investigate an investigation was conducted on the relationship between the expression and clinico-pathological features of LSCC.@*RESULT@#DNA-PK was lowly expressed in NLM and highly expressed in LSCC,the positive rate of DNA-PK expression was 26.67% (4/15), 78.13% (50/64), respectively, and there was significant different difference between the two groups (P 0.05).@*CONCLUSION@#DNA-PK may be involved in disease development of LSCC.

Descrição de periodicidade do sinal eletroglotográfico durante a emissão dos exercícios de vibração sonorizada de língua e lábios comparados à vogal sustentada /E/ / Comparison of tongue and lip trills with phonation of the sustained vowel /E/ regarding the periodicity of the electroglottographic waveform and the amplitude of the electroglottographic signal

INTRODUÇÃO: Os exercícios de vibração sonorizada de lábios e língua têm-se se mostrado eficientes quando utilizados tanto no tratamento de pacientes disfônicos como no aquecimento ou preparação vocal. Há grande variação do coeficiente de contato de um mesmo sinal eletroglotográfico e dificuldade na sincronização da luz estroboscópica durante a emissão dos exercícios de vibração sonorizada de língua e lábios, sendo levantada a possibilidade de aperiodicidade de vibração das pregas vocais durante a execução desses exercícios. OBJETIVO: descrever a vibração das pregas vocais durante a emissão de vibrações sonorizadas de língua e lábios comparando-as com a emissão da vogal /E/ sustentada quanto à regularidade e amplitude dos ciclos vibratórios na eletroglotografia, em cantores eruditos profissionais. METODOLOGIA: Participaram desse estudo 10 cantores eruditos profissionais, que emitiram a vogal /E/ sustentada e os exercícios de vibração sonorizados de língua e de lábios na mesma frequência e intensidade durante a execução da eletroglotografia. Foi realizada a inspeção visual da onda eletroglotográfica, quanto à periodicidade e amplitude, além do espectrograma do sinal quanto aos harmônicos presentes em cada amostra. As amostras foram randomizadas e analisadas por 3 avaliadoras. Além disso, foram extraídas as medidas de jitter e shimmer do sinal eletroglotográfico para confirmação dos resultados, além da frequência da variação de vibração dos exercícios de vibração sonorizada. RESULTADOS: Os avaliadores tiveram coeficiente alfa de Cronbach em mais de 0,9 na maior parte das amostras, indicando alto grau de concordância. Na inspeção visual do sinal eletroglotográfico foi considerada na vogal /E/ sustentada: onda periódica com amplitude regular e harmônicos múltiplos da frequência fundamental. Durante o exercício de vibração sonorizada de língua e lábios foram consideradas onda quase-periódica com amplitude oscilante (frequencia aproximada de 23Hz e 24Hz)...

INTRODUCTION: Lip and tongue trills have been effectively used as vocal warmups in the treatment of dysphonia and in the training of professional voice users. In a previous study, we found that the closed quotient varied widely during tongue and lip trills. We encountered difficulty in synchronizing the stroboscopic illumination with the vocal fold vibration during the trill exercises. We hypothesize that there is aperiodicity of vocal fold vibration during tongue and lip trills. AIM: to compare the vocal fold vibration seen during lip and tongue trills with that seen during phonation of the sustained vowel /E/, in terms of the periodicity of the EGG wave form and the amplitude of the EGG signal, in professional voice users. METHODS: We used electroglottography (EGG) to compare the vocal fold vibration seen during tongue and lip trills with that seen during phonation of the sustained vowel /E/, in terms of the EGG waveform periodicity and signal amplitude, in 10 classically trained, professional singers. The participants produced the sustained vowel /E/ and performed tongue and lip trills at the same frequency and intensity. The periodicity of the waveform and the amplitude of the signal were visually analyzed by three blinded, experienced readers. To confirm the visual analysis results, we measured the jitter and shimmer of the signal and the frequency of variation in vocal fold vibration during the trill exercises. RESULTS: Cronbach's alpha coefficient values were high (>0,9), indicating high inter-rater reliability. In sustained vowel /E/ was considered periodic wave and regular amplitude. In tongue and lip trills the waveform EGG was considered quasi-periodic and the amplitude of the EGG signal was classified as oscillating. The mean amplitude was as follows: 24.4 Hz during lip trills performed at high intensity; 24.7 Hz during tongue trills performed at high intensity; 23.3 Hz during lip trills performed at low intensity; and 24.3 Hzl...

The expression of BUB1 in laryngeal squamous cell carcinoma and its clinical significance / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression and clinical significance of BUB1 protein in laryngeal squa mous cell carcinoma (LSCC) tissues.@*METHOD@#The expression of BUB1 protein was measured by immunohistochemistry (EliVision two steps) in 55 cases of LSCC tissues,30 cases of adjacent normal laryngeal mucosa tissues, the relationship of BUB1 expression with clinical pathologic factors in LSCC was also analyzed.@*RESULT@#The positive rate of BUB1 protein in LSCC tissues (50.9%, 28/55) was significantly lower than that in adjacent normal laryngeal mucosa tissues (83.3%, 25/30), P 0.05, respectively).@*CONCLUSION@#The low expresssion of BUB1 protein is closely related to the tumorigenesis and development of LSCC, and can be a molecular marker for prognosticating metastasis and prognosis of LSCC.

Expression of programmed cell death 4 and its correlation with proliferation and apoptosis in laryngeal squamous cell carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the expression of PDCD4 and its relationship with cell proliferation and apoptosis in laryngeal squamous cell carcinomas and to evaluate its clinical significance.@*METHOD@#The immunohistochemical staining method was applied to investigate the expression of PDCD4 and Ki-67 in 60 laryngeal squamous cell carcinomas tissues and 21 their surrounding laryngeal normal mucosa tissues. TUNEL method was applied to detect the apoptosis. The proliferation index (PI) and apoptosis index (AI) were defined.@*RESULT@#The positive rate of PDCD4 protein was significantly lower in laryngeal squamous cell carcinomas than that in the laryngeal normal mucosa tissues (P < 0.01). The expression of PDCD4 had relation with the differentiation grading and lymph node metastasis (P < 0.05), but not related to tumor sites and TNM stage. The PI of laryngeal squamous cell carcinomas tissues was higher than that of the normal laryngeal mucosa tissues (P < 0.01). No relation was found among PI and tumor sites, differentiation grading and lymph node metastasis. PI had correlation with TNM stage (P < 0.05). The AI of the cancer was higher than that of normal laryngeal mucosa tissues (P < 0.01). There was no relationship between AI and tumor sites, TNM stage and lymph node metastasis. AI correlated with differentiation grading (P < 0.01). The PI in PDCD4 positive group was significantly lower than in PDCD4 negative group (P < 0.05). The AI in PDCD4 positive group was significantly higher than in PDCD4 negative group (P < 0.05).@*CONCLUSION@#The expression of PDCD4 is low in laryngeal squamous cell carcinomas and it may play important roles in occurrence and development of laryngeal squamous cell carcinomas through the inducing apoptosis and inhibiting proliferation.

Clinical classification and management of squamous intraepithelial lesions of the vocal cord / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the clinical classification of the squamous intraepithelial lesions (SILs) of vocal cord and their outcomes after different therapeutic procedures.</p><p><b>METHODS</b>Three hundred and forty-three patients with the SILs of vocal cord were enrolled. Based on the history of the diseases, macroscopic appearance by video rhino aryngoscopic, stroboscopic and microlaryngoscopic examination, and pathological findings, the correlation of clinical features, treatment modalities and treatment effect of the vocal cord SILs were discussed.</p><p><b>RESULTS</b>According to the morphological characteristics, 343 patients were divided into four types. TypeI, leukoplakia combined with inflammation (n = 19); type II, leukoplakia combined with polyps by friction (n = 72); type III, leukoplakia combined with sulcus vocalis (n = 64); type IV, keratosis (n = 188). Patients with type I lesions were treated by medications. The vocal cord configuration and the voice of the patients in type I returned to normal after treatment. Patients with type II, III, IV lesions were treated by CO(2) laser. Type II were treated by subepithelial cordectomy, type III by mucosa slicing with dredging, type IV by sub ligament cordectomy or trans muscular cordectomy. The cure rate of patients with type II, III, IV lesions was 90.7% (294/324) after single surgery, the recurrent rate was 9.3% (30/324). Twenty-one patients (11.2%), all in type IV, developed carcinogenesis. Eight cases were diagnosed in the first surgery and 13 cases in the second. Among the 13 cases diagnosed in the second surgery, 2 cases had partial laryngectomy for the third surgery.</p><p><b>CONCLUSIONS</b>Since the squamous intraepithelial lesions of vocal cord manifested differently, conservative treatment or CO(2) laser surgery should be used. In this way, a less invasive procedure, better recovery of the voice and less complication could be expected.</p>