Finck C
CHU Sart Tilman, Service d'Oto-rhino-laryngologie et de Chirurgie Cervico-faciale, Liège, Belgique.
Rev Laryngol Otol Rhinol (Bord). 2005;126(5):295-300.
Our knowledge of vocal fold structure has profoundly evolved since the description by M. Hirano in 1974 of the laminar organization of the connective tissue of the human vocal fold, the lamina propria. The molecular composition of the extracellular matrix (ECM) of the lamina propria is essential in determining the viscoelastic properties of the tissue. This is particularly true in the superficial layer of the lamina propria (also called Reinke's space). With the epithelium, Reinke's space constitutes the vocal fold main vibrator. In normal subjects, the jelly like structure of the Reinke's space is due to a very loose fibrous scaffolding and to a balance between the interstitial proteins of the ECM: Proteoglycans like decorin and hyaluronic acid and glycoproteins like fibronectin. Vibratory trauma leads, in disease states, to molecular modification of the extracellular matrix of Reinke's space resulting in benign cordal lesions like nodules, submucosal fibrosis and vocal folds scars. Improving the knowledge of the homeostasis of Reinke's space ECM can lead to improvement of the therapeutic and prevention strategies of vocal fold benign lesions. The main histologic and viscoelastic characteristics, as well as surgical treatment of cordal nodular lesions and scars are described. The recent researches in the field of regeneration of Reinke's space are evoked.
自1974年平野真人描述了人类声带固有层结缔组织的层状结构以来，我们对声带结构的认识有了深刻的发展。固有层细胞外基质（ECM）的分子组成对于决定组织的粘弹性特性至关重要。在固有层的表层（也称为Reinke间隙）尤其如此。Reinke间隙与上皮一起构成了声带的主要振动器。在正常受试者中，Reinke间隙的果冻状结构是由于非常松散的纤维支架以及ECM的间质蛋白之间的平衡所致：如核心蛋白聚糖和透明质酸等蛋白聚糖以及如纤连蛋白等糖蛋白。在疾病状态下，振动性创伤会导致Reinke间隙细胞外基质的分子改变，从而导致声带良性病变，如结节、粘膜下纤维化和声带瘢痕。增进对Reinke间隙ECM稳态的了解可改善声带良性病变的治疗和预防策略。本文描述了声带结节性病变和瘢痕的主要组织学和粘弹性特征以及手术治疗方法。文中还提及了Reinke间隙再生领域的最新研究。
