喉闭锁的组织解剖结构：功能学考虑。
Histoanatomical structures of laryngeal atresia: Functional considerations.
机构信息
Department of Pediatric Otolaryngology-Head Neck Surgery, Jeanne de Flandre Hospital-CHU Lille, Lille, France.
CERIM EA2694, Lille University, Lille, France.
出版信息
Laryngoscope. 2020 Jan;130(1):252-256. doi: 10.1002/lary.27855. Epub 2019 Feb 8.
OBJECTIVE
To study the histoanatomical structure of laryngeal atresia with a focus on the laryngeal functional components in order to evaluate the functional prognosis of laryngeal atresia repair.
METHODS
Twenty-one consecutives cases of laryngeal atresia were diagnosed at our institution between 2009 and 2016. Morphological analysis by macroscopic exam during autopsy was performed in 19 cases. Histological study of the larynx included hematoxylin and eosin staining and protein S100 immunostaining. Our analysis focused on the vocal folds, structures of the lamina propria, cricoarytenoid joints, muscles, and innervation. For each case, associated malformations were classified into two groups: severe and moderate.
RESULTS
Antenatal diagnosis was suspected because of congenital high airway obstruction syndrome in nine cases (37%). Associated malformations were present in 19 cases (90%), including severe malformations in 12 cases (57%). Atresia involved the cricoid in all cases, with a residual lumen in only one case and the glottis in 18 cases. Separation between the cricoid and arytenoid cartilages was observed in all cases. Fusion of the vocal process of the arytenoids in the midline was present in 13 cases. According to the gestational age, posterior maculae flavae (MF) were present in 17 of 19 cases, with abnormal structure and median fusion in 13 cases. Anterior MF were present in nine of 18 cases, with fusion on the midline in five cases. Intrinsic abductors and adductors muscles were identifiable in all cases, with fusion of thyroarytenoids muscles in the midline in 18 cases. Both recurrent laryngeal nerves were observed in all cases.
CONCLUSION
Laryngeal atresia is generally associated with other malformations, with a high risk of fatal outcomes. We observed that the functional structures of the glottic plane were present in most cases, with the exception of MF, which were frequently abnormal.
LEVEL OF EVIDENCE
4 Laryngoscope, 130:252-256, 2020.
目的
研究喉闭锁的组织解剖结构，重点关注喉功能成分，以评估喉闭锁修复的功能预后。
方法
2009 年至 2016 年期间，我院共诊断出 21 例喉闭锁病例。19 例通过尸检行大体解剖分析。对喉进行组织学研究，包括苏木精和伊红染色及蛋白 S100 免疫染色。我们的分析重点是声带、固有层结构、环杓关节、肌肉和神经支配。对每个病例，相关畸形分为两组：严重畸形和中度畸形。
结果
9 例（37%）因先天性高位气道阻塞综合征而疑诊产前诊断。19 例（90%）存在相关畸形，其中 12 例（57%）为严重畸形。所有病例的环状软骨均受累，仅 1 例有残余管腔，18 例有喉闭锁。所有病例均观察到环状软骨与杓状软骨分离。13 例杓状软骨的杓状突在中线融合。根据胎龄，19 例中有 17 例存在后外侧黄斑点（MF），13 例存在结构异常和中央融合。18 例中有 9 例存在前 MF，5 例存在中线融合。所有病例均可见固有内收肌和外展肌，18 例中有 18 例杓状肌在中线融合。所有病例均观察到双侧喉返神经。
结论
喉闭锁通常与其他畸形相关，其致命结局的风险较高。我们发现，除 MF 外，大多数病例的声门平面功能结构存在，而 MF 通常异常。
证据水平
4 级喉镜，130：252-256，2020 年。
Zotero 插件