Acta Oto-Laryngologica
ISSN: 0001-6489 (Print) 1651-2251 (Online) Journal homepage: http://www.tandfonline.com/loi/ioto20
Experimental Studies On The Treatment Of Unilateral Vocal Cord Paralysis M. Neiger & R. Baumann To cite this article: M. Neiger & R. Baumann (1975) Experimental Studies On The Treatment Of Unilateral Vocal Cord Paralysis, Acta Oto-Laryngologica, 80:1-6, 150-154, DOI: 10.3109/00016487509121313 To link to this article: http://dx.doi.org/10.3109/00016487509121313
Published online: 08 Jul 2009.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ioto20 Download by: [RMIT University Library]
Date: 19 April 2016, At: 23:30
Acta Otolaryngol 80: 150-154, 1975
EXPERIMENTAL STUDIES ON THE TREATMENT OF UNILATERAL VOCAL CORD PARALYSIS M. Neiger and R. Baumann From the Department of Otolaryngology, University of Bern, Bern, Switzerland
Downloaded by [RMIT University Library] at 23:30 19 April 2016
(Received November 30, 1974)
Abstract. After the injection of Teflon and Silicon behind the vocal cords of sheeps we noticed that these materials are quite well supported. The little particles of Teflon are surrounded by conjective tissue whereas the Silicon is enclosed in an unic membrane. We could not see a migration of the materials in the depth.
The injection of Teflon behind a paralysed vocal cord is a well known prognostic and therapeutic method. The reaction of the surrounding tissue to the foreign body has previously been described by Arnold (1962), Reichhardt (1970), Goff (1973) and others. Besides Teflon, we have made an experimental study of another material-Silicon. Both materials were tested in animals living under normal conditions. We wished to check whether parts of the foreign body migrate or are absorbed. Teflon was extremely favorable for this study, as its particles are birefringent and therefore easy to localise under polarised light. In three 12-week-old lambs we injected Teflon paste behind one and Silicon liquid behind the other vocal cord. Silicon was sterilised immediately before the operation at a temperature of 120°C for 10 minutes. Temperature and length of sterilisation determine the viscosity of the Silicon liquid. All the animals endured the operation well; they did not seem to have any trouble and developed normally afterwards. One of the sheep gave birth young after a normal pregnancy. After 3, 6 and 10 months the animals were Acta OtolaryngolSO
killed, the larynx was removed immediately and frozen in liquid nitrogen. Frozen sections of 2030 pm were made and stained with hematoxylineosin. Whereas the sectioning of the Tefloninjected side raised no problems, the sectioning of the Silicon-injected side was difficult, as the Silicon was expelled during the procedure. We found two types of tissue reactions with the Teflon paste: (1) The Teflon lay as an isolated deposit encapsulated by a dense fibrotic capsule and completely separated from the surrounding tissue (Fig. 1). Outside the capsule no Teflon particles were visible (Fig. 2). This type of reaction definitely explains the observation of Horn in the cheek of a hamster, inasmuch as form and localisation of the Teflon deposit remain unchanged. Once walled in by the fibrotic capsule, the foreign body can no longer move. (2) The foreign body could lie as a deposit, but it was neither enclosed by a dense capsule nor completely separated from the surrounding tissue (Fig. 3) as demonstrated by the muscle fibres running through the Teflon particles (Fig. 4). These two forms were not related to the length of time that the Teflon remained in the tissue, as we found the first form in the animals killed at 3 and at 10 months, the second in the animal killed at 6 months. It seems far more likely that the site of injection, or the surrounding tissue, is decisive. Thus, we found the first form of reaction when Teflon was injected in connective or in fatty tissue, the second when more consistent
Downloaded by [RMIT University Library] at 23:30 19 April 2016
Treatment of unilateral vocal cord paralysis
15 1
Fig. 1. Teflon deposit with strong connective capsule.
Fig. 2. NO Teflon particles visible
outside the capsule under polarised light.
Fig. 3. Teflon deposit without capsule in between muscle tissue. Acta Otolavyngol80
Downloaded by [RMIT University Library] at 23:30 19 April 2016
152 M. Neiger and R. Baumann
Fig. 6. Infiltration of histiocytes and lymphocytes. Fig. 4 . Muscle fibres (arrow) in Teflon deposit.
tissue such as muscles or glands were present. Whereas the Teflon pushed aside the tissue in the first case, it infiltrated existing cleavage spaces in the second case. The cytological reaction remained the same in both previously described types. The Teflon particles induced a strong conjunctive reaction, inasmuch as they were surrounded by the connective tissue (Fig. 5). Furthermore, we noted a
moderate infiltration of histiocytes and lymphocytes (Fig. 6) and more or less giant cells of foreign body type (Fig. 7). As concerns the migration of the Teflon particles, some of them were found quite a distance from the large deposits (Fig. 8). When studying their localisation in serial sections, it was obvious that they either remained in the canal of injection, or that they belonged to a more widely spread Teflon deposit, as described
Fig. 5. Connective reaction. Actu Otoluryngol80
Treatment of unilateral vocal cord paralysis
153
Downloaded by [RMIT University Library] at 23:30 19 April 2016
Fig. 7. Giant cells of foreign body type.
Fig. 8. Particles of Teflon in the canal of injection.
Fig. 9. Pseudo-cyst caused by Silicon injection. 11 - 152952
Acta Otolaryngol80
154 M . Neigev and R. Baumann
We could not find any giant cells of foreign body type. Silicon therefore seems to be better tolerated than Teflon; furthermore, it may have the advantage of being removed more easily in case of unexpected reactions. Unfortunately it has not yet been set free for use on human beings.
Downloaded by [RMIT University Library] at 23:30 19 April 2016
ZUSAMMENFASSUNG
Fig. 10. Border of the Silicon pseudo-cyst.
in form two. It was not possible to detect Teflon particles further away from the deposit nor in lymphatic spaces. It is therefore most probable that no migration of Teflon takes place. As to the Silicon, we can only answer the question of reaction on the tissue. Beside the sections of the larynxes, we also studied some sections of ears of rabbits. There was here a marked difference between Teflon and Silicon. The connective tissue did not infiltrate the Silicon nor did any cells migrate into the foreign body. The Silicon remained like a cyst in the tissue (Fig. 9). The wall of the cyst showed a certain increase of connective tissue, but without forming a real capsule. A slight infiltration of histiocytes and lymphocytes was present. The border of the tissue looked like a pseudo-endothelium with flat and long spread cells (Fig. 10).
Acta Otolaryngol80
Lammern wurde hinter das eine Stimmband Teflon und hinter das andere Silikonpaste injiziert. Nach 3, 6 und 10 Monaten wurden die Kehlkopfe histologisch untersucht. Dabei zeigte sich, dass die Teflonpartikel in einer dichten bindegewebeartigen Kapsel eingeschlossen waren, wenn sie im Fettgewebe lagen. War die Injektion in Muskel- oder Driisengewebe erfolgt, fehlte die Kapsel, und das primare Gewebe war zwischen den Teflonpartikeln noch erkennbar. Silikon loste nur eine leichte Reaktion aus und lag wie der Zysteninhalt in einer einfachen bindegewebeartigen Mernbran. Ein Abwandern von Teflonpartikel uber Lymphspalten konnte nicht festgestellt werden.
REFERENCES Arnold, G. E. 1962. Vocal rehabilitation of paralytic dysphonia. VI. Further studies of intracordal injection materials. Arch Otoluryngol 76, 358. Goff, W. F. 1973. Intracordal Polytef (Teflon) injection. Arch Otolaryngol97, 371. Horn, E. 1973. Intravitalmikroskopische Beobachtungen an der Hamsterbackentasche nach Instillation eines Teflonpastendepots. Z Laryngol Rhino1 Otol52, 837. Reichhardt, W. 1970. Intracordale Injektionen. Experimentelle Untersuchungen auf Gewebsvertraglichkeit und Eignung von Siliconen und Teflon am Kaninchen. Inaugural Diss., Munchen.
M. Neiger, M.D. Dept. of Otolaryngology University of Bern Inselspital Bern Schwitzerland
ISSN: 0001-6489 (Print) 1651-2251 (Online) Journal homepage: http://www.tandfonline.com/loi/ioto20
Experimental Studies On The Treatment Of Unilateral Vocal Cord Paralysis M. Neiger & R. Baumann To cite this article: M. Neiger & R. Baumann (1975) Experimental Studies On The Treatment Of Unilateral Vocal Cord Paralysis, Acta Oto-Laryngologica, 80:1-6, 150-154, DOI: 10.3109/00016487509121313 To link to this article: http://dx.doi.org/10.3109/00016487509121313
Published online: 08 Jul 2009.
Submit your article to this journal
Article views: 1
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ioto20 Download by: [RMIT University Library]
Date: 19 April 2016, At: 23:30
Acta Otolaryngol 80: 150-154, 1975
EXPERIMENTAL STUDIES ON THE TREATMENT OF UNILATERAL VOCAL CORD PARALYSIS M. Neiger and R. Baumann From the Department of Otolaryngology, University of Bern, Bern, Switzerland
Downloaded by [RMIT University Library] at 23:30 19 April 2016
(Received November 30, 1974)
Abstract. After the injection of Teflon and Silicon behind the vocal cords of sheeps we noticed that these materials are quite well supported. The little particles of Teflon are surrounded by conjective tissue whereas the Silicon is enclosed in an unic membrane. We could not see a migration of the materials in the depth.
The injection of Teflon behind a paralysed vocal cord is a well known prognostic and therapeutic method. The reaction of the surrounding tissue to the foreign body has previously been described by Arnold (1962), Reichhardt (1970), Goff (1973) and others. Besides Teflon, we have made an experimental study of another material-Silicon. Both materials were tested in animals living under normal conditions. We wished to check whether parts of the foreign body migrate or are absorbed. Teflon was extremely favorable for this study, as its particles are birefringent and therefore easy to localise under polarised light. In three 12-week-old lambs we injected Teflon paste behind one and Silicon liquid behind the other vocal cord. Silicon was sterilised immediately before the operation at a temperature of 120°C for 10 minutes. Temperature and length of sterilisation determine the viscosity of the Silicon liquid. All the animals endured the operation well; they did not seem to have any trouble and developed normally afterwards. One of the sheep gave birth young after a normal pregnancy. After 3, 6 and 10 months the animals were Acta OtolaryngolSO
killed, the larynx was removed immediately and frozen in liquid nitrogen. Frozen sections of 2030 pm were made and stained with hematoxylineosin. Whereas the sectioning of the Tefloninjected side raised no problems, the sectioning of the Silicon-injected side was difficult, as the Silicon was expelled during the procedure. We found two types of tissue reactions with the Teflon paste: (1) The Teflon lay as an isolated deposit encapsulated by a dense fibrotic capsule and completely separated from the surrounding tissue (Fig. 1). Outside the capsule no Teflon particles were visible (Fig. 2). This type of reaction definitely explains the observation of Horn in the cheek of a hamster, inasmuch as form and localisation of the Teflon deposit remain unchanged. Once walled in by the fibrotic capsule, the foreign body can no longer move. (2) The foreign body could lie as a deposit, but it was neither enclosed by a dense capsule nor completely separated from the surrounding tissue (Fig. 3) as demonstrated by the muscle fibres running through the Teflon particles (Fig. 4). These two forms were not related to the length of time that the Teflon remained in the tissue, as we found the first form in the animals killed at 3 and at 10 months, the second in the animal killed at 6 months. It seems far more likely that the site of injection, or the surrounding tissue, is decisive. Thus, we found the first form of reaction when Teflon was injected in connective or in fatty tissue, the second when more consistent
Downloaded by [RMIT University Library] at 23:30 19 April 2016
Treatment of unilateral vocal cord paralysis
15 1
Fig. 1. Teflon deposit with strong connective capsule.
Fig. 2. NO Teflon particles visible
outside the capsule under polarised light.
Fig. 3. Teflon deposit without capsule in between muscle tissue. Acta Otolavyngol80
Downloaded by [RMIT University Library] at 23:30 19 April 2016
152 M. Neiger and R. Baumann
Fig. 6. Infiltration of histiocytes and lymphocytes. Fig. 4 . Muscle fibres (arrow) in Teflon deposit.
tissue such as muscles or glands were present. Whereas the Teflon pushed aside the tissue in the first case, it infiltrated existing cleavage spaces in the second case. The cytological reaction remained the same in both previously described types. The Teflon particles induced a strong conjunctive reaction, inasmuch as they were surrounded by the connective tissue (Fig. 5). Furthermore, we noted a
moderate infiltration of histiocytes and lymphocytes (Fig. 6) and more or less giant cells of foreign body type (Fig. 7). As concerns the migration of the Teflon particles, some of them were found quite a distance from the large deposits (Fig. 8). When studying their localisation in serial sections, it was obvious that they either remained in the canal of injection, or that they belonged to a more widely spread Teflon deposit, as described
Fig. 5. Connective reaction. Actu Otoluryngol80
Treatment of unilateral vocal cord paralysis
153
Downloaded by [RMIT University Library] at 23:30 19 April 2016
Fig. 7. Giant cells of foreign body type.
Fig. 8. Particles of Teflon in the canal of injection.
Fig. 9. Pseudo-cyst caused by Silicon injection. 11 - 152952
Acta Otolaryngol80
154 M . Neigev and R. Baumann
We could not find any giant cells of foreign body type. Silicon therefore seems to be better tolerated than Teflon; furthermore, it may have the advantage of being removed more easily in case of unexpected reactions. Unfortunately it has not yet been set free for use on human beings.
Downloaded by [RMIT University Library] at 23:30 19 April 2016
ZUSAMMENFASSUNG
Fig. 10. Border of the Silicon pseudo-cyst.
in form two. It was not possible to detect Teflon particles further away from the deposit nor in lymphatic spaces. It is therefore most probable that no migration of Teflon takes place. As to the Silicon, we can only answer the question of reaction on the tissue. Beside the sections of the larynxes, we also studied some sections of ears of rabbits. There was here a marked difference between Teflon and Silicon. The connective tissue did not infiltrate the Silicon nor did any cells migrate into the foreign body. The Silicon remained like a cyst in the tissue (Fig. 9). The wall of the cyst showed a certain increase of connective tissue, but without forming a real capsule. A slight infiltration of histiocytes and lymphocytes was present. The border of the tissue looked like a pseudo-endothelium with flat and long spread cells (Fig. 10).
Acta Otolaryngol80
Lammern wurde hinter das eine Stimmband Teflon und hinter das andere Silikonpaste injiziert. Nach 3, 6 und 10 Monaten wurden die Kehlkopfe histologisch untersucht. Dabei zeigte sich, dass die Teflonpartikel in einer dichten bindegewebeartigen Kapsel eingeschlossen waren, wenn sie im Fettgewebe lagen. War die Injektion in Muskel- oder Driisengewebe erfolgt, fehlte die Kapsel, und das primare Gewebe war zwischen den Teflonpartikeln noch erkennbar. Silikon loste nur eine leichte Reaktion aus und lag wie der Zysteninhalt in einer einfachen bindegewebeartigen Mernbran. Ein Abwandern von Teflonpartikel uber Lymphspalten konnte nicht festgestellt werden.
REFERENCES Arnold, G. E. 1962. Vocal rehabilitation of paralytic dysphonia. VI. Further studies of intracordal injection materials. Arch Otoluryngol 76, 358. Goff, W. F. 1973. Intracordal Polytef (Teflon) injection. Arch Otolaryngol97, 371. Horn, E. 1973. Intravitalmikroskopische Beobachtungen an der Hamsterbackentasche nach Instillation eines Teflonpastendepots. Z Laryngol Rhino1 Otol52, 837. Reichhardt, W. 1970. Intracordale Injektionen. Experimentelle Untersuchungen auf Gewebsvertraglichkeit und Eignung von Siliconen und Teflon am Kaninchen. Inaugural Diss., Munchen.
M. Neiger, M.D. Dept. of Otolaryngology University of Bern Inselspital Bern Schwitzerland
