Disarrangement of collagen fibers in Reinke's edema.
OBJECTIVE
To describe the arrangement of collagen fibers in the superficial layer of the lamina propria of the vocal folds with Reinke' edema.


METHODS
Cross sectional analysis of the lamina propria of the vocal folds with Reinke's edema (RE).


METHODS
The picrosirius polarization method was used to study the arrangement of collagen fiber. Findings of collagen disarrangement were categorized semiquantitatively and correlated with RE severity, age, cigarette smoking and duration of dysphonia.


RESULTS
Analysis of 20 specimens of vocal folds with RE showed that the intertwined network of collagen fibers resembling a wicker-basket normally observed in vocal folds was disarranged in RE. The collagen fibers were loosely arranged, fragmented and intermixed with varying amounts of myxoid stroma. Moderate and large areas of disarrangement (90% of cases) predominated. Collagen fiber arrangement in the region underneath the epithelium was better preserved when compared with fibers in the deeper region of the superficial layer of the lamina propria. There was a statistical difference in collagen disarrangement between grade II and grade III severity (P = .007) that appeared to be due to the large areas of disarrangement observed in 73% of patients with grade III severity and in 44% of grade II severity. Age was the only variable correlated with collagen fiber disarrangement (r = 0.47, P = .037).


CONCLUSIONS
Our findings suggest that the flexible framework which maintains the uniformity of the lamina propria was lost in RE caused by the disarrangement of the collagen fibers.
Department of Otolaryngology, The University of São Paulo School of Medicine, São Paulo, Brazil. sakaeflavio@yahoo.com.br
Flavio Akira
FA
Sakae
Rui
R
Imamura
Luiz U
LU
Sennes
Thais
T
Mauad
Paulo H
PH
Saldiva
Domingos H
DH
Tsuji
D001391:Azo Compounds / Q000032:analysis; D003094:Collagen / Q000648:ultrastructure*; D004396:Coloring Agents / Q000032:analysis; D005260:Female; D006801:Humans; D007819:Laryngeal Edema / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000648:ultrastructure*; D012907:Smoking; D014827:Vocal Cords / Q000737:chemistry / Q000473:pathology*; D014832:Voice Disorders / Q000209:etiology
D001391:Azo Compounds; D004396:Coloring Agents; C009798:C.I. direct red 80; D003094:Collagen