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A multidimensional study of the intrinsic laryngeal musculature

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Title:
A multidimensional study of the intrinsic laryngeal musculature
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Hardee, Terry L
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English
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xi, 205 leaves : ill. ; 28 cm.

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Subjects / Keywords:
Average linear density ( jstor )
Cartilage ( jstor )
Dissection ( jstor )
Laryngeal cartilages ( jstor )
Larynx ( jstor )
Ligaments ( jstor )
Muscles ( jstor )
Photographic slides ( jstor )
Specimens ( jstor )
Vocal cords ( jstor )
Dissertations, Academic -- Speech -- UF
Larynx -- Muscles ( lcsh )
Speech thesis Ph. D
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

Notes

Thesis:
Thesis (Ph. D.)--University of Florida, 1985.
Bibliography:
Includes bibliographical references (leaves 200-204).
Additional Physical Form:
Also available online.
General Note:
Typescript.
General Note:
Vita.
Statement of Responsibility:
by Terry L. Hardee.

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University of Florida
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University of Florida
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Copyright [name of dissertation author]. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
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Full Text















A MULTIDIMENSIONAL STUDY
OF THE INTRINSIC LARYNGEAL MUSCULATURE






BY






TERRY L. HARDEE

















A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY


UNIVERSITY OF FLORIDA 1935

























To D.V.H., K.F.H., and D.K.H.












Copyright by

Terry L. Hardee

1985














AC KNOWLEDG~iENTS



My sincerest appreciation is expressed to my committee chairman, Dr. Thomas B. Abbott, and to Dr. G. Paul Moore, for their skilled direction, invaluable expertise, and contributions regarding this project. Gratitude is also expressed to Drs. Linda J. Lonbardino and Russell M. Bauer, whose suggestions early in my graduate school program guided my course selection preference and research interests. Appreciation is also expressed to Robert Algozzine, whose cooperative nature has facilitated growth in a positive setting for so many of his students. And a simple thank you is extended to Dr. Doug Hicks, Dr. Warren Rice, Dr. Floyd Thompson, Charles l*ills and Terry Ansman for their not so simple technical assistance.














TABLE OF CONTENTS


Page

ACKNOWLEDGMENTS ................................................... iii

LIST OF TABLES ..................................................... vi

LIST OF FIGURES .................................................... ix

ABSTRACT ............................................................ x

CHAPTERS

I BACKGROUND AND PURPOSE ................................... 1

Introduction ............................................. 1
Review of the Literature ................................. 2
The Advent of Laryngeal Awareness ................... 2
Laryngeal Investigation: Anomaly and Disease ....... 6 Further Refined Investigative Techniques ............ 8
Statement of Purpose .................................... 11

II METHODS ................................................. 14

Procedures .............................................. 14
Specimens .......................................... 14
Chemical Processing ................................ 14
Decalcification .................................... 15
Dehydration ........................................ 15
Block Preparation and Celloidin Embedding .......... 16 Dissection ......................................... 19
Van Gieson Stain ................................... 20
Measurement ............................................. 20
Photographic Apparatus ............................. 20
Instrumentation .................................... 21
Structures to Be Measured .......................... 22
Shrinkage Study .................................... 22

III RESULTS ................................................. 24

Some Aspects of Measurement ............................. 24
Shrinkage Study ......................................... 27
Hypotheses: Empirical Reply ............................ 29
Tabular Data ............................................ 34


iv








Apparent Size of Structures Arranged by Slide. 38
Apparent Size of Structures Arranged by Structure
Across Slides ......................................... 41
Summation: The Missing Dimension Due to Dissection
Plane ................................................. 43

IV DISCUSSION AND CONCLUSIONS .............................. 48

Interpretation of Results with Graphic Illustrations .... 48 Conclusions ............................................. 74
Implications for Future Research ........................ 77

APPENDIX

A STRUCTURES OF INTEREST .................................. 80

B APPARENT SIZE OF STRUCTURES ARRANGED BY SLIDE ........... 83

C APPARENT SIZE OF STRUCTURES ARRANGED BY STRUCTURE
ACROSS SLIDES .......................................... 137

D SUMMATION: THE MISSING DIMENSION DUE TO DISSECTION
PLANE .................................................. 184

BIBLIOGRAPHY ...................................................... 200

BIOGRAPHICAL SKETCH ............................................... 205



























v















LIST OF TABLES


Table Page

B-1 Apparent Size of Structures/Specimen 1/Sagittal Plane/
Left Block.......................................................... 83

B-2 Apparent Size of Structures/Specimen 1/Sagittal Plane/
Right Block ............................................ 85

B-3 Apparent Size of Structures/Specimen 2/T-ransverse Plane/
Superior Block ......................................... 89

B-4 Apparent Size of Structures/Specimen 2/Transverse Plane/
Medial Block ........................................... 92

B-5 Apparent Size of Structures/Specimen 3/Coronal Plane!
Anterior Block ......................................... 95

B-6 Apparent Size of Structures/Specimen 3/Coronal Plane/
Posterior Block.................................................. 105

B-7 Apparent Size of Structures/Specimen 4/Sagittal Plane/
Left Block ............................................ 113

B-8 Apparent Size of Structures/Specimen 4/Sagittal Plane!
Right Block ........................................... 116

B-9 Apparent Size of Structures/Specimen 5/Transverse Plane/
Left M~edial Block...................................... 118

B-i0 Apparent Size of Structures/Specimen 5/Transverse Plane/
Right Medial Block..................................... 121

B-li Apparent Size of Structures/Specimen 6/Coronal Plane/
Anterior Block......................................... 123

B-12 Apparent Size of Structures/Specimen 6/Coronal Plane!
Posterior Block........................................ 129

C-i Apparent Size of Structures/Specimen 1/Sagittal Plane!
Left Block ............................................ 137

C-2 Apparent Size of Structures/Specimen 1/Sagittal Plane!
Right Block............................................i139


v i










C-3 Apparent Size of Structures/Specimen 2/Transverse Plane/
Superior Block ................. ............................ 142

C-4 Apparent Size of Structures/Specimen 2/Transverse Plane/
Medial Block ................. .............................. 144

C-5 Apparent Size of Structures/Specimen 3/Coronal Plane/
Anterior Block ............................................ 147

C-6 Apparent Size of Structures/Specimen 3/Coronal Plane/
Posterior Block ........................................... 156

C-7 Apparent Size of Structures/Specimen 4/Sagittal Plane/
Left Block ................................................ 162

C-8 Apparent Size of Structures/Specimen 4/Sagittal Plane/
Right Block ............................................... 165

C-9 Apparent Size of Structures/Specimen 5/Transverse Plane/
Left Medial Block ......................................... 167

C-10 Apparent Size of Structures/Specimen 5/Transverse Plane/
Right Medial Block ........................................ 169

C-11 Apparent Size of Structures/Specimen 6/Coronal Plane/
Anterior Block ............................................ 171

C-12 Apparent Size of Structures/Specimen 6/Coronal Plane/
Posterior Block ........................................... 177

D-1 Apparent Size of Structures/Specimen 1/Sagittal Plane/
Left Block ................................................ 184

D-2 Apparent Size of Structures/Specimen 1/Sagittal Plane/
Right Block ............................................... 185

D-3 Apparent Size of Structures/Specimen 2/Transverse Plane/
Superior Block ............................................ 186

D-4 Apparent Size of Structures/Specimen 2/Transverse Plane/
Medial Block .............................................. 187

D-5 Apparent Size of Structures/Specimen 3/Coronal Plane/
Anterior Block ............................................ 183

D-6 Apparent Size of Structures/Specimen 3/Coronal Plane!
Posterior Block ........................................... 190

D-7 Apparent Size of Structures/Specimen 4/Sagittal Plane/
Left Block ................................................ 192



vii








D-8 Apparent Size of Structures/Specimen 4/Sagittal Plane/
Right Block ............................................... 193

D-9 Apparent Size of Structures/Specimen 5/Transverse Plane/
Left Medial Block ......................................... 194

D-10 Apparent Size of Structures/Specimen 5/Transverse Plane/
Right Medial Block ........................................ 195

D-11 Apparent Size of Structures/Specimen 6/Coronal Plane/
Anterior Block ............................................ 196

D-12 Apparent Size of Structures/Specimen 6/Coronal Plane/
Posterior Block ........................................... 198






































viii














LIST OF FIGURES


Figure Page

1 Slide 46-F1-11A/Specimen 3/Coronal Plane/Anterior
Block...................................................50

2 Slide 46-F1-17A/Specimen 3/Coronal Plane/Anterior
Block...................................................51

3 Slide 46-F2-4A/Specimen 3/Coronal Plane/Anterior
Block.................................................... 53

4 Slide 46-F2-12A/Specimen 3/Coronal Plane/Anterior
Block...................................................55

5 Slide 46-F3-2A/Specimen 3/Coronal Plane/Anterior
31ock...................................................57

6 Slide 46-F3-18A/Specimen 3/Coronal Plane/Anterior
Block ....................................................59

7 Slide 46-F1-3P/Specimen 3/Coronal Plane/Posterior
Block...................................................60

8 Slide 46-F1-17P/Specimen 3/Coronal Plane/Posterior
Block...................................................62

9 Slide 46-F3-2P/Specimen 3/Coronal Plane/Posterior
Block ....................................................64

10 Slide 46-F3-12P/Specimen 3/Coronal Plane/Posterior
Block ....................................................66

11 Slide 48-F2-7S/Specimen 2/Transverse Plane/Superior
Block.................................................... 68

12 Slide 48-Fl-3M/Specimen 2/Transverse Plane/Medial
Block...................................................70

13 Slide 75-F1-16R/Specimen 1/Sagittal Plane/Right
Block...................................................71

14 Slide 75-F2-17R/Specimen 1/Sagittal Plane/Right
Block...................................................73


ix














A Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy A MULTIDIMENSIONAL STUDY
OF THE INTRINSIC LARYNGEAL MUSCULATURE BY

TERRY L. HARDEE

December, 1985


Chairman: Thomas B. Abbott, Ph.D. Major Department: Speech


The study of laryngeal anatomy has a long history. It has examined cartilaginous framework and later muscular composition. Laryngeal replicas were modeled out of wax to depict structure. Laryngeal material was also embedded in various mediums and sectioning ensued. Recognizing early examination of the larynx has been fairly extensive, the crucial question becomes what new information may be gathered as a result of the current study? The current study attempts to assess the feasibility of generating intrinsic laryngeal musculature measurements from photographic slides of the remaining celloidin embedded block in adult male disease-free specimens cut in multiplanar serial section. It also is an attempt to follow size, configurational and relational changes in the intrinsic laryngeal musculature. A total of six celloidin embedded topically stained specimens were dissected via coronal, sagittal, and transverse planes,



x








respectively. Area, perimeter, height and width measurements were made of the soft tissue structures of interest when clearly present. Structures void of discernible boundaries were not measured in a particular slide and this accounts for the disappearance and reappearance of a structure in the tabular data found in the appendices. Shrinkage data were generated in an attempt to determine the approximate amount that muscular tissue shrinks as a result of the chemical processes of fixation, decalcification and dehydration. These measurement values taken together with the shrinkage data yield a normative data base closely representative of in vivo conditions.

Tabular data are presented in three forms. First, tabular data are presented in a progressive slide by slide sequence in which all structures of interest shown in the sectional plane are delineated by name and measure. Secondly, individual intrinsic laryngeal muscles are identified and measured as they are presented throughout a given specimen. This information is combined with the serial laryngeal illustrations. Finally, as a result of the chosen plane of dissection, one dimension is not measurable. The last set of tables presents a summation of range of structures of interest in the missing dimension. It is entirely likely subsequent studies may expand the quantity and type of measurements generated.












xi














CHAPTER I
BACKGROUND AND PURPOSE



Introduction

A perusal of a number of anatomical texts indicates the larynx often receives a rather cursory presentation. The superficial descriptions many times result in both extrinsic and intrinsic laryngeal musculature being addressed in a few paragraphs (Anderson, 1984; Anthony & Thibodeau, 1979, 1980; Basmajian, 1980, 1982). Frequently the information available on the larynx requires the reader to seek additional sources (Burke, 1980; Crouch & McClintic, 1971; Gardner et al., 1963). This type of discourse demonstrates the need for detailed treatment. The anatomy texts are likely to b-- the major source of enlightenment and initial contact for many students and unfortunately the superficial treatment of the larynx prejudices students about the importance of this vital organ. These texts properly concentrate their limited presentations on the structure of the larynx, and although that information is often incomplete, the question of function or physiology may be totally omitted (Ellis, 1976; Ellis & Feldman, 1977; Evans, 1976; Francis & Martin, 1975). A few texts provide a limited improvement of laryngeal information (Christensen & Telford, 1972; Dienhart, 1979). However the general dearth of illuminating information perhaps suggests that the larynx has not been regarded as a particularly important organ. Although it


1





2



has specific biological functions, the larynx is the primary organ of speech and deserves a less circumscribed and more comprehensive treatment. It is regrettable so few texts in comparison to the number of texts available provide the reader a firm foundation in laryngeal anatomy and physiology.

The purpose of this study was to examine the intrinsic laryngeal musculature revealed by multiplanar serial sectioning of the celloidin block. The end product would be a better understanding than is currently available of laryngeal structure as revealed by the techniques utilized in this study.



Review of the Literature

The Advent of Laryngeal Awareness

The larynx has been a subject of inquiry for centuries. The

literature demonstrates an early keen interest in the larynx. There exists various citations crediting dissimilar sources with discovery of diverse aspects of the larynx (Andrews & Badger, 1979; Canalis, 1980; Cooper, 1985; Fink, 1975; Whicker & Devine, 1972). These sources run the gamut from identification of the larynx as an entity in the body to labeling of cartilaginous and soft tissue structures. There has also been speculation regarding function, and actual physiology is a separate issue. As a consequence of the scientific question under consideration, the historical perspective reflected differs. Some sources cite Hippocrates (Whicker & Devine, 1972) as the initial laryngeal investigator. Hippocrates was purportedly interested in function (Andrews & Badger, 1979; Whicker & Devine,




3



1972). It has been suggested that several hundred years elapsed between the first and second individuals to address the larynx. The

first to identify the larynx is thought to have been Aristotle (Fink, 1975) and the second, Galen (Fink, 1975; Whicker & Devine, 1972). Whicker and Devine (1972) credit Galen (192 A.D.) with referencing the thyroid, arytenoid and cricoid cartilages. Galen is also purported to have believed each muscle throughout the entire body possessed a distinct function and he did attempt to designate function for the laryngeal musculature. Galen is considered to be the father of early anatomical dissection. His concepts remained widely employed and undisputed for centuries.

Leonardo da Vinci (1452-1519) perhaps was the unheralded

anatomist of his period (Fink, 1975; Whicker & Devine, 1972). Da Vinci believed the voice to be related to the larynx. To support his theory da Vinci removed certain organs--the larynx, lungs and trachea as a unit and forced air out through the trachea and lungs. Da Vinci believed, in a live subject, this same action would result in voice. Another early advocate of laryngeal study was Vesalius (Fink, 1975; Whicker & Devine, 1972). Prior to his departure from the University of Padua in 1543, Vesalius contributed much on the subject of many different organ systems, including the larynx. Still another advocate of laryngeal study was Bartolomaeous Eustachius (Fink, 1975; Whicker & Devine, 1972). His contribution was that of laryngeal drawings. Although Eustachius lived in the 1500s, his work was not revealed until the 1700s. Studies often ascribed specific functions to certain laryngeal musculature. Sometimes these ascribed functions were not




4



the result of conclusive empirical investigation and later were proven to be incorrect. Galen's work was ultimately subject to challenge. One such example is found in the case of Casserius (1601) who disproved Galen's theory on pitch (Fink, 1975). Other researchers besides Casserius were also concerned with pitch. Dodart (1634-1707) addressed the issue of pitch modulation and considered pitch to be controlled by glottal tension and width. Perhaps even more profound was the idea postulated by Winslow (1756) which supported consideration of the laryngeal musculature functioning together as a single unit. This concept circumvented the abyss of single muscle and single action only theories. In 1724 the corniculate cartilages were designated as additional entities in the laryngeal cartilaginous framework by Santorini (Fink, 1975). Not quite 60 years later the cuneform cartilages were identified. There is some discrepancy as to whom the credit for this identification belongs, either Wrisberg (1780) or Wrisberg's deceased associate Haller (1778), or even Camper (1767) (Camper, 1779; Fink, 1975; Haller, 1973). The identification of the cuneform cartilages probably should be credited to Camper (1767) who did publish this information in 1779 and who apparently was acknowledged by others prior to that publication as having identified the cartilages. Giovanni Battista Morgagni (1682-1771) for whom the ventricle of Morgagni is named studied various pathologies and the resultant changes in anatomy. Particular areas of emphasis were areas important for speech, the pharynx, larynx, and the palate (Canalis, 1980; Whicker & Devine, 1972). Significant anatomical identification continued. Still later Francois Magendie discovered, by approximating








the arytenoid cartilages and blowing air into the larynx that sound could be produced (Whicker & Devine, 1972). Hence, in Magendie's lifetime, late 1780s to late 1880s, the issue of laryngeal function was again addressed. Studies following Magendie began to look more closely, even explicitly, at function. The first successful indirect laryngoscopy was self performed by Manuel Garcia in 1855 with the use of mirrors and sunlight. Laryngoscopy and the means by which to achieve it generated a widespread interest. For the first time man had a means of viewing the interior of the larynx and movements of the vocal folds and arytenoid cartilage movement. Garcia (1855) and then Czermak (1861), who used lighting sources other than sunlight, conducted laryngeal inspections which led to detailed descriptions of intrinsic laryngeal activity. Czermak (1861) illustrated the differing types of glottal activity such as closure during certain biological functions which he observed.

Early studies of the larynx were consistent with the level of scientific knowledge and instrumentation available. As the base of scientific information has been augmented, the refinement of skills and investigative methods have reflected scientific and technological advancements. Further, the types of questions which can be addressed today are appreciably different from earlier times. Perhaps the questions are not intrinsically more difficult, but certainly they are more technical. The scientific method employed dictates, limits, or influences the types of results derived as well as their interpretation. A review of the 20th century literature elucidates the relationship between the state of the art and the type of research








conducted. The technique at issue for this study is celloidin embedding followed by serial sectioning when applied to laryngeal material. The assumed position is such that a slice by slice progression through the larynx yields an appreciation of the component parts.

Laryngeal Investigation: Anomaly and Disease

There is very little available research which has concerned

itself with sectioning of the larynx via a specific plane. A thesis project conducted by Jean Robert-Leroux (1936) was probably the first study to incorporate serial sectioning in cancerous specimens. This study followed the patient's preoperative course with direct and indirect laryngoscopy, x-ray evaluation, surgical procedure, and postoperatively with serial sectioning and histological examination of the laryngeal specimens. The major emphasis of that study was the location and extent of the tumor. The availd bility of such information was and still is a useful learning tool.

As early as 1943 a study conducted by Broyles examined the anterior commissure tendon. Broyles (1943) concentrated on the anterior commissure tendon because he believed an area with "weak" or "deficient" cartilaginous protection was susceptible to disease. Particular attention was given to squamous cell carcinoma. Cross sections were made of the anterior commissure and surrounding tissue and thyroid cartilage in two carcinoma specimens, a young adult and a 62 year old male. Broyles (1943) concluded that carcinoma occurring in the anterior larynx and reoccurring should be examined closely. In the event that a "midline incision of the thyroid cartilage" was the








surgical technique employed, a return of carcinoma should not be viewed as a recurrence, but rather as a continuation. The growth would be suspect of having been in the tendon itself or its "insertion into the thyroid cartilage" (p. 344).

Kernan (1951) studied laryngeal carcinoma via horizontal

celloidin embedded serial sections. The specimens were derived from patients whom he had followed throughout the course of their treatment. Kernan (1951) was most concerned with illustrating the insidious nature of subglottic carcinoma and the failures of too conservative surgery or inappropriate use of radiation therapy as forms of treatment. Serial sectioning and histologic techniques were used on the resulting specimens. Kernan (1951) concluded that treatment failures need to be studied in depth.

Kelemen (1953) investigated congenital laryngeal stridor in four newborns. He also had a control group consisting of laryngeal specimens from four normal newborns. Dissections were parallel for each group. Three larynges were sectioned in the horizontal plane and the fourth was dissected in the "frontal plane" (p. 246). Specimens were infiltrated with celloidin before cutting. The horizontal sectioning resulted in 640, 800, and 900 sections respectively. Sectioning for the frontal plane required a midsagittal split, with the right side of the larynx further divided into 340 slices. A hematoxylin and an eosin stain were used on every tenth horizontal slice. Staining for the frontal plane employed Van Gieson and Gomori stains in addition to the previously mentioned hematoxylin and eosin




8



stains. Kelemen (1953) concluded that anatomical anomalies were present and accounted for the stridor. Further Refined Investigative Techniques

G.F. Tucker, Jr. (1961) utilized histologic methods to determine a more precise classification system delineating the limits of carcinoma. He believed a better system was necessary as some systems omitted the submucosal structures. Hence, a more universal system would be desirable. The clinical means of determining the extent of the lesion depends on the absence of fold mobility. Tucker (1961) pointed out a classification system based on dissection is far more specific. For this reason Tucker (1961) conducted a coronal serial section laryngeal dissection of celloidin embedded specimens. Specimens were cut on a Spencer microtome following a modified decalcification, dehydration and embedding procedure. A variety of different stains was used. Tucker (1961) concluded that coronz.1 serial sectioning allowed the inspection of a tumor in relation to the remaining healthy structures. It also permitted speculation as to the initial disease locale prior to the spread of the disease.

Livingston et al. (1976) developed a rather innovative means of studying structure. Although concerned with the brain, horizontal slices were studied via filmed computer graphics. This technique was applied to various brain structures throughout the horizontal slices. The advantage of using computer graphics is that it enables the entire brain to be represented in a three-dimensional fashion as well as allowing the viewer the flexibility of visualizing the brain externally or to travel through the inner structures.




9



Michaels and Gregor (1980) conducted a study which compared their own method of laryngeal preparation and dissection to the more traditional time proven methods. Their method consisted of fixation in a 10% buffered formol saline for a minimum of 2 days after which the specimen was sectioned serially on a meat slicer. Michaels and Gregor (1980) judged their method superior by virtue of less chemical intervention as well as the option of leaving the specimen whole prior to dissection. This technique was used with both normal and diseased specimens.

Gregor et al. (1980) addressed the efficacy of using computed tomography (CT) as a noninvasive means of studying the larynx. This group took various laryngeal sections and compared the pathological findings via conventional tomography with those obtained by CT scan. Their results indicated that particular areas were better evaluated through the use of the CT scan, ". . an accurate assessment of laryngeal anatomy and involvement by tumor, particularly of the preepiglottic space, paracordal area, anterior commissure, and cricoarytenoid area [and] . the presence of anterior or posterior commissure involvement is of paramount importance in precluding the possibility of conservative laryngeal surgery" (p. 291).

Hicks (1981a, b) made various measurements of 31 laryngeal specimens to establish normative data documenting changes in the larynx over the decades of life. His particular hypothesis also addressed the possibility that these changes occurred as a result of the aging process. Specimens were derived from both male and female subjects ranging in age from 47 to 90 years of age. A total of 54




10



separate measures were taken. These measures were primarily linear although one measure was angular and six concerned weight. Structures of particular interest were the vocal folds, hyoid bone and laryngeal cartilages. Hicks (1981a, b) concluded specimens derived from female subjects were in all cases smaller than that of their male counterparts. The superior angle of the thyroid cartilage was found to be under 900 in males and over 900 in females. This finding held true with all age groups. Lastly, Hicks (1981a, b) concluded changes in the human voice over the span of decades are not attributable to changes in the hyoid bone or cartilage.

Mafee, Schild, Valvassori, and Capek (1983) verified the presence and general extent of carcinoma by using celloidin embedded specimens to complement the results of computed tomography. Seven specimens, cut only in the transverse plane, were cut down to the level appropriate for the computed tomography scan. Results indicated sectioning did indeed confirm the computed tomography findings. Mafee et al. (1983) concluded computed tomography scanning to be the best means of laryngeal integrity assessment available.

Silverman and Korobkin (1983) utilized computed tomography on

normal larynges. The purpose was to scan the larynges in transaxial, coronal and sagittal planes to demonstrate disease-free laryngeal anatomy. These data were to serve as a basis of comparison for obscure anatomical anomalies induced by disease states.

Kahane and Kahn (1984) examined the intrinsic laryngeal

musculature of infants. Particular emphasis was placed on weight, differences due to gender, and intermuscular interactions. Nine








infant larynges were collected. Seven of these subjects died as a result of sudden infant death syndrome. Five subjects were male and four were female. Muscles were dissected off, blotted, and weighed on a Mettler balance. Kahane and Kahn (1984) compared their data to that of adult data generated by Bowden and Scheure (1960). Kahane and Kahn (1984) concluded the weights of respective intrinsic muscles established in infancy, maintained their proportional relationships in adulthood as well. A consistent finding in both infant and adult larynges indicated the cricothyroid muscle to have the largest mean weight. Bowden and Scheure (1960) did not address differences due to gender in the weight of the adult intrinsic laryngeal musculature. However Kahane and Kahn (1984) found no differences due to gender in their infant intrinsic laryngeal musculature. They further concluded intermuscular interactions or functions aimed at delineating vocal and nonvocal laryngeal behaviors would require additional research.



Statement of Purpose

A review of the literature indicates there is little serial sectioning information available on disease-free larynges. The purpose of this study was to examine disease-free human larynges in block following serial dissection. The major thrust of the proposed study was to delineate specific soft tissue structures and how those structures appear different depending on the plane of dissection. Horizontal, coronal, and sagittal serial section planes were employed as a means to facilitate examination. Six adult male human larynges were dissected. Comparative measures were made primarily regarding




12



soft tissue. The proposed measurements required the soft tissue structures be revealed at different sequential levels for the purpose of viewing and comparing those structures in relation to one another as well as in relation to hard tissue. Further, this technique allows the course of particular soft tissue structure(s) to be illustrated. Serial sectioning best demonstrated the internal configuration of these structures. The relevance of this study's contribution to the field of speech pathology is such that these measurements are used to facilitate a greater understanding of laryngeal anatomy.

This study has been designed to address several questions. In order to answer these questions the following null hypotheses were tested:

(1) There are no significant inferences relative to laryngeal

behavior or function which can be postulated based on the

course of muscle fibers demonstrated by this technique.

This hypothesis leads to the question, is it possible to

infer cartilaginous and soft tissue behavior based on the

combined information of the chosen measurements and

illustration?



(2) There is no significant differentiation of tissue in block

when topically stained.

This hypothesis generates a two part question. To what

extent is it possible to differentiate via a stain (a) soft

tissue from cartilage and (b) soft tissue from other soft

tissue?




13





(3) There are no significant demonstrations of accurate real life

measurements of soft tissue structures of interest as a

result of the combined block embedding technique and

photography.

The question generated by this hypothesis reflects a

comparison of techniques. Will the block technique including

photography of the cut block surface demonstrate the

capability of measurements of soft tissue structures?



(4) There are no significant changes in the structures of

interest seen during progressive serial sectioning in one

plane of one specimen in its entirety.

The question is as follows: is it possible to measure

the dimensions of critical structures following the removal

of each slice, by means of scaled photography of the

remaining block, and to demonstrate change in those

dimensions?



(5) There is no significant effect as a result of photographic

and/or illustrative reconstruction of the identified soft

tissue structures in a given specimen.

Is it possible to reconstruct a specimen by photographic

and/or illustrative means?














CHAPTER II
METHODS



The purpose of this study was to determine the viability of

obtaining measurement values of the intrinsic laryngeal musculature from a photographic slide of the remaining celloidin embedded block at given intervals following serial sectioning.



Procedures

Specimens

Adult male disease-free specimens were collected from autopsy in a 10% formalin solution. All specimens were caucasian and male. The age of the specimens ranged from 45 to 75 years of age, specifically 46, 48, 62, 68, 69, and 75, respectively. All organ donors expired due to causes other than that of any form of laryngeal pathology or compromi se.

Chemical Processing

Specimens were allowed to remain fixed in the formalin solution for 48 to 72 hours after which decalcification procedures were followed. The formalin solution was poured off and the specimen was rinsed three times in tap water before being placed in the decalcification solution.






14




15



Decalcification

Decalcification softens cartilage and bone and allows it to be cut. Since the specimens were adult larynges in which cartilages are usually calcified to some extent, decalcification was necessary. Fresh solution was used every other day. The old solution was poured off and fresh solution was poured on the specimen. This procedure generally continued for approximately 2 weeks. Specimens were x-rayed every fifth day to determine the extent of calcification remaining. At the end of decalcification, the specimen was rinsed in several changes of running tap water during a 24 hour period. Dehydration

Based upon previous research on dehydration (Lillie & Fullmer, 1976; Humason, 1979), specimens were placed in a 70% ethyl alcohol solution which was changed twice during a 24 hour period. Immediately afterwards specim ns were placed in an 80% solution.

Specimens remained in the 80% ethyl alcohol solution for 12 hours and then fresh 80% solution was poured on and remained on for the next 12 hours. Immediately afterwards specimens were placed in a 95% solution.

Specimens remained in the 95% ethyl alcohol solution for 12 hours and then were placed in fresh 95% solution for 12 subsequent hours. Immediately afterwards specimens were placed in a 100% solution.

Specimens remained in the 100% (absolute) ethyl alcohol solution, which was changed twice during a 24 hour period. Lastly, specimens were immediately placed in a solution consisting of half ether and




16



half absolute ethyl alcohol, referred to as ether alcohol, which was also changed twice during a 24 hour period.

Following dehydration, the celloidin processing was begun. Block Preparation and Celloidin Embedding

The specimens selected for sagittal plane sectioning were split mid-sagittally and dissection proceeded in a medial to lateral progression, first on one side and then the other. Coronal specimens were cut in half along the anterior to posterior continuum and then

set up into two separate blocks, an anterior and a posterior block. Each block was dissected from the central coronal plane of cut on out anteriorly and posteriorly, respectively. Finally, the two transverse specimens were cut into superior, medial and inferior blocks. One specimen had a center sagittal cut, the other did not. In one case rendering three blocks, superior, medial and inferior, that contained both right and left structures. In the other case, where the right and left halves were separated at the median sagittal plane, six blocks, superior, medial and inferior existed. In one case soft tissue measures resulted in bilateral representation within the same block. The other case or second transverse specimen resulted in unilateral representation of soft tissue structures. In the case of the six block transverse specimen, the medial blocks contained the designated structures of interest. The inferior and superior blocks consisted largely of cartilage and some fat. In all cases the large block cuts were made with the use of a brain knife or a band-saw.

Specimens were placed in a 5% celloidin solution and remained there for 2 weeks. Five percent celloidin solution consists of 150




17



grams of nitrocellulose dissolved in 3000 ml of ether alcohol. Specimens were then placed in a 10% celloidin solution and remained there for 2 weeks. Ten percent celloidin solution consists of 300 grams of nitrocellulose dissolved in 3000 ml of ether alcohol. Finally, specimens were placed in a 20% celloidin solution and remained there for 2 weeks. Twenty percent celloidin solution consists of 600 grams of nitrocellulose dissolved in 3000 ml of ether alcohol.

After the six weeks of celloidin processing the specimen was prepared for cutting or set up into a block. Essentially this was achieved by several steps. The side or surface of interest of the specimen was placed face down in the dish. A quantity sufficient to cover the specimen with 20% celloidin was poured into the dish. A piece of paper with the autopsy identification number was placed on the top surface of the specimen. Li effect this top surface became adjacent to the microtome mount and, therefore, in reality was at the bottom of the mounted specimen block. The identification number was recorded in pencil, as inks wash out or run. Next, the lid was loosened and the specimen allowed to dry until it was the consistency of gelatin. Chloroform was poured over the specimen, sufficient to cover it, and left overnight. The dish was sealed tightly with tape. The next day the excess celloidin was cut off around the edges of the specimen. The specimen was put back in the dish, and fresh chloroform poured over it. The specimen remained like this for one hour. This step allowed the portion of the specimen, face down in the dish, to harden as a part of the block. The block appeared hazy,




18



after it was successfully hardened. If the celloidin had remained clear, then a celloidin strip would have been cut out of the dish. This strip would have existed at the lateral margins of the dish, virtually all the way around the dish. The specimen would have been covered in chloroform once again, the lid replaced, and left for one hour. The most significant step was to be sure to place the correct side face down in the dish. The correct side was the side or surface intended to be cut first. This side was the top of the block.

Once the specimen was hardened into the block, it was mounted on the microtome sledge plate. This was achieved as a result of several steps. The chloroform was poured off. The specimen was placed in a separate dish and covered with ether alcohol where it remained for 5 minutes. The sledge plate and 20% celloidin were ready for immediate use. A small amount of ether alcohol, was followed quickly by a small amount of 20% celloidin poured onto the sledge plate. 'These solutions established a mounting base for the specimen. The specimen block was immediately placed on the solution base and oriented in such a fashion that it was at an angle to the blade. The purpose was to ease the blade into the specimen block, thereby reducing the shock to the specimen. It was also important to note the composition of the structure encountered first by the blade to avoid bone where possible. once the specimen was oriented on the solution base, the specimen was covered in 20% celloidin to seal the block onto the sledge. The specimen, sledge and all, was placed in chloroform for one hour. The specimen should not remain in the chloroform over one hour, as changes result in the block. The block was mounted on the




19



sliding microtome and dissection began. Specimens not slated for immediate dissection were hardened into a block and then stored in a 70% ethanol alcohol solution. Slices cut from a dissected block were placed on individual sheets of numbered bibulous paper and also stored in 70% ethanol alcohol solution. Storage may be maintained in this fashion for an indefinite period of time. Additional 70/00 ethanol alcohol solution should be periodically poured onto any stored material.

Dissection

Following the celloidin processing, each specimen was serially dissected. Some experimentation was necessary to determine the optimal slice thickness which was determined to be a 35 micron thickness. Each specimen was cut in its entirety in one plane. The newly exposed surface of the remaining block was stained and cleared in order to accentuate muscle, connective tissue and cartilage. Serial sectioning was documented by photographic means. Specimens were dissected in units of 5 to 10 microtome passes, 35 microns each on a sliding microtome. The first specimens to undergo serial sectioning were photographed after every tenth pass. Subsequent specimens were photographed in block following the fifth microtome pass. This alteration in dissection protocol was believed necessary to observe subtle structural changes. Tables available with this text (Appendices B-D) clearly demonstrate measures of the structures of interest did not occur with every photographic slide but rather were made as deemed necessary. Photographic documentation was used to record the progression through the larynx and change in intrinsic





20



musculature revealed in serial section. The stain ultimately selected was Van Gieson stain, and the clearing solution selected was 70%" ethanol alcohol .

Van Gieson Stain

A saturated aqueous solution of picric acid consisted of 100 nil of distilled water and 2 grams of picric acid. While a 1% aqueous solution of acid fuchsin required 1 gram of acid fuchsin and 100 mil of distilled water. In order to yield Van Gieson stain, 5 mil of 1% aqueous solution of acid fuchsin was combined with 100 mil of picric acid. The Van Gieson stain was chosen because of the multitude of stains tested it best delineated the structures of interest. Muscle was expected to take on a yellow hue, while collagen was expected to be in the red/pink distribution (Humason, 1979; Luna, 1968).



Measurement

Photographic Apparatus

A commercially available copy stand equipped with twin tungsten lights was mounted with an Olympus (CM?) 35 mm camera and a 90 mm Vivitar lens. The copy stand was stationed across from the sliding microtome. The preferred F stop was between 5.6 and 8, while the preferred shutter speed was 1/30 second. The film selected was Kodachrome 25 which produced faithful color representation and contained fine grain emulsion. To facilitate accurate measurement a 1/10 inch grid was present in each photographic slide, adjacent to the identification number assigned each particular slide. The slide identification number incorporated the age of the specimen, the roll




21



and number of the exposure on the film, as well as plane markers. The presence of L or R signals the sagittal plane and either the left or right side respectively. The presence of A or P signals the coronal plane and either the anterior or posterior aspect respectively, whereas the presence of I, M, S or IL, ML, SL signals the transverse plane and either inferior, medial, superior, or inferior left, medial left, or superior left aspect respectively. Instrumentation

Serial sectioning was conducted through the use of a sliding microtome model number 1400 Leitz. The means of measurement was a graphics tablet referred to as the Versawriter Tablet, marketed by Versa Computing, Inc., of Newbury Park, CA. The versawriter was interfaced with an Apple He computer. A numerical value appears on the screen and was accurate to greater than 30/1000 inch. A line drawing of the structure of interest was displayed on the screen along with a numerical value. This value was directly proportional to the value identified utilizing the 1/10 inch grid for calibration. Area and perimeter values were also determined. In securing measures, the same procedure or manner in which the measure(s) were made, were consistently followed, except when not possible due to the limits of the size of the graphics tablet (8 inches x 12.5 inches). In some instances the orientation of the tablet had to be changed, as in measuring the height of the thyroid cartilage. Similarly, this reorientation was also necessary at times when measuring the distance between the apexes and prominences of the thyroid cartilages. Photographic images of the slides in serial section were projected one




22



at a time onto the surface of the tablet for measurement. A standard screen was cut and secured onto the tablet surface. The photographic images were projected from a Kodak Ektagraphic slide projector model AF-2 fitted with a Kodak Ektanar lens. Structures to Be Measured

Soft tissue measurements were of three basic types: anterior to posterior, medial to lateral, and superior to inferior. These measurements were made when appropriate for a particular plane and applied to specific soft tissue structures. For instance coronal slices allowed for medial to lateral and superior to inferior measures (Tucker, 1971), whereas sagittal slices allowed for anterior to posterior and superior to inferior measures. And transverse slices allowed for anterior to posterior and medial to lateral measures. The structures of interest were measured as closely as could be determined by the delineated boundaries. These values represented apparent height, width, and depth as opposed to actual height, width, and depth. Each structure was followed as closely as possible. In the event that a structure curved, if it was necessary to follow the curve in order to get a more representative measure, the curve was followed. Some cartilaginous measures were included (Hicks, 1981b; Mane, 1971). Obviously not all structures appeared in all planes in all specimens.



Shrinkage Study

In addition to the processing of the specimens as mentioned above, it was clear that the numerical values determined from the




23



information on the structures of interest would be altered from what their actual values were in life. These values were expected to be altered as a result of shrinkage due to the chemical processing. In order to have an idea of what that change was, another specimen separate from the six adult male specimens previously mentioned was taken fresh from autopsy prior to any fixation in formalin. This specimen was then processed as each of the other specimens and measured and weighed (when appropriate) through each phase of the chemical processing procedure.














CHAPTER III
RESULTS



The current study assessed the utility of the intact celloidin embedded specimen block as a photographed medium for generating representative measures of the intrinsic laryngeal musculature. Serial sectioning of the intact block was conducted in three planes of dissection, coronal, sagittal, and transverse.



Some Aspects of Measurement

Structures were consistently measured throughout the progression into or out of the larynx as long as clear boundaries were identifiable. Absence of a measurement indicated the boundaries were either obscure or that the structure of interest ceased to exist in a given specimen. Utilization of the celloidin embedding, serial sectioning and topical block staining techniques did indeed make it possible to view and measure the structures of interest in relation to one another as well as in relation to cartilage. The course of a given intrinsic laryngeal muscle as well as transition in its size and shape distribution were revealed via serial sectioning. Changes in size were corroborated by the area, perimeter, anterior to posterior, medial to lateral and inferior to superior measures generated. These values were listed in the attached appendices. For further demonstration of structural change illustrations were included


24




25



representing each plane. The illustrations in conjunction with the tabular data clearly depict structural transition. The specimen which received the most extensive illustrative depiction, including both the anterior and posterior blocks, was specimen 3. Specific slides were chosen in the progression through this specimen to convey the effect of serial sectioning. Examination of additional illustrations addressing the sagittal (specimen 1) and transverse (specimen 2) planes displayed some of the same musculature. The plane of dissection dictated the visual depiction of each muscle. A specific muscle in one plane was not always easily recognized in another plane.

Originally it was intended that as many soft tissue structures as possible would be measured. Among the intended was the quadrangular membrane. This structure was never observed. It was also intended that muscles known to have separate bundles would be identified by those bundles. However, since it was not possible to consistently identify both bundles throughout dissection, the structure was referred to by the primary muscle name. For instance pars oblique and pars recta were referred to as cricothyroid. This same format with few exceptions was followed for the thyroarytenoid and interarytenoideus muscles. Also the vibratory mass was measured only on coronal specimens. The mass perimeter was defined as extending from the medial border of the thyroarytenoid muscle including the mucosa, measuring laterally to the thyroid cartilage, proceeding inferiorly to the level of the superior border of the cricoid cartilage, and finally proceeding in a superior-medial progression consistent with the lower border of the thyroarytenoid muscle.




26



Measurement to the level of the superior border of the cricoid cartilage was as stated unless there was an obvious muscle boundary just lateral and inferior to the apex of the cricoid cartilage. This concept was considered useful since it was considered that more than the thyroarytenoid musculature vibrated during sound production. Hence, these measures were taken in an attempt to quantify the approximate size of such a mass in healthy adult male specimens. It was of course impossible to state the exact size of such a mass, as well as to account for individual variation.

The phonatory position was simply a measure of the glottal width divided in half. In theory each healthy vocal fold did approximate to midline. The phonatory position therefore represented the distance each fold moved medially in order to approximate at midline. In essence this measure quantified the cadaveric position of the vocal folds and from that point estimated the distance of medial movement necessary for sound to be generated. It was also necessary to keep in

mind that this potential displacement was merely an approximate value since the tissue had been altered due to chemical processing, and shrinkage.

Measures for all structures were generally secured by moving the tracing point in a superior to inferior, medial to lateral and/or anterior to posterior direction. Care was taken to proceed slowly to allow the Apple Ie computer to keep pace with the Versawriter Graphics tablet. Consistency in speed or rate of movement of the tablet arm as well as consistent sensitivity to pressure were maintained. Periodic reliability checks were made in an effort to




27



monitor speed and sensitivity. Calibration of the Versawriter tablet with the measurement grid incorporated in each slide occurred at the beginning of each session. If any movement of the projector occurred, the program was restarted and recalibrated. In certain planes, due to the nature of dissection in that plane, certain structures were not observed. They were, however, identified and measured in a different plane. This was especially true in the case of ligaments. In all specimens cartilage was easily distinguished from soft tissue musculature and ligaments. In most cases fiber tracts were followed via Kodak 35 mm slide projection without much difficulty. The same slides, made into prints, showed far less differentiation. Each slide carried with it the photographic 1/2-inch grid equivalent to 12.7 mm as well as a slide number. Once again, the slide number was composed of the age of the specimen, the number of the roll of film thus far used on that specimen block, and the number of slices which had been cut into that block.

The data generated by this study established the normative data base of intrinsic laryngeal musculature in adult male disease-free specimens. This was a small sample and meant to serve as a data base with that limitation in mind. These data yield the area, perimeter, and essentially height, width, and depth values of intrinsic laryngeal musculature in six adult male specimens.



Shrinkage Study

A specimen from a 45 year old, disease-free, adult male was taken fresh from autopsy and subjected to each of the chemical processing




28



stages the other specimens had been subjected to prior to serial sectioning. The rationale was to determine the amount of shrinkage introduced via chemical processing. This was of significant interest since no such data could be found concerning the larynx and none particularly concerning the intrinsic musculature of the larynx.

The initial weight of the specimen was 107.7 grams. The specimen was then cut sagittally, rendering the right half to be used, weighing 57.4 grams. Polypropylene sutures were sewn in two places, constructing a backwards "L" configuration. A triangular shape could actually be discerned. A set of Riefler calipers were used to measure the sides of the triangle. Volume displacement conducted in a 70% ethyl alcohol solution yielded 43 ml; while the values of the distance between sutures were 1.0 min inferior suture, .7 min lateral suture, and

1.4 min hypotenuse.

The specimen was then placed in a formalin solution for 48 hours and then measured. Weight was 62 grams; the inferior suture was .9 min; the lateral suture was .6 min; the hypotenuse was 1.3 min; volume displacement was 41 ml. The specimen was then decalcified and x-rayed. The specimen remained in the decalcification solution with appropriate changes to fresh solution for 11 days. Weight was then 52.4 grams; inferior suture was .9 min; lateral suture was .6 min; the hypotenuse 1.3 min; volume displacement was 37 ml.

The specimen was placed in running tap water for 1 day to remove any acid from the decalcification solution. Weight was 50.5 grams; inferior suture was .9 min; lateral suture was .6 min; the hypotenuse was 1.3 min; volume displacement was 41 ml.




29



The specimen was placed in 70% ethyl alcohol solution which was changed twice during the course of the day. At the end of that 24 hour period the weight was 50.2 grams; inferior suture was .9 mm; lateral suture was .6 mm; the hypotenuse was 1.3 mm; volume displacement was 39 ml.

At the end of the dehydration phase the specimen was placed in an ethyl ether or ether alcohol solution which was changed twice in a 24 hour period. Weight was 38.5 grams; inferior suture was .9 mm; lateral suture was .6 mm; the hypotenuse was 1.2 mm; volume displacement was 35 ml. At this point, overall shrinkage for the inferior suture segment was 10%; for the lateral suture segment, 14%; and for the hypotenuse segment, 14%. Total overall shrinkage due to chemical processing was 18% by volume and 21% by weight.



Hypotheses: Empirical Reply

The first hypothesis was concerned with postulated larynqeal behavior based on muscle fiber course revealed via serial sectioning. More particularly, was it possible to infer cartilaginous and soft tissue behavior based on the combined information of the measurements and illustrations? It was possible to infer behavior and in fact vibratory behavior was inferred for the vibratory mass (Hirano et al., 1983). The mass encompassed tissue well beyond the thyroarytenoid musculature proper as delineated in the coronal specimens. This conjecture was based on the muscle fiber tracts observed in the described musculature. However, behavior of the laryngeal cartilage was not inferred, nor was behavior of any soft




30



tissue intrinsic structure. Although it was possible to observe and trace intrinsic fiber tracts in most cases, it was not possible to infer unique locations and behavior beyond the course and functions already attributed to individual muscles by recognized anatomists (Bailey & Biller, 1985; Gray, 1985; Hollinshead, 1974; McMinn et al., 1981; Paff, 1973; Pernkopf, 1963-64; Sobotta & Uhlenhuth, 1957;

Zemlin, 1981).

The second hypothesis addressed differentiation of tissue

utilizing the block embedding and staining techniques. Particular attention was given to the delineation of soft tissue from cartilage and soft tissue from other soft tissue as a result of staining. The Van Gieson stain did easily differentiate soft tissue or intrinsic musculature from cartilage. However, although the Van Gieson stain was the stain of choice following many trial stains and clearing procedures, it failed to easily differentiate muscle tissue fiber tracts in all cases. Fiber tracts were generally discernible, but not always. Overstaining obscured the course of various tracts. And although it was not reasonable to expect a stain to selectively and differentially stain the same type of tissue, in this case the composition of muscle tissue, still the ability to follow certain fiber tracts was anticipated. Some color change was evident across and within specimens. The Van Gieson stain was expected to turn muscle tissue yellow and collagen tissue hues of red and pink. These color parameters probably would have been consistent and blatantly obvious had the medium been paraffin. Some deviation from this color pattern was anticipated since the clarity of the medium of choice was




31



celloidin rather than paraffin. Celloidin had demonstrated clearer visualization of tissue in the slice than did paraffin. That is to say for histologic preparation of microscopic slides celloidin was preferred over paraffin. When left in block, the specimen was viewed through the block and in that way the structures soon to be encountered in the dissection were seen well before they were at the surface of the block. The intensity of the Van Gieson stain in some instances tended to obscure the visibility of the individual fiber tracts. It was believed that this obscurity was in part due to the nature of the thickness of the block rather than due to the medium being celloidin. It is likely that some irregularities in staining were the result of the specimen being stained in block rather than by the slice. The traditional means of preparation involves a slice, perhaps 10-15 microns thick, stained via hematoxylin and eosin and then mounted on a microscopic slide. Hematoxylin and eosin are better stains for histologic observation. Although the current study was not a histologic study, the stain choice was more for macroscopic purposes. Microtome slices for the current study were 35 microns thick and the remaining stained block was much thicker. Still it is likely that some of the staining irregularities were due to the block itself. Each time slices were removed and the block surface stained and cleared, the surface of the block was changed. In some instances penetration deep into the block via the clearing medium can result in staining irregularities. This was not the problem in this case since the clearing agent was not allowed to remain on the block surface sufficiently long enough to penetrate deep into the medium and cause




32



undesired change layers below. If that had been the case the undesired change would have been compounded by each additional staining and clearing. However, it is likely that the staining irregularities were the result of surface changes in the block, as well as constraints of stain absorption time, and finally the thickness of the block. Another possible contributory factor was the method of application of the stain. Initially the stain was applied via a cotton tipped applicator which resulted in some remnants of cotton on the surface of the block. The cotton tipped applicator was then abandoned and a suctioned dropper used. Again, certain problems appear to have resulted from the block itself. The block was preferred intact to demonstrate the internal configuration of the intrinsic musculature in relation to one another. The presumption was made that the configuration would represent actual relationships if the laryngeal structures was allowed to remain intact in the celloidin block. Hence, for structural intactness, some sacrifice resulted in less clearly defined fiber tracts.

The third hypothesis concerned demonstration of accurate life measurements of soft tissue structures of interest related to the block embedding technique. Specifically, was the block technique preferable to the histologic slice technique for purposes of more accurate depiction and therefore more accurate measurement, i.e., closely associated with in vivo specimens? One advantage of the block technique was the maintenance of the specimens' original shape. Furthermore, the intrinsic musculature remaining following dissection was allowed to retain its shape and configuration. There was no





33



evident shearing, tearing, or stretching of the block resulting in alteration of laryngeal tissue. However, to obtain an approximation of accurate real life measurements, in as much as is possible, a shrinkage study was conducted to determine the amount of shrinkage of laryngeal muscular tissue due to chemical processing. The overall shrinkage was determined to be 18/0 by volume and 21% by weight. The measurement values taken together with the shrinkage data yield a more accurate representation of structure size and configuration than would have been possible by just the measurements alone.

The fourth hypothesis addressed the possibility of observing existing change in the structures of interest during progressive serial sectioning in a given specimen. A specimen sectioned in one plane throughout its entirety, can easily be examined for structural transition. The actual question generated considered the ability to measure the dimensions of critical structures, subsequent to the removal of each slice, by viewing the remaining block. A second question generated by this hypothesis concerned the ability to demonstrate change in the dimensions of those critical structures. As a consequence of examination of the attached tabular data, it is evident that it was possible to measure the critical structures in block subsequent to serial sectioning and to demonstrate a definite change in the dimensions of those structures.

The fifth and final hypothesis was concerned with a photographic and/or illustrative reconstruction of the identified soft tissue structures. The question generated addressed the reconstruction of a specimen and the quality of that reconstruction through the use of





34


photographic and/or illustrative means. It was possible to reconstruct the specimen through either means. This study generated a total of 792 slides, only some of which were selected for measurement and illustration. There was sufficient material available for reconstruction via photographic slides. The illustrations were drawn from the slides, tracings of those slides, and when available photographic prints. The illustrations were chosen due to the clarity of their reproduction.



Tabular Data

The first set of tables is found in Appendix B. Data presented there are organized according to slide. In other words, slides are presented in the order in which they were photographed during the serial sectioning. All intrinsic laryngeal musculature of interest

and cartilage, largely identified as landmarks, appearing in each consecutive slide were identified and measured. Specimen 1 was dissected via the sagittal plane and presented with both left and right sides. These sides were each infiltrated with celloidin and became celloidin blocks. Sectioning began with the most medial aspect of each block. The first slide appearing in this set of tables is 75-F1-5L. This was the fifth photographic slide on the first roll of film. There were five microtome passes at 35 microns each between each photographic slide. We were, therefore, 25 passes into the left sagittal block of specimen 1 when this photographic slide was taken. The only structure of interest appearing in this slide and, therefore, at the surface of the block was the interarytenoideus muscle. This




35



structure was measured on the graphics tablet which resulted in area, perimeter, inferior-superior distance, and anterior-posterior distance measures. The next slide listed in this set of tables is 75-Fl-9L, which contained measurement values for the posterior cricoarytenoid muscle and the interarytenoideus muscle. This identification and measurement of structures of interest continued all the way through the block. The result was a roster of the structures of interest and their measurement values as they appeared in the specimen organized by slide. Upon examination of Table B-2 the same information was made available for the right block of sagittal specimen 1. A progression through the B set of tables, B-3, presents information on the superior block of specimen 2. Specimen 2 was dissected in the transverse plane, resulting in the measurement parameters to be slightly different. Area, perimeter, and anterior-posterior distance were still categories; however, medial-lateral distance was a new parameter. These parameters were valid for any transverse specimen, and in this case applicable for both the superior and medial blocks. The superior block was dissected from its inferior surface on up through the epiglottis or the top of the superior block. The medial block was dissected from its superior surface on down through the base of the cricoid ring. Specimen 3 was a coronal specimen, which resulted in both an anterior and a posterior block. Dissection began at the medial aspect for both blocks. The parameters of measurement dictated by the coronal plane of dissection include area, perimeter, inferior-superior distance, and also medial-lateral distance. Every plane of dissection dictated essentially two directional parameters





36



while one directional parameter was totally void by definition of that particular plane of dissection. This void in directional parameters was thought of as the missing dimension. Sorie advantage did occur as the result of serial sectioning by plane. Structures were seen in their appropriate relation to other structures while their configurations remained intact. The usage of different planes allowed the same structure(s) to be viewed from different perspectives. The tabular listings indicated that measures were not made on every slide. Slides were chosen based on change evidenced in the structures measured in the preceding slide as compared to how the same structures appeared in the current slide and for clarity of boundaries. Essentially Appendix B allows the identification and measurement of structures on the surface of the remaining block. At any point in the progression through the larynx, the appearance and/or disappearance of structures of interest were known. It was as if one was examining the

surface of the remaining block and possessed the ability to proceed or recede through the dissection.

The second set of tables is given in Appendix C. This set is organized by the structure of interest. The first table again addresses the left block of specimen 1, which was dissected in the sagittal plane. The structure identified initially was that of the cricothyroid muscle. Two slides are listed, 75-F2-14L and 75-F3-1L, as containing the cricothyroid muscle in the left block of specimen 1. Measurement values are given for the area, perimeter, inferiorsuperior, and anterior-posterior distance of the cricothyroid muscle as it appeared in those two slid-es. The next structure of interest




37



listed was the interarytenoideus muscle. Five different slides are listed as containing the interarytenoideus muscle and appropriate measurement values are given for each. This procedure is followed with each of the structures of interest all the way through the left block of specimen 1. Table C-2 presents the same information, that is, identification and measurement of the structures of interest organized by structure for the entire right block of specimen 1.

Table C-3 lists information organized by the structure of interest on the superior block of specimen 2. Specimen 2 was a transverse specimen and by virtue of definition of this plane of dissection slightly different information is given. Measurement values were generated for area, perimeter, anterior-posterior, and lateral-medial distance.

Table C-5 addresses the anterior block of the coronally dissected specimen 3. Measurement parameters include area, perimeter, inferiorsuperior distance, and medial-lateral distance. Again, since this is the C set of tables, information is organized by the structures of interest.

Finally, Appendix D or the D set of tables is organized in a

slightly different fashion. As was indicated earlier, by definition of a particular plane, a specific parameter of directional information was absent. Specimens 1 and 4 were sagittal dissection specimens. By virtue of the sagittal dissection plane no information was given on the medial-lateral appearance of structures of interest. For transverse dissection specimens, specimens 2 and 5, no information was given on the inferior-superior distance of appearance of structures of




38



interest. Specimens subject to the coronal plane of dissection included specimens 3 and 6. This plane of dissection did not display anterior-posterior distance on structures of interest. Appendix D presents a summation of the missing dimension for each plane of dissection for each specimen. This information was the result of tabulation of the number of slides in which the structures of interest appeared in, multiplied by the number of microtome passes occurring between photographic slides, and multiplied again by the unit of slice thickness of 35 microns. This value was then converted from microns to millimeters. The number of microtome passes between slides varied with the specimen.



Apparent Size of Structures Arranged by Slide

Examination of the available data was that the course of each particular muscle was visible. Some structures were easily identifiable in all planes and in all blocks, while others were barely discernible.

Specimen 1 (Table B-i) demonstrated a definite core of consistent intrinsic musculature. It also manifested the infrequent appearance of ligaments, such as the posterior cricoarytenoid ligament and the anterior cricoarytenoid ligament, as well as the singular entry of the conus elasticus. Slide by slide, a sequential progression, medial to lateral, existed through each block of this specimen. Measurement values were given for the structures of interest. These values allowed the comparison of structures of interest within a given level of the remaining block. Size differences were noted and alteration in




39



size from slide to slide for the same and different structures were also noted. Due to the nature of the consistency of the core a continuity of pattern was predictable. There was an anticipation of the appearance of structures thought of as comprising the core of intrinsic musculature via the sagittal plane.

Specimen 2 (Table B-3) had a slightly different core than did specimen 1. The consistency of this core depended on how far up or down into the block dissection had occurred.

Specimen 3 (Table B-5) generated the most data. These measures are perhaps due to nearly simultaneous bilateral representation. The core of the initial slide in both the anterior and posterior blocks was the same. This representation of muscles was expected since the first slide in each block represents the two medial surfaces that were in contact prior to embedding. And although the agreement in muscular representation was anticipated, it was not exactly true for specimen 6 (Table B-11) which was the second coronally dissected specimen. The vibratory mass and its associated measurements existed nearly throughout the entire specimen, that is in both blocks. A coronally dissected specimen was perhaps the easiest in which to view the structures of interest in continuity. Due to the bilateral representation there was generally a symmetrical comparison.

Specimen 4 (Table B-7), although a sagittal dissection specimen, presented somewhat differently than did specimen 1. A likely reason for this difference was the number of microtome passes between photographic slides was twice the number in specimen 4 than those occurring in specimen 1. This difference was a factor in all the same




40



plane dissection comparisons. Also another possible factor in this particular case was the initial size of the specimen itself. The outward appearance of a specimen may be deceiving, perhaps due to the presence of extensive extrinsic laryngeal musculature.

Specimen 5 (Table B-9), another transverse specimen, was set up into six different celloidin blocks. Due to the number of blocks in specimen 2, it was possible to examine for bilateral representation of musculature. Specimen 5 lacked bilateral representation as a result of a center cut and each side cut into thirds. Sectioning revealed the structures of interest were located in the medial blocks. There was certainly some structural asymmetry present as was clear in the case of the lateral cricoarytenoid muscle. This structure appeared at different levels slices apart on the two sides. In part this difference was due to asymmetry. However it is quite likely that the structure was present earlier on the right side but with dubious boundaries. A center cut for transverse specimens is not recommended for future dissections.

Specimen 6 (Table B-li), a coronal dissection, closely resembled the anterior block of specimen 3 in terms of appearance of structures of interest. However the posterior block was somewhat atypical. It was not possible to measure the distance from the cricoid cartilage to the true vocal fold. It was equally impossible to assess any glottal aperture or phonatory position. Again, the number of microtome passes differed on these two coronal specimens. However, it is unlikely that this factor alone could account for the absence of the glottal

aperture and true vocal folds in the posterior block. Perhaps the




41



band-saw cut was further posterior on this specimen than it was on specimen 3. This factor could possibly explain the presence of these structures in the anterior block alone.

The impact of examination of these tables is such that some

differences and similarities across specimens should be clear. The entire set of tables in Appendix B or the listing of structures by slide was the most appropriate for targeting the structures of interest in relation to one another leaving the internal configuration intact. Further the concept of a system working together is conveyed.



Apparent Size of Structures Arranged by Structure Across Slides

Appendix C is the most appropriate set of tables for targeting

the specific structures of interest individually, as they appeared in the slides. Information available herein best indicates change within a structure. Change was determined by examination of the numerical extremes in the area measure of a given structure. If an area measure was not given, then the most and least values of the directional parameter given were used. Change within a structure was significant as it addressed the participation, size, or extent of involvement of a structure. This information further contributed to the normative data available for each specimen.

The left block of specimen 1 (Table C-i) indicated the structure exhibiting the most change in size was that of the thyroarytenoid muscle, while the least change was exhibited by the lateral cricoarytenoid muscle and the cricothyroid ligament. The right block of specimen 1 demonstrated the most change in size in the anterior




42



cricoarytenoid ligament, while the structure with the least change was the lateral cricoarytenoid muscle.

Specimen 2 (Table C-3), a transverse dissection, indicated some of the same musculature. The most transition or size change within the superior block occurred in the thyroarytenoid muscle, while the least transition occurred in the posterior cricoarytenoid ligament. The medial block of the same specimen indicated the most transition in the cricothyroid muscle and the least transition in the thyroarytenoid muscle.

Specimen 3 (Table C-5) was a coronal dissection and was divided into anterior and posterior blocks. Dissection yielded different information in these blocks. The iost extensive transition occurred in the thyroarytenoid muscle and the least size transition in the lateral cricoarytenoid muscle. The posterior block of the same specimen again indicated the thyroarytenoid muscle as the structure which demonstrated the most transition, and the lateral cricoarytenoid muscle, the least transition.

Specimen 4 (Table C-7) was a sagittal specimen split into two blocks, left and right respectively. The left block presented the most extensive structural transition in the thyroarytenoid muscle and the least transition in the anterior cricothyroid ligament. The distribution of intrinsic musculature in the right block was somewhat different. The most extensive structural transition occurred in the cricothyroid muscle and the least in the interarytenoideus.

Specimen 5 (Table C-9) was the second of two transverse

specimens. This specimen was divided into six small blocks and then




43



dissected in serial section. It was determined that the medial block, bilaterally, contained the structures pertinent to the purposes of this study. The most transition in size distribution in the left block implicated two muscles, the posterior cricoarytenoid and the thyroarytenoid muscles. The least change was indicated in the lateral cricoarytenoid muscle. Further the thyroarytenoid muscle represented the most change in the right medial block, while the lateral cricoarytenoid muscle demonstrated the least change.

The last specimen addressed in the terms of structural transition was the sixth specimen (Table C-11). This was the second coronally dissected specimen presenting with both an anterior and a posterior block. The greatest size transition, in soft tissue of the anterior block, occurred in the area of the vibratory mass. However, the single soft tissue structure which demonstrated the most transition was the conus elasticus. The least transition was revealed in the cricothyroid muscle. Measurement values in the posterior block demonstrated, assessment of one aspect of the vibratory mass, the thyroarytenoid muscle to thyroid cartilage, manifested the most transition. The single structure demonstrating the most change was the thyroarytenoid muscle. And lastly, the lateral cricoarytenoid muscle displayed the least transition in a given soft tissue structure.



Summation: The Missing Dimension Due to Dissection Plane

The last set of tables (Appendix D) is most appropriate for quantification of the extent of the missing dimension. This




44



previously unavailable directional parameter was assessed by summation across the number of slides in which a structure was identified. The information herein presented differs from the soft tissue measures evidencing the most and least transition within a block as presented in Appendix C. The current data set was not numerically derived from a most to least site transition in a structure. Rather, Appendix D addresses the continued presence, range, or extension of a structure. The summation, or Appendix D set of tables, of the previously intangible dimension indicated in specimen 1 (Table D-I) was the medial to lateral dimension. The most extensive soft tissue structure in specimen 1 was the thyroarytenoid muscle. The least extensive range involved two structures, the lateral cricoarytenoid muscle and the conus elasticus. The right block of specimen 1 (Table D-2) demonstrated the soft tissue structure of greatest range was the thyroarytenoid muscle. The structure with the least range was the posterior cricoarytenoid ligament.

The superior block of transverse specimen 2 (Table D-3) indicated the thyroarytenoid and the posterior cricoarytenoid ligament as structures with the greatest and least musculature range respectively. This was determined by a summation of inferior to superior dimension. The medial block in this transverse specimen (Table D-4) indicated two soft tissue structures of equivalent range. They were the lateral cricoarytenoid muscle and the posterior cricoarytenoid muscle. The structure of the least range proved to be the thyroarytenoid muscle.




45



Specimen 3, a coronal dissection, was divided into anterior and posterior blocks. The previously intangible dimension of specimen 3 entailed a depth measurement as the unknown directional parameter, or the anterior to posterior distance. The anterior block (Table D-5) revealed the soft tissue structure of greatest range again represented two equivalent range structures. Those structures were the thyroarytenoid and cricoarytenoid muscles. Also the surface of the true vocal fold demonstrated the same numerical value. However, the vibratory mass, which extended beyond the limits of a single muscle was even more extensive. The least range values of two structures

were of equivalent standing. Those structures were the thyromuscularis and thyrovocalis bundles of the thyroarytenoid muscle.

The posterior block of specimen 3 (Table D-6) presented the

structure of greatest range as the cricothyroid muscle. Whereas the structure of least range concerned a portion of the vibratory n:ass. The portion referenced was the existing distance from the cricoid cartilage to the true vocal fold. The surface of the cord itself entailed a minute distance, but the intrinsic laryngeal muscle which exhibited the least range was the lateral cricoarytenoid muscle.

Specimen 4 was set up into two blocks, left and right

respectively. This specimen was dissected in the sagittal plane from the medial aspect, outward to the most lateral aspect of the specimen. The missing dimension was determined by the summation of the medial to lateral dimension. The soft tissue structure in the left block (Table D-7) of greatest range was the cricothyroid muscle. The least range value implicated the posterior cricoarytenoid




46



muscle and the lateral cricoarytenoid muscle. The right block of the same specimen (Table D-8) evidenced the greatest distance by the thyroarytenoid muscle and the least distance shared equally between the lateral cricoarytenoid and the interarytenoideus muscles.

The second and last transverse specimen was specimen 5. It was dissected in six blocks, two of which contained relevant information for the current soft tissue study. The intangible dimension in a transverse specimen again was the inferior to superior dimension. The left medial block (Table D-9) demonstrated the most and least range in the posterior cricoarytenoid and the interarytenoideus muscles respectively. The right medial block of the same specimen (Table D-1O) indicated the most extensive range involved the posterior cricoarytenoid muscle and the least extensive, the lateral cricoarytenoid muscle.

The sixth and final specimen was comprised of two blocks,

anterior and posterior dissected in the coronal plane (Table D-11). The missing dimension of a coronal dissection once again was the anterior to posterior distance. This distance was conspicuously occupied by the thyroarytenoid muscle. However both the area of the vibratory mass and the distance between the thyroarytenoid muscle and the thyroid cartilage demonstrated greater values as did the surface of the true vocal folds. All of these were equivalent measures. The single intrinsic muscle which demonstrated the least presence was the cricothyroid muscle. However another soft tissue structure, the conus elasticus, was even less apparent. The last block of specimen 6 (Table D-12) was the posterior block. The structure of greatest range




47



occurring in this block was the cricothyroid muscle and the structure of least range was the lateral cricoarytenoid muscle.

The structures identified here as most and least prevalent were determined by quantifiable range extension. Some of the structures indicated were also indicated as significant in other data sets. In summary, the multivariate dissection technique used in this study allowed a multivariate approach to assessment. The assessment confirmed the importance of many of the same intrinsic laryngeal musculature structures throughout the larynx regardless of the assessment parameter.














CHAPTER IV
DISCUSSION AND CONCLUSIONS



The current investigation determined the plausibility of

generating measurements from. a 35 mm slide of the intact celloidin embedded laryngeal block while leaving the component laryngeal structures in their proper configurational relationships to one another.



Interpretation of Results with Graphic Illustrations

Illustrations of specimen 3 graphically demonstrate the intrinsic musculature of interest. Alteration in size, configuration, and intermuscular relation are depicted. Specimen 3 was selected for illustration since it was the better of two specimens subjected to coronal plane dissection. This dissection approach generally yielded bilateral muscular representation. Additional illustrations were included for contrastive purposes of sagittal dissection specimen 1 and transverse dissection specimen 2. The slides measured and illustrations chosen were not always paired. Slides were chosen for measurement by an interval of roughly every fourth or fifth consecutive slide. The selection also depended on the clarity of the intrinsic structures of interest due to boundary definition, staining, and block glare or block thickness. Slides selectedfor illustration were selected on their ability to visually demonstrate change and the


48




49


appearance or disappearance of structure(s). The purpose of the selection dictated the terms of the choice. Figures 1 through 10 are depictions of specimen 3. Figure I (46-Fl-IIA) represents the 11th photographic slide on film one in the anterior block. Specific structures were identified as present in the remaining block. Those structures included the left cricothyroid muscle, thyroarytenoid muscles, conus elasticus, surface of the true vocal fold, cricoid and thyroid cartilage and vibratory mass. In the event of unclear boundaries, structures although identifiable as present, were not measured. This particular figure is also listed in the tabular data, Appendices B, C and D. Tabular listing was not always tile case as not all illustrated slides were measured.

Figure 2 (46-FI-17A) represents the 17th photographic slide on film one in the anterior block. Specific structures identified included the left cricothyroid muscle, thyroarytenoid muscles, conus elasticus, cricoid and thyroid cartilages, and ventricle of Morgagni. This specific slide was not chosen for measurement. However surrounding slides (46-FI-14A; 46-F2-1A) were chosen and support the identification of the same structures as depicted in this illustration. Area and perimeter values for the left cricothyroid and thyroarytenoid muscles, directional parameter measures for the conus elasticus and the surface width of the true vocal fold, all thyroid cartilage and phonatory position measures increased from Figure 1 to slide 46-FI-14A; however, the medial aspect of the thyroarytenoid muscle to the thyroid cartilage and the area of the vibratory mass measures both decreased. Examination of slide 46-F2-IA indicated most







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soft tissue measures declined with the exception of the left conus elasticus, the area of the right vibratory mass, and the height from the cricoid cartilage to the true vocal folds which increased bilaterally. The distance between the thyroid cartilage apexes and inferior prominences both declined. Phonatory position also declined. Visual inspection of Figures 1 and 2 do not reveal much difference between the two illustrations.

Figure 3 (46-F2-4A) represents the fourth photographic slide on film two in the anterior block. Specific structures identified included the left cricothyroid muscle, left lateral cricoarytenoid muscle, thyroarytenoid muscles, conus elasticus, thyroid and cricoid cartilages and the ventricle of Morgagni. Comparison of the area and perimeter measures when given, and the directional parameter for those structures lacking an area measure indicated the alteration in the soft tissue structures from 46-F2-4A to 46-F2-6A as listed: a decrease in the lateral cricoarytenoid, cricothyroid, and thyroarytenoid muscles, as well as a decrease in area of the medial aspect of the thyroarytenoid muscle to the thyroid cartilage. The vibratory mass area had decreased on the right and increased on the left. Whereas the distance of the conus elasticus, surface width of the true vocal fold, height from the cricoid cartilage to the true vocal fold increased. Thyroid cartilage measures decreased with the exception of the height of the left cartilage. Phonatory position also decreased. Visual depiction indicated a change in shape or configuration evident in the thyroarytenoid muscle and the left cricothyroid muscle.






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Figure 4 (46-F2-12A) represents the 12th photographic slide on film two in the anterior block. Specific structures identified included the left cricothyroid muscle, thyroarytenoid muscles, the left lateral cricoarytenoid muscle, conus elasticus, cricoid and thyroid cartilages as well as the ventricle of Morgagni. This specific slide was not chosen for measurement. However, surrounding slides (46-F2-6A; 46-F2-13A) were chosen and support the identification of the same structures as depicted in this illustration. These slides were 35 microtome passes apart at 35 microns each. Intrinsic musculature area and perimeter or directional parameter transition indicated a decrease in the left lateral cricoarytenoid and thyroarytenoid muscles and a decrease in the conus elasticus in both thyroid apexes and prominences, similarly there was a decrease in height, and a decrement in the medial aspect of the thyroarytenoid to the thyroid cartilage. However the cricothyroid muscle and the height value from the cricoid cartilage to the true vocal fold indicated an increase. In some instances the increased or decreased values were not altered much from the previous value as measurements were extended four decimal places. Measurement of the area or directional parameter of the vibratory mass, phonatory position and surface width of the true vocal fold were not made due to lack of boundary clarity. The tabular data indicate change; however, the visual depiction of Figures 3 and 4 demonstrate a marked transition in the overall appearance and configuration of Figure 4. From this point through Figures 5 and 6 marked visual configurational transition again occurred.







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Figure 5 (46-F3-2A) represents the second photographic slide on film three in the anterior block. Specific structures were identified. The thyroartyenoid muscle became meshed together near midline. Slides preceding 46-F3-2A presented the thyroarytenoid muscle as two separate bilaterally distributed muscles. The first slide listed in the tabular data which followed (46-F3-2A) was 46-F3-5A. Fiber tract discernment in this case allowed the identification of discrete bundles of the thyroarytenoid muscle. However when the bundle fiber tracts were not easily discerned the major muscle label, thyroarytenoid, was again used. Another bilaterally identified structure was the cricothyroid muscle. However the conus elasticus at this point had ceased to exist. Measurement from slides 46-F2-13A, the slide closest to Figure 4, and 46-F3-5A were examined in order to address transition in Figure 5. The lateral cricoarytenoid muscle ceased to exist, whereas the right cricothyroid muscle became clearly measurable. Both bundles of the thyroarytenoid muscle, thyromuscularis and thyrovocalis, were demarcated in

46-F3-5A. Clarity of the discrete muscular bundle fiber tracts or the thyroarytenoid muscle only occurred once throughout dissection and that was at this interval. The boundary of the thyroarytenoid muscle and the mucosal layer which surrounds it superiorly and medially was once again obvious. This in turn made possible the resumed measurement of the surface of the true vocal fold, phonatory position and the area of the vibratory mass. Since these were resumed measures, they were not present in 46-F2-13A. However values taken from slide 46-F2-6A and compared to 46-F3-5A indicated a decrement on






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all three. Measurements of the left cricothyroid muscle on 46-F3-5A indicated a reduction in area. Thyroid cartilage measures indicated a decrement in the distance between the superior apexes as well as the inferior apexes, while height increased. Vibratory mass measures indicated an increase in the height from the cricoid cartilage to the true vocal fold and a decrease in the medial aspect of the thyroarytenoid muscle to the thyroid cartilage. The overall configuration of the remaining block had become narrowed and the fused tracheal rings clearly present.

Figure 6 (46-F3-18A) represents the 18th photographic slide on film three of the anterior block. This slide was so far forward in the anterior block that all the soft tissue structures of interest ceased to exist. The "U" shaped thyroid cartilage was the only identifiable landmark.

Figure 7 (46-FI-3P) represents the third photographic slide on

film one of the posterior block. Identifiable structures included the cricothyroid and thyroarytenoid muscles bilaterally, conus elasticus, arytenoid, cricoid and thyroid cartilages and the pyriform sinus were also identified. This particular slide is listed in the tabular data. Numerical values of this figure are easily compared to the values associated with Figure 1, which was the first anterior block illustration. These figures represent the most medially depicted aspects of the anterior and posterior blocks respectively. Measurement indicated the area of the left cricothyroid muscle, conus elasticus, and the surface width of the right true vocal fold smaller in Figure 7 than in Figure 1. Also the area of the vibratory mass







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measures of the cricoid cartilage to the true vocal fold, the medial aspect of the thyroarytenoid muscle to the thyroid cartilage and the phonatory position were documented as decreased in Figure 7. No value was given for the analogous measure of the true vocal fold surface on the left. Whereas the area of the thyroarytenoid muscles and the area of the right vibratory mass declined. No value was generated for the same structure on the left. Finally, the cartilaginous framework increased in all cases in Figure 7. Visual inspection of Figures 1 and 7 indicate definite configurational changes in musculature, especially the thyroartenoid muscles. The right cricothyroid muscle evidenced a definite boundary. The introduction of the arytenoid cartilages and the pyriform sinus both by their presence indicated posterior progression in block dissection.

Figure 8 (46-F1-17P) represents the 17th photographic slide on film one of the posterior block. Specific structures identified included the right thyroarytenoid muscle, the lateral cricoarytenoid muscles, cricothyroid muscles, right conus elasticus, arytenoid, cricoid and thyroid cartilages and the pyriform sinus. Tabular data indicates the closest slide to Figure 8 (46-F1-17P) was 46-F2-1P. Structural comparison between the measurement values generated for Figure 7 (46-F1-3P) and those of slide 46-F2-1P indicated the following: the left posterior cricoarytenoid muscle had been revealed through sectioning. Also the lateral cricoarytenoid muscle exhibited a definite boundary and was once again a measurable structure in the specimen block. The area of the left cricothyroid and right thyroarytenoid muscles had increased as had the area of the right







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vibratory mass and the phonatory position. Whereas the presence of other structures declined. Structures which decreased in size were the conus elasticus, all thyroid cartilage measures and the medial aspect of the thyroarytenoid muscle to the thyroid cartilage. Visual inspection of Figure 8 as compared to Figure 7 demonstrates the folds of the left pyriform sinus disappeared and were replaced by a perforation. The left arytenoid cartilage was nearly entirely exposed. The right side of the specimen revealed the transitional stage of the peeling away of the thyroarytenoid muscle and the discovery of the arytenoid cartilage underneath. The larynx itself had taken on an archway configuration.

Figure 9 (46-F3-2P) represents the second slide on film three of the posterior block. Specific structures identified included the right lateral cricoarytenoid, left posterior cricoarytenoid, fragments of the interarytenoideus muscle, right cricothyroid muscle, articular facet of the cricothyroid joint and the arytenoid, cricoid and thyroid cartilages. Slide 46-F2-16P was selected for comparison purposes. Examination of the tabular data indicates that the right thyroarytenoid muscle, although present in slide 46-F2-16P, had ceased to exist in Figure 9. This same muscle was in the process of being dissected off in Figure 8, and by Figure 9, it had been completely cut away. Measurement values of the slide closest to Figure 8 (46-FI-17P) and the slide closest to Figure 9 were selected for comparison. Those slides were 46-F2-1P and 46-F2-16P respectively. Examination of tabular data reveals soft tissue structures which had increased in area were the posterior cricoarytenoid muscle and the medial aspect of






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the thyroarytenoid muscle to the thyroid cartilage. The phonatory position had also increased. Structures which decreased in size were the right lateral cricoarytenoid, right cricothyroid, and right thyroarytenoid muscles as well as the right vibratory mass. The fragmented interarytenoideus muscle was a new entity in the tabular data at this level. Cartilaginous framework demonstrated an increase in the distance between the superior apexes of the thyroid cartilage, as well as an increase in the distance between the inferior prominences. Height of the thyroid cartilage increased on the right and decreased on the left. Visual examination of Figure 9 (46-F3-2P) reveals the archway effect of the epiglottis to have vanished. The left arytenoid cartilage was replaced by the seemingly ever expanding cricoid cartilage. The right lateral cricoarytenoid muscle had assumed a more lateral position than it had in Figure 8. The conus elasticus and the right thyroartyenoid muscle had ceased to exist. The left posterior cricoarytenoid muscle had aligned itself with the cricoid cartilage. Two final observations which indicated this particular slide for selection were the presence of the articular facet of the cricothyroid joint and the fragmented appearance of the interarytenoideus muscle.

Figure 10 (46-F3-12P) represents the 12th slide on film three of the posterior block. Specific structures identified included the interarytenoideus muscle, right cricothyroid muscle, posterior cricoarytenoid muscles, superior cornu of the thyroid cartilages, arytenoid, cricoid and thyroid cartilages as well as the inferior pharyngeal constrictor muscle. The tabular slide data chosen as






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closest to Figure 10 (46-F3-12P) were that of slide 46-F3-14P. These data were taken in conjunction with the data presented in slide 46-F2-16P which was previously chosen as closest to Figure 9 (46-F3-2P) and compared. Examination indicated area values for the posterior cricoarytenoid and interarytenoideus muscles were increased in Figure 10 as compared to Figure 9, whereas the values for the cricothyroid muscle decreased. The lateral cricoarytenoid muscle was no longer present. Cartilaginous measures indicated the distance between the superior apexes had decreased as had the height of the thyroid cartilage. Visual inspection revealed the presence of the inferior pharyngeal constrictor muscle, fragmented thyroid cartilage with separate superior cornu, the remnants of the right arytenoid cartilage and a very prevalent cricoid cartilage.

Figure 11 (48-F2-7S) represents the seventh slide on film two of the superior block of specimen 2. Specimen 2 was a transverse dissection specimen. Specific structures of interest included the thyroarytenoid muscles, arytenoid and thyroid cartilages. Since this was a transverse dissection specimen it was cut into three blocks before serial sectioning and the surface of least interest was mounted face down on the block. This block was dissected from its inferior surface proceeding in a superior direction. Primary structures of interest were the thyroarytenoid muscles while the arytenoid and thyroid cartilage served as landmarks. Measurement data were generated only on the thyroarytenoid muscles. Visual inspection revealed a winged cartilaginous appearance.






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Figure 12 (48-Fl-3M) represents the third slide on film one of the medial block of specimen 2, or an inferior level of the same specimen depicted in Figure 11. In this instance the medial block was at issue and dissection proceeded from a superior to an inferior direction. Tabular data indicates some difference existed between the surrounding slides (48-Fl-2M) and 48-F1-4M). Specific structures of interest included bilateral distribution of the thyroarytenoid, lateral cricoarytenoid, and the posterior cricoarytenoid muscles and the cricoid cartilage. The thyroarytenoid muscle ceased to exist as dissection proceeded in an inferior direction. As this muscle dropped out another, the cricothyroid muscle, appeared. Figure 12 (48-Fl-3M) reflects the transition in progress as the lateral cricoarytenoid, posterior cricoarytenoid, and the thyroartyenoid muscles were depicted bilaterally with increased area in all lateral and posterior cricoarytenoid muscles. The cartilaginous framework consisted primarily of the cricoid cartilage. Visual examination of Figure 12 reveals a ring shaped structure sparingly draped with musculature.

Figure 13 (75-F1-16R) represents the 16th slide on film one of the right block of specimen 1. Specimen 1 was a sagittal dissection specimen. Specific structures identified included the thyroarytenoid, lateral cricoarytenoid, posterior cricoarytenoid muscles, arytenoid, cricoid, epiglottis and thyroid cartilages. Tabular data indicates the surrounding slides were (75-Fl-14R and 75-F1-18R). Both slides concurred with Figure 13 as to the presence of the posterior cricoarytenoid, lateral cricoarytenoid, and thyroarytenoid muscles as soft tissue structures of interest. Area values for all three







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diminished as dissection proceeded laterally. Visual inspection revealed the inferior pharyngeal constrictor muscle and what appeared to be the fragmented beginning of the interarytenoideus muscle while a nearly midline position was assumed by the arytenoid cartilage.

Figure 14 (75-F2-17R) represents the 17th slide on film two of the right block of specimen 1. Specific structures identified included the thyroarytenoid muscle, cricothyroid muscle, posterior cricoarytenoid muscle, interarytenoideus muscle, arytenoid, cricoid and thyroid cartilages. Tabular data indicate the closest surrounding slide of Figure 14 (75-F2-17R) was 75-F2-18R. This slide listed the interarytenoideus, posterior cricoarytenoid, and cricothyroid muscles as present. The anterior cricoarytenoid ligament was also indicated. Comparison of Figures 13 and 14 as a result of compared tabular data on the slides indicated as closest to the appropriate figures, 75-F1-18R for Figure 13 and 75-F2-18R for Figure 14 respectively, were as listed. Area measurement indicated the posterior cricoarytenoid muscle increased, while the cricothyroid and interarytenoideus muscles were both new additions at the level of dissection for Figure 14. The area of the thyroarytenoid muscle was demonstrated as decreased. Figure 14 did not evidence an anterior cricoarytenoid ligament. Visual examination revealed the most extensive features were a definite interarytenoideus muscle, and the unmistakable characteristic shapes of both the arytenoid and cricoid cartilage.







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Conclusions

The purpose of this study was to examine disease-free adult male larynges in block following serial dissection. A multiplanar approach to serial sectioning allowed measurement of soft tissue structures of interest in the remaining specimen block. This study combined three different empirical phases. All three phases of this study together indicated significant information. It was determined that the block technique of laryngeal assessment was a viable method for experimental studies designed to address the intrinsic laryngeal musculature. It was also indicated that change in the critical structures of interest as well as a means for quantifying that change was possible. And lastly, an empirically derived chemically induced percent shrinkage estimate was established. This variable was never before quantified on laryngeal material. The generated basic data base was intended as incomplete in vivo values. However these values, augmented with the empirically determined shrinkage values of 10% for measurements taken along the course of a muscle and 14% for measurements perpendicular to that course, represent as nearly as possible in vivo values. Concisely, the triad reflected a proven method with quantifiable normative data base combined with a now known chemical shrinkage factor. A series of successive progressive measures contributed to the resolution of the triad. One step along the continuum allowed by the method chosen was that structures were viewed in relation to one another. Specimen blocks were examined for change in soft tissue size and configuration as indicated by the presence of the illustrations and tabular data. Further, this method allowed the possibility of




75



tracing the course of a particular muscle while transition in other structures was noted. Each muscle was treated singularly, but was viewed in relation to other musculature. Specific muscles were selected out but not removed from their natural habitats. Each identifiable soft tissue structure of interest was identified and measured. This involved area, perimeter and directional parameters of inferior to superior, medial to lateral and the anterior to posterior dimensions. Tabular data incorporated in the appendices reflected the establishment of this basic normative data base. Subsequently the same treatment was given to all other soft tissue structures of interest within a given slide of the remaining block. Muscular course or range was also noted. Although this study addressed intrinsic laryngeal musculature, certain non-muscular structures such as cartilages were utilized primarily as landmarks. The vibratory mass and various aspects of that mass were described in the text but not demarcated on the illustrations. All together these serial successive progressive steps resulted in quantifiable data on adult male intrinsic laryngeal musculature generated to assess the celloidin block embedding technique.

The information available in the tables clearly indicated transition occurred in the size of the various intrinsic musculature. The illustrations, to some degree, capture the configurational transition in some of the same structures. Although these transitions perhaps would have been more evident if it had been possible to include all-the available Kodak 35mm slides of each specimen in serial section, and thereby witness the quantitative




76



change, per specific muscle. It was, however, not possible to include the bulk of the Kodak 35mm slides as a part of this text. It was anticipated that the combination of the illustrations in addition to the measures of each muscle would jointly convey these transitions effectively. In reviewing the various available anatomy texts, it was clear that in many the larynx was given light cursory treatment. Descriptions of laryngeal musculature as previously mentioned were generally relegated to a few paragraphs. One had to ponder why the larynx apparently was such an unimportant organ. Perhaps, the significance of such an organ grew due to increased instrumentation capabilities which in turn allowed a means of putting to task various questions. This was most evident via the engineering and radiological literature (Damste et al., 1968; Hirano, 1977; Hirano et al., 1981; Run and Chung, 1983). Although the engineers' proclivity for the true vocal folds was an exhaustive pursuit to capture and mathematically catalog the very essence of the true folds, other investigators' quests have addressed the true folds as well as other intrinsic musculature (Hirano et al., 1983). Other means of describing and cataloguing were sometimes preferred as mathematical formulas did not always facilitate resolution (Cooper, 1985; Mueller & Sweeney, 1985). Surely the true vocal folds do not accomplish phonation alone, without assistance from other structures (Hirano, 1974, 1977; Hirano et al., 1981, 1983). Although the true vocal folds can be considered critical for phonation, the surrounding musculature likely contributed to the overall structure and function, including phonation, of the larynx. Since the present study was not geared to elucidate




77



phonation, nor the possible function of a given muscle during phonation, the structures were viewed concomitantly.



Implications for Future Research

Certain aspects of the method chosen for this study deserve refinement. Block thickness may be altered by designating smaller specimen blocks. Perhaps a smaller block would reduce obscurity due to block thickness and improve visibility. Care, however, must be taken to quantify the actual size of the whole specimen and markers drawn on the specimen denoting the points of intended cut. It is recommended that documentation occur as a result of actual measurement and a photographic record made establishing the size of the whole specimen prior to brain-knife cut. Slides should also be used to demonstrate the areas on the specimen targeted for brain-knife cut and lastly a photographic record should depict the specimen after the block cuts have been established. This will display the actual placement of the cut and assist in determination of what structures are on the fresh surface of the cut. Another aspect of refinement concerns the block surface. Alterations in the block surface perhaps can be controlled for by careful monitoring of staining and clearing procedures to insure consistency. It is also recommended that two different types of trials be conducted, a stain absorption time trial and then a clearing agent trial to better establish the optimal conditions for staining and clearing to avoid any irregularities in the block surface and the resulting stain. Lastly, it is also recommended that two photographic half inch measurement grids be in




78



each photographic slide. The suggested placement is one on each side of the block. This will obviate any irregularities in camera angle and insure an accurate scale of measure. Apart from suggestions concerning improvements in the methodology utilized in the current study, other research implications include the application of the methodology indicated in additional investigations. one possible study concerns the usage of the celloidin embedded block technique in cases of laryngeal carcinoma. A far more descriptive study would involve determination of the subject's vocal frequency prior to and during a given disease state. Subsequent modeling attempts could best be attempted by an engineer concerned with tissue thickness, elasticity, mass differential and curve fitting to describe the properties of the mass and therefore possible implications concerning

vibratory function.

In summary, the block embedding method and photography of the exposed surface of the specimen, as opposed to the traditional histological slice technique, was demonstrated to be a viable method for laryngeal investigation. Though this method was not absolved of all problems, there existed certain advantages in assessment of structures in an intact specimen block. Soft tissue structures of interest and cartilage maintained their proper relationships to one another, while the course and configurational transitions were revealed through serial sectioning. It was possible to consider intrinsic musculature separately or as a group. The block was not subject to tearing although certain stresses were undoubtedly introduced onto the surface of the block from the microtome blade




79



during dissection. Secondly, a generated normative data base was established regarding laryngeal intrinsic musculature in adult disease-free male specimens. This was a small sample size and data were to be viewed with an awareness of that limitation. Lastly, an empirically derived shrinkage estimate was established in an attempt to assess laryngeal tissue shrinkage as a result of chemical processing. Thereby, a closer approximation of actual in vivo values was possible. Essentially, the celloidin embedding method made possible the preparation of specimens in order that said data were extracted. This in turn was combined with the shrinkage factor which in turn facilitated an approach to elucidate structural dimensions in the living.














APPENDIX A
STRUCTURES OF INTEREST


1. Posterior Cricoarytenoid Muscle

2. Lateral Cricoarytenoid Muscle

3. Interarytenoids

a. Transverse Arytenoid Muscle

b. Oblique Arytenoid Muscle

4. Cricothyroid Muscle

a. Pars Oblique

b. Pars Recta

5. Thyroarytenoid Muscle a. Thyromuscularis

b. Thyrovocalis

6. Conus Elasticus a. Cricothyroid Ligament b. Cricothyroid Membrane

7. Quadrangular Membrane

8. Cricoarytenoid Ligaments a. Anterior Cricoarytenoid Ligament

b. Posterior Cricoarytenoid Ligament

*9. Surface width of TVF



* In the sagittal plane of dissection, this structure is referred to as
"height of the TVF."


80




81



10. Thyroid Cartilage
a. Distance between superior apexes
b. Distance between inferior prominences
c. Height
11. Vibratory Mass Measures
a. Height from Cricoid cartilage to TVF b. Phonatory position (glottal width/2)
c. Medial aspect of Thyroarytenoid muscle to Thyroid cartilage
d. Area

























APPENDIX B
APPARENT SIZE OF STRUCTURES ARRANGED BY SLIDE








Table B-1. Apparent Size of Structures/Specimen 1/Sagittal Plane/Left
Block

Peri- Inferior- AnteriorArea meter Superior Posterior Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)

75-Fl-5L Interarytenoideus Muscle .0707 1.1431 .3068 .2682

75-F1-9L Posterior Cricoarytenoid
Muscle .0332 1.0662 .3837 .0565

Interarytenoideus Muscle .0684 1.2454 .2647 .2664

75-F1-13L Posterior Cricoarytenoid
Muscle .0718 1.2962 .4913 .0689

Interarytenoideus Muscle .0645 1.1818 .3184 .1771

Thyroarytenoid Muscle .0461 .8798 .3342 .1285

Posterior Cricoarytenoid
Ligament .2190
75-Fl-18L Posterior Cricoarytenoid
Muscle .0711 1.5063 .6244 .1040

Interarytenoideus Muscle .0560 1.1498 .4497 .0619

Thyroarytenoid Muscle .1093 1.2671 .2326 .4155

Posterior Cricoarytenoid
Ligament .2091

75-F2-5L Posterior Cricoarytenoid
Muscle .0710 1.3485 .5375 .1034

Interarytenoideus Muscle .0127 .5903 .1846 .0216

Thyroarytenoid Muscle .3625 2.6789 .2630 1.0387

Posterior Cricoarytenoid
Ligament .0629

75-F2-9L Posterior Cricoarytenoid
Muscle .0753 1.4958 .6256 .1011

Thyroarytenoid Muscle .5553 2.9600 .5425 1.1944



83




84



Table B-1--continued.


Peri- Inferior- AnteriorArea meter Superior Posterior Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)


75-F2-9L
(cont.) Posterior Cricoarytenoid
Ligament .1099

75-F2-14L Posterior Cricoarytenoid
Muscle .0626 1.5335 .6680 .1079
Lateral Cricoarytenoid
Muscle .0497 1.1466 .2128 .3146

Cricothyroid Muscle .3260 2.6021 .3953 1.0607

Thyroarytenoid Muscle .3379 2.3723 .7633 .4423

Conus Elasticus -Cricothyroid Ligament .3567

75-F3-1L Posterior Cricoarytenoid
Muscle .0464 .9284 .3931 .1044

Cricothyroid Muscle .2912 2.4133 .6381 .4925

Thyroarytenoid Muscle .0723 1.2612 .2320 .4319

75-F3-5L Thyroarytenoid Muscle .2114 2.0595 .3273 .7110

75-F3-10L Thyroarytenoid Muscle .1304 1.9755 .1641 .6557

75-F3-14L Thyroarytenoid Muscle .2928 2.6509 .4667 .7022




85



Table B-2. Apparent Size of Structures/Specimen 1/Sagittal Plane/Right
Block

Peri- Inferior- AnteriorArea meter Superior Posterior Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)

75-Fl-7R Thyroarytenoid Muscle .1318 2.0219 .2949 .6773

75-Fl-10R Posterior Cricoarytenoid
Muscle .0468 .8388 .2694 .1151

Thyroarytenoid Muscle .2292 2.4642 .3717 .9157

Thyroid Cartilage 1.0628

75-F1-14R Posterior Cricoarytenoid
Muscle .0528 .9230 .2926 .1077

Lateral Cricoarytenoid
Muscle .0381 .8314 .2240 .0606

Thyroarytenoid Muscle .2855 2.5105 .4953 .7123

Thyroid Cartilage 1.1093

75-FI-18R Posterior Cricoarytenoid
Muscle .0395 .8420 .2545 .1254

Lateral Cricoarytenoid
Muscle .0087 .4817 .0866 .0932

Thyroarytenoid Muscle .2517 2.5753 .3719 .7938

Anterior Cricoarytenoid
Ligament .5944

Thyroid Cartilage 1.0378

75-F2-3R Posterior Cricoarytenoid
Muscle .0439 .8940 .3089 .1116

Lateral Cricoarytenoid
Muscle .0368 1.0733 .2972 .2483

Thyroarytenoid Muscle .2595 2.5892 .3084 .6724

Anterior Cricoarytenoid
Ligament .6189




86


Table B-2--continued.


Peri- Inferior- AnteriorArea meter Superior Posterior Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)


75-F2-3R
(cont.) Thyroid Cartilage .9614
75-F2-9R Posterior Cricoarytenoid
Muscle .0489 .9773 .2760 .1361

Cricothyroid Muscle .0511 1.2982 .5173 .0828

Thyroarytenoid Muscle .2747 1.999 .4168 .5179

Anterior Cricoarytenoid
Ligament .3941

Thyroid Cartilage .9306

75-F2-13R Posterior Cricoarytenoid
Muscle .0211 .6673 .1951 .0819

Cricothyroid Muscle .0745 1.2826 .4429 .1122

Thyroarytenoid Muscle .3309 2.2542 .6543 .4656

Thyroid Cartilage 1.0544

75-F2-18R Interarytenoideus Muscle .0346 1.0269 .4081 .0629

Posterior Cricoarytenoid
Muscle .0859 1.8817 .7122 .1023

Cricothyroid Muscle .0531 1.0358 .3938 .1174

Thyroarytenoid Muscle .0741 1.4425 .1536 .4873

Anterior Cricoarytenoid
Ligament .7455

Thyroid Cartilage .7618

75-F3-6R Posterior Cricoarytenoid
Muscle .0749 1.4190 .6045 .1129

Interarytenoideus Muscle .0324 .9207 .3433 .0300




87



Table B-2--continued.


Peri- Inferior- AnteriorArea meter Superior Posterior Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)

75-F3-6R
(cont.) Cricothyroid Muscle .0671 1.0945 .3199 .1495

Thyroarytenoid Muscle .1499 1.7387 .1725 .6242

Anterior Cricoarytenoid
Ligament .5145

Thyroid Cartilage .9296

75-F3-9R Posterior Cricoarytenoid
Muscle .0972 1.6961 .6931 .1149

Interarytenoideus Muscle .0258 1.1329 .4390 .0446

Thyroarytenoid Muscle .0902 1.3978 .4474 .1639

Thyroid Cartilage .9534

75-F3-13R Posterior Cricoarytenoid
Muscle .0672 1.2091 .4379 .1514

Interarytenoideus Muscle .0725 1.2628 .4163 .1019

Cricothyroid Muscle .0605 1.2089 .4756 .1551

Thyroarytenoid Muscle .0747 1.1475 .2457 .3353

Anterior Cricoarytenoid
Ligament .0733
Posterior Cricoarytenoid
Ligament .0640
Thyroid Cartilage .8256

75-F3-17R Posterior Cricoarytenoid
Muscle .0784 1.4652 .5421 .0909

Interarytenoideus Muscle .0214 .6236 .1524 .0650

Cricothyroid Muscle .0978 1.5023 .6228 .1260




88



Table B-2--continued.


Peri- Inferior- AnteriorArea meter Superior Posterior Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)

75-F3-17R
(cont.) Thyroarytenoid Muscle .0626 .9493 .1428 .2108

Thyroid Cartilage .8343

75-F4-3R Thyroid Cartilage .9030

75-F4-6R Thyroid Cartilage 1.1037




89



Table B-3. Apparent Size of Structures/Specimen 2/Transverse
Plane/Superior Block


Peri- Anterior- MedialArea meter Posterior Lateral Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)


48-Fl-IS Posterior Cricoarytenoid
Muscle .0320L* 1.0162L .1025L .3930L
.0197R .7225R .0767R .2932R

Lateral Cricoarytenoid
Muscle .0345R 1.5641R .6469R .0444R

Interarytenoideus Muscle .1064L 1.8258L .6315L .1581L
.0760R 1.6346R .6567R .1489R

48-F1-3S Posterior Cricoarytenoid
Muscle .0255L .7777L .0713L .2946L
.0090R .4071R .0544R .2177R

Lateral Cricoarytenoid
Muscle .0330L 1.6164L .6423L .0621L
.0402R 1.4805R .6240R .0344R

Thyroarytenoid Muscle .0964L 1.9906L .8567L .1750L
.1040R 1.7785R .6959R .1241R

48-F1-5S Posterior Cricoarytenoid
Muscle .0170L .7776L .0524L .3097L
.0060R .4200R .0359R .1717R

Lateral Cricoarytenoid
Muscle .0570L 1.4869L .6105L .0855L
.0480R 1.5244R .6732R .0499R

Thyroarytenoid Muscle .2059L 2.5773L .8108L .2413L
.1620R 2.1371R .8737R .1773R

48-F1-7S Posterior Cricoarytenoid
Muscle .0092L .6432L .0189L .2546L
.0020R .2769R .0142R .1242R

Lateral Cricoarytenoid
Muscle .1457L 2.2453L 1.0320L .1370L
.0897R 1.7136R .7249R .1619R

Thyroarytenoid Muscle .0906L 2.4542L 1.0513L .1072L
.0682R 1.4426R .5567R .1351R




Full Text
148
Table C-5continued.
Structure
SI ide ft
Area
(Sq. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral -
(Inch)
Thyroarytenoid Muscle
(cont.)
46-FI-14A
. 0831L
.0537R
1.2322L
1.0832R
. 3168L
.3600R
. 2833 L
.1873R
46-F2-1A
.0687L
.0604R
1.0864L
1.1418R
.3312L
.42 66 R
.2587L
2246R
46-F2-6A
.0633L
.0449R
.9813L
1.2506R
.2964L
1.5469R
. 2549L
. 1903R
46-F2-13A
.0462L
.034 3 R
.9206L
.7473R
.3387L
.2811R
.27 32 L
. 1597R
46-F2-18A
.0567L
.0304R
. 9853L
8816R
.2903L
.3545R
.1476L
. 1389 R
(Thyromuscularis)
46-F3-5A
.0294L
.0179 R
.8176L
.6546R
.2998L
.2 903 R
.0898L
.051OR
46-F3-9A
.0184L
.02 05 R
6306L
. 7587 R
.2201L
- 2754 R
.0440L
. 1577R
(Thyrovocalis Muscle)
46-F3-5A
.3465L
.2 925 R
.1185L
.0864R
Conus Elasticus
46-F1-4A
.4542 L
. 5153 R
46-F1-8A
.47 64 L
.5311R
46-FI-11A
.4716L
.55 91R
46-F1-14A
4869L
. 5497 R
46-F2-1A
.4998L
. 5140R
46-F2-6A
.5855L
. 5341R
A


102
Table B-5--continued.
SIide #
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
46-F2-18A
(cont.)
Area of Vibratory Mass
-1048 L
.0768R
1.3948L
1.2301R
.47 OIL
4454R
.2195 L
. 1356R
46-F3-5A
Cricothyroid Muscle
.0288L
. 0154R
.6632L
. 52 28R
. 17 71L
.14 91R
. 1231L
.0742 R
Thyroarytenoid Muscle
(Thyromuscularis)
.0294L
.0179R
8176L
.654 6 R
. 2998L
2903R
. 0898L
. 051OR
Thyrovocalis Muscle
.3465L
. 2925 R
.1185 L
.0864R
Surface Width of TVF
.1683L
.191OR
Thyroid Cartilage
-- Distance between
Superior Apexes
.4799
-- Distance between
Inferior Prominences
.4602
-- Height
1.1228L
9953R
Vibratory Mass Measures
Height from Cricoid
to TVF
. 6247L
. 7314R
Phonatory Position
(glottal width/2)
.0140
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
0769L
.0628R
-- Area of Vibratory Mass
.0502L
. 0633R
.9391L
. 12287R
3079L
.3050R
. 1294L
. 1161R


47
occurring in this block was the cricothyroid muscle and the structure
of least range was the lateral cricoarytenoid muscle.
The structures identified here as most and least prevalent were
determined by quantifiable range extension. Some of the structures
indicated were also indicated as significant in other data sets. In
summary, the multivariate dissection technique used in this study
allowed a multivariate approach to assessment. The assessment
confirmed the importance of many of the same intrinsic laryngeal
musculature structures throughout the larynx regardless of the
assessment parameter.


19
sliding microtome and dissection began. Specimens not slated for
immediate dissection were hardened into a block and then stored in a
70% ethanol alcohol solution. Slices cut from a dissected block were
placed on individual sheets of numbered bibulous paper and also stored
in 70% ethanol alcohol solution. Storage may be maintained in this
fashion for an indefinite period of time. Additional 70% ethanol
alcohol solution should be periodically poured onto any stored
material.
Dissection
Following the celloidin processing, each specimen was serially
dissected. Some experimentation was necessary to determine the
optimal slice thickness which was determined to be a 35 micron
thickness. Each specimen was cut in its entirety in one plane. The
newly exposed surface of the remaining block was stained and cleared
in order to accentuate muscle, connective tissue and cartilage.
Serial sectioning was documented by photographic means. Specimens
were dissected in units of 5 to 10 microtome passes, 35 microns each
on a sliding microtome. The first specimens to undergo serial
sectioning were photographed after every tenth pass. Subsequent
specimens were photographed in block following the fifth microtome
pass. This alteration in dissection protocol was believed necessary
to observe subtle structural changes. Tables available with this text
(Appendices B-D) clearly demonstrate measures of the structures of
interest did not occur with every photographic slide but rather were
made as deemed necessary. Photographic documentation was used to
record the progression through the larynx and change in intrinsic


143
Table C-3--continued.
Area
Peri- Anterior-
meter Posterior
Lateral -
Medial
Structure
SIide ff
(Sq.Inch)
(Inch)
(Inch)
(Inch)
Thyroarytenoid Muscle
48-F1-3S
.0964L
. 1040R
1.9906L
1.7785R
.8567L
. 695 9 R
.1750L
. 1242R
48-F1-5S
.2059L
.1620R
2.5773L
2.1371R
.8108L
.87 3 7 R
.2413L
. 1773R
48-F1-7S
.0906L
.0682R
2.4542L
1.4426R
1.0513L
.55 67 R
.1072L
.1351R
48-F1-9S
.1448L
. 1629R
2.1263L
1.9569R
.8937L
.75 34R
2528L
. 1991R
48-FI-11S
.2008L
.17 00R
2.4097L
1.9276R
.8879L
.7193 R
.2327 L
. 1691R
48-F1-13S
.1529L
. 1054R
2.8661L
1.9985R
.7762L
.9418R
. 2527L
.1583R
48-F1-15S
.1034L
.0835R
2.1327L
1.8802R
8983L
. 75 90R
.2468L
1946R
48-F2-1S
.1179L
.1266R
2.2061L
2.1804R
.7507L
. 8851R
. 1385L
. 1336R
48-F2-3S
.0996L
.1087R
1.7850L
1.8041R
.6382L
. 6907 R
. 1225L
. 1489R
43-F2-5S
.1378L
.0802R
2.2892L
1.8075R
.9084L
.8836R
. 1250L
.0832R
48-F2-7S
.1390L
. 1487R
2.1711L
2.1528R
9096L
.8257 R
.1854L
.1155 R
48-F2-9S
.0950L
0719R
2.0835L
1.5469R
.7782L
6469R
. 1755L
.0931R
48-F2-11S
0518L
.0812 R
1.1320L
1.3308R
.4329L
.4815 R
.1263L
.15 96 R
Posterior Cricoarytenoid
Ligament
48-F1-11S
.0520
1.3507
.2008
.3505
* L = 1 eft, R = right; no
letter =
neither L
nor R is
indicated



Figure 12. Slide 48-Fl-3M/Specimen 2/Transverse Plane/Medial Block.
o


CHAPTER IV
DISCUSSION AND CONCLUSIONS
The current investigation determined the plausibility of
generating measurements from a 35 mm slide of the intact celloidin
embedded laryngeal block while leaving the component laryngeal
structures in their proper configurational relationships to one
another.
Interpretation of Results with Graphic Illustrations
Illustrations of specimen 3 graphically demonstrate the intrinsic
musculature of interest. Alteration in size, configuration, and
intermuscular relation are depicted. Specimen 3 was selected for
illustration since it was the better of two specimens subjected to
coronal plane dissection. This dissection approach generally yielded
bilateral muscular representation. Additional illustrations were
included for contrastive purposes of sagittal dissection specimen 1
and transverse dissection specimen 2. The slides measured and
illustrations chosen were not always paired. Slides were chosen for
measurement by an interval of roughly every fourth or fifth
consecutive slide. The selection also depended on the clarity of the
intrinsic structures of interest due to boundary definition, staining,
and block glare or block thickness. Slides selected^ for illustration
were selected on their ability to visually demonstrate change and the
48


A MULTIDIMENSIONAL STUDY
OF THE INTRINSIC LARYNGEAL MUSCULATURE
BY
TERRY L. HARDEE
A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
1935

To D.V.H., K.F.H., and D.K.H
Copyright by
Terry L. Hardee
1985

ACKNOWLEDGMENTS
My sincerest appreciation is expressed to my committee chairman,
Dr. Thomas B. Abbott, and to Dr. G. Paul Moore, for their skilled
direction, invaluable expertise, and contributions regarding this
project. Gratitude is also expressed to Drs. Linda J. Lombardino and
Russell M. Bauer, whose suggestions early in my graduate school
program guided my course selection preference and research
interests. Appreciation is also expressed to Robert Algozzine, whose
cooperative nature has facilitated growth in a positive setting for so
many of his students. And a simple thank you is extended to Dr. Doug
Hicks, Dr. Warren Rice, Dr. Floyd Thompson, Charles Mills and Terry
Ansman for their not so simple technical assistance.
i i i

TABLE OF CONTENTS
Page
ACKNOWLEDGMENTS iii
LIST OF TABLES vi
LIST OF FIGURES ix
ABSTRACT x
CHAPTERS
IBACKGROUND AND PURPOSE 1
Introduction 1
Review of the Literature 2
The Advent of Laryngeal Awareness 2
Laryngeal Investigation: Anomaly and Disease 6
Further Refined Investigative Techniques 8
Statement of Purpose 11
IIMETHODS 14
Procedures 14
Specimens 14
Chemical Processing 14
Decalcification 15
Dehydration 15
Block Preparation and Celloidin Embedding 16
Di ssection 19
Van Gieson Stain 20
Measurement 20
Photographic Apparatus 20
Instrumentation 21
Structures to Be Measured 22
Shrinkage Study 22
IIIRESULTS 24
Some Aspects of Measurement 24
Shrinkage Study 27
Hypotheses: Empirical Reply 29
Tabular Data 34
IV

Apparent Size of Structures Arranged by Slide 38
Apparent Size of Structures Arranged by Structure
Across Slides 41
Summation: The Hissing Dimension Due to Dissection
Plane 43
IV DISCUSSION AND CONCLUSIONS 48
Interpretation of Results with Graphic II1ustrations....48
Concl usions 74
Implications for Future Research 77
APPENDIX
A STRUCTURES OF INTEREST 80
B APPARENT SIZE OF STRUCTURES ARRANGED BY SLIDE 83
C APPARENT SIZE OF STRUCTURES ARRANGED BY STRUCTURE
ACROSS SLIDES 137
D SUMMATION: THE MISSING DIMENSION DUE TO DISSECTION
PLANE 184
BIBLIOGRAPHY 200
BIOGRAPHICAL SKETCH 205
v

LIST OF TABLES
Table Page
B-l Apparent Size of Structures/Specimen 1/Sagittal Plane/
Left Block 83
B-2 Apparent Size of Structures/Specimen 1/Sagittal Plane/
Right Block 85
B-3 Apparent Size of Structures/Specimen 2/Transverse Plane/
Superior Block 89
B-4 Apparent Size of Structures/Specimen 2/Transverse Plane/
Medial Block 92
B-5 Apparent Size of Structures/Specimen 3/Coronal Plane/
Anterior Block 95
B-6 Apparent Size of Structures/Specimen 3/Coronal Plane/
Posterior Block 105
B-7 Apparent Size of Structures/Specimen 4/Sagittal Plane/
Left Block 113
B-8 Apparent Size of Structures/Specimen 4/Sagittal Plane/
Right Block 116
B-9 Apparent Size of Structures/Specimen 5/Transverse Plane/
Left Medial Block 118
B-10 Apparent Size of Structures/Specimen 5/Transverse Plane/
Right Medial Block 121
B-11 Apparent Size of Structures/Specimen 6/Coronal Plane/
Anterior Block 123
B-12 Apparent Size of Structures/Specimen 6/Coronal Plane/
Posterior Block 129
C-l Apparent Size of Structures/Specimen 1/Sagittal Plane/
Left Block 137
C-2 Apparent Size of Structures/Specimen 1/Sagittal Plane/
Right Block 139
vi

C-3 Apparent Size of Structures/Specimen 2/Transverse Plane/
Superior Block 142
C-4 Apparent Size of Structures/Specimen 2/Transverse Plane/
Medial Block 144
C-5 Apparent Size of Structures/Specimen 3/Coronal Plane/
Anterior Block 147
C-6 Apparent Size of Structures/Specimen 3/Coronal Plane/
Posterior Block 156
C-7 Apparent Size of Structures/Specimen 4/Sagittal Plane/
Left Block 162
C-8 Apparent Size of Structures/Specimen 4/Sagittal Plane/
Right Block 165
C-9 Apparent Size of Structures/Specimen 5/Transverse Plane/
Left Medial Block 167
C-10 Apparent Size of Structures/Specimen 5/Transverse Plane/
Right Medial Block 169
C-ll Apparent Size of Structures/Specimen 6/Coronal Plane/
Anterior Block 171
C-12 Apparent Size of Structures/Specimen 6/Coronal Plane/
Posterior Block 177
D-l Apparent Size of Structures/Specimen 1/Sagittal Plane/
Left Block 184
D-2 Apparent Size of Structures/Specimen 1/Sagittal Plane/
Right Block 185
D-3 Apparent Size of Structures/Specimen 2/Transverse Plane/
Superior Block 186
D-4 Apparent Size of Structures/Specimen 2/Transverse Plane/
Medial Block 187
D-5 Apparent Size of Structures/Specimen 3/Coronal Plane/
Anterior Block 183
D-6 Apparent Size of Structures/Specimen 3/Coronal Plane/
Posterior Block 190
D-7 Apparent Size of Structures/Specimen 4/Sagittal Plane/
Left Block 192
vi i

D-8 Apparent Size of Structures/Specimen 4/Sagittal Plane/
Right Block 193
D-9 Apparent Size of Structures/Specimen 5/Transverse Plane/
Left Medial Block 194
D-10 Apparent Size of Structures/Specimen 5/Transverse Plane/
Right Medial Block 195
D-11 Apparent Size of Structures/Specimen 6/Coronal Plane/
Anterior Block 196
D-12 Apparent Size of Structures/Specimen 6/Coronal Plane/
Posterior Block 198
vi i i

LIST OF FIGURES
Figure
Page
1 Slide 46-Fl-llA/Specimen 3/Coronal Plane/Anterior
Block 50
2 Slide 46-Fl-17A/Specimen 3/Coronal Plane/Anterior
B1 ock 51
3 Slide 46-F2-4A/Specimen 3/Coronal Plane/Anterior
Block 53
4 Slide 46-F2-12A/Specimen 3/Coronal Plane/Anterior
Block 55
5 Slide 46-F3-2A/Specimen 3/Coronal PIane/Anterior
Block 57
6 Slide 46-F3-18A/Specimen 3/Coronal Plane/Anterior
Block 59
7 Slide 46-Fl-3P/Specimen 3/Coronal Plane/Posterior
Block 60
8 Slide 46-Fl-17P/Specimen 3/Coronal Plane/Posterior
Block 62
9 Slide 45-F3-2P/Specimen 3/Coronal Plane/Posterior
Block 64
10 Slide 46-F3-12P/Specimen 3/Coronal Plane/Posterior
B1 ock 66
11 Slide 48-F2-7S/Specimen 2/Transverse Plane/Superior
Block 68
12 Slide 48-Fl-3M/Specimen 2/Transverse Plane/Medial
Block 70
13 Slide 75-Fl-16R/Specimen 1/Sagittal Plane/Right
Block 71
14 Slide 75-F2-17R/Specimen 1/Sagittal Plane/Right
Block 73
IX

A Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy
A MULTIDIMENSIONAL STUDY
OF THE INTRINSIC LARYNGEAL MUSCULATURE
BY
TERRY L. HARDEE
December, 1985
Chairman: Thomas B. Abbott, Ph.D.
Major Department: Speech
The study of laryngeal anatomy has a long history. It has
examined cartilaginous framework and later muscular composition.
Laryngeal replicas were modeled out of wax to depict structure.
Laryngeal material was also embedded in various mediums and sectioning
ensued. Recognizing early examination of the larynx has been fairly
extensive, the crucial question becomes what new information may be
gathered as a result of the current study? The current study attempts
to assess the feasibility of generating intrinsic laryngeal
musculature measurements from photographic slides of the remaining
celloidin embedded block in adult male disease-free specimens cut in
multiplanar serial section. It also is an attempt to follow size,
configurational and relational changes in the intrinsic laryngeal
musculature. A total of six celloidin embedded topically stained
specimens were dissected via coronal, sagittal, and transverse planes,
x

respectively. Area, perimeter, height and width measurements were
made of the soft tissue structures of interest when clearly present.
Structures void of discernible boundaries were not measured in a
particular slide and this accounts for the disappearance and
reappearance of a structure in the tabular data found in the
appendices. Shrinkage data were generated in an attempt to determine
the approximate amount that muscular tissue shrinks as a result of the
chemical processes of fixation, decalcification and dehydration.
These measurement values taken together with the shrinkage data yield
a normative data base closely representative of in vivo conditions.
Tabular data are presented in three forms. First, tabular data
are presented in a progressive slide by slide sequence in which all
structures of interest shown in the sectional plane are delineated by
name and measure. Secondly, individual intrinsic laryngeal muscles
are identified and measured as they are presented throughout a given
specimen. This information is combined with the serial laryngeal
illustrations. Finally, as a result of the chosen plane of
dissection, one dimension is not measurable. The last set of tables
presents a summation of range of structures of interest in the missing
dimension. It is entirely likely subsequent studies may expand the
quantity and type of measurements generated.
xi

CHAPTER I
BACKGROUND AND PURPOSE
Introduction
A perusal of a number of anatomical texts indicates the larynx
often receives a rather cursory presentation. The superficial
descriptions many times result in both extrinsic and intrinsic
laryngeal musculature being addressed in a few paragraphs (Anderson,
1984; Anthony & Thibodeau, 1979, 1980; Basmajian, 1980, 1982).
Frequently the information available on the larynx requires the reader
to seek additional sources (Burke, 1980; Crouch & McClintic, 1971;
Gardner et al., 1963). This type of discourse demonstrates the need
for detailed treatment. The anatomy texts are likely to be the major
source of enlightenment and initial contact for many students and
unfortunately the superficial treatment of the larynx prejudices
students about the importance of this vital organ. These texts
properly concentrate their limited presentations on the structure of
the larynx, and although that information is often incomplete, the
question of function or physiology may be totally omitted (Ellis,
1976; Ellis & Feldman, 1977; Evans, 1976; Francis & Martin, 1975). A
few texts provide a limited improvement of laryngeal information
(Christensen & Telford, 1972; Dienhart, 1979). However the general
dearth of illuminating information perhaps suggests that the larynx
has not been regarded as a particularly important organ. Although it
1

2
has specific biological functions, the larynx is the primary organ of
speech and deserves a less circumscribed and more comprehensive
treatment. It is regrettable so few texts in comparison to the number
of texts available provide the reader a firm foundation in laryngeal
anatomy and physiology.
The purpose of this study was to examine the intrinsic laryngeal
musculature revealed by multipianar serial sectioning of the celloidin
block. The end product would be a better understanding than is
currently available of laryngeal structure as revealed by the
techniques utilized in this study.
Review of the Literature
The Advent of Laryngeal Awareness
The larynx has been a subject of inquiry for centuries. The
literature demonstrates an early keen interest in the larynx. There
exists various citations crediting dissimilar sources with discovery
of diverse aspects of the larynx (Andrews & Badger, 1979; Canal is,
1980; Cooper, 1985; Fink, 1975; Whicker & Devine, 1972). These
sources run the gamut from identification of the larynx as an entity
in the body to labeling of cartilaginous and soft tissue structures.
There has also been speculation regarding function, and actual
physiology is a separate issue. As a consequence of the scientific
question under consideration, the historical perspective reflected
differs. Some sources cite Hippocrates (Whicker & Devine, 1972) as
the initial laryngeal investigator. Hippocrates was purportedly
interested in function (Andrews & Badger, 1979; Whicker & Devine,

3
1972). It has been suggested that several hundred years elapsed
between the first and second individuals to address the larynx. The
first to identify the larynx is thought to have been Aristotle (Fink,
1975) and the second, Galen (Fink, 1975; Whicker & Devine, 1972).
Whicker and Devine (1972) credit Galen (192 A.D.) with referencing the
thyroid, arytenoid and cricoid cartilages. Galen is also purported to
have believed each muscle throughout the entire body possessed a
distinct function and he did attempt to designate function for the
laryngeal musculature. Galen is considered to be the father of early
anatomical dissection. His concepts remained widely employed and
undisputed for centuries.
Leonardo da Vinci (1452-1519) perhaps was the unheralded
anatomist of his period (Fink, 1975; Whicker & Devine, 1972). Da
Vinci believed the voice to be related to the larynx. To support his
theory da Vinci removed certain organs--the larynx, lungs and trachea
as a unit and forced air out through the trachea and lungs. Da Vinci
believed, in a live subject, this same action would result in voice.
Another early advocate of laryngeal study was Vesalius (Fink, 1975;
Whicker & Devine, 1972). Prior to his departure from the University
of Padua in 1543, Vesalius contributed much on the subject of many
different organ systems, including the larynx. Still another advocate
of laryngeal study was Bartolomaeous Eustachius (Fink, 1975; Whicker &
Devine, 1972). His contribution was that of laryngeal drawings.
Although Eustachius lived in the 1500s, his work was not revealed
until the 1700s. Studies often ascribed specific functions to certain
laryngeal musculature. Sometimes these ascribed functions were not

4
the result of conclusive empirical investigation and later were proven
to be incorrect. Galen's work was ultimately subject to challenge.
One such example is found in the case of Casserius (1601) who
disproved Galen's theory on pitch (Fink, 1975). Other researchers
besides Casserius were also concerned with pitch. Dodart (1634-1707)
addressed the issue of pitch modulation and considered pitch to be
controlled by glottal tension and width. Perhaps even more profound
was the idea postulated by Winslow (1756) which supported
consideration of the laryngeal musculature functioning together as a
single unit. This concept circumvented the abyss of single muscle and
single action only theories. In 1724 the corniculate cartilages were
designated as additional entities in the laryngeal cartilaginous
framework by Santorini (Fink, 1975). Not quite 60 years later the
cuneform cartilages were identified. There is some discrepancy as to
whom the credit for this identification belongs, either Wrisberg
(1780) or Wrisberg's deceased associate Haller (1778), or even Camper
(1767) (Camper, 1779; Fink, 1975; Haller, 1973). The identification
of the cuneform cartilages probably should be credited to Camper
(1767) who did publish this information in 1779 and who apparently was
acknowledged by others prior to that publication as having identified
the cartilages. Giovanni Battista Morgagni (1682-1771) for whom the
ventricle of Morgagni is named studied various pathologies and the
resultant changes in anatomy. Particular areas of emphasis were areas
important for speech, the pharynx, larynx, and the palate (Canalis,
1980; Whicker & Devine, 1972). Significant anatomical identification
continued. Still later Francois Magendie discovered, by approximating

5
the arytenoid cartilages and blowing air into the larynx that sound
could be produced (Whicker & Devine, 1972). Hence, in Magendie's
lifetime, late 1780s to late 1880s, the issue of laryngeal function
was again addressed. Studies following Magendie began to look more
closely, even explicitly, at function. The first successful indirect
laryngoscopy was self performed by Manuel Garcia in 1855 with the use
of mirrors and sunlight. Laryngoscopy and the means by which to
achieve it generated a widespread interest. For the first time man
had a means of viewing the interior of the larynx and movements of the
vocal folds and arytenoid cartilage movement. Garcia (1855) and then
Czermak (1861), who used lighting sources other than sunlight,
conducted laryngeal inspections which led to detailed descriptions of
intrinsic laryngeal activity. Czermak (1861) illustrated the
differing types of glottal activity such as closure during certain
biological functions which he observed.
Early studies of the larynx were consistent with the level of
scientific knowledge and instrumentation available. As the base of
scientific information has been augmented, the refinement of skills
and investigative methods have reflected scientific and technological
advancements. Further, the types of questions which can be addressed
today are appreciably different from earlier times. Perhaps the
questions are not intrinsically more difficult, but certainly they are
more technical. The scientific method employed dictates, limits, or
influences the types of results derived as well as their
interpretation. A review of the 20th century literature elucidates
the relationship between the state of the art and the type of research

6
conducted. The technique at issue for this study is celloidin
embedding followed by serial sectioning when applied to laryngeal
material. The assumed position is such that a slice by slice
progression through the larynx yields an appreciation of the component
parts.
Laryngeal Investigation: Anomaly and Disease
There is very little available research which has concerned
itself with sectioning of the larynx via a specific plane. A thesis
project conducted by Jean Robert-Leroux (1936) was probably the first
study to incorporate serial sectioning in cancerous specimens. This
study followed the patient's preoperative course with direct and
indirect 1aryngoscopy, x-ray evaluation, surgical procedure, and
postoperatively with serial sectioning and histological examination of
the laryngeal specimens. The major emphasis of that study was the
location and extent of the tumor. The availability of such
information was and still is a useful learning tool.
As early as 1943 a study conducted by Broyles examined the
anterior commissure tendon. Broyles (1943) concentrated on the
anterior commissure tendon because he believed an area with weak" or
"deficient" cartilaginous protection was susceptible to disease.
Particular attention was given to squamous cell carcinoma. Cross
sections were made of the anterior commissure and surrounding tissue
and thyroid cartilage in two carcinoma specimens, a young adult and a
62 year old male. Broyles (1943) concluded that carcinoma occurring
in the anterior larynx and reoccurring should be examined closely. In
the event that a "midline incision of the thyroid cartilage" was the

7
surgical technique employed, a return of carcinoma should not be
viewed as a recurrence, but rather as a continuation. The growth
would be suspect of having been in the tendon itself or its "insertion
into the thyroid cartilage" (p. 344).
Kernan (1951) studied laryngeal carcinoma via horizontal
celloidin embedded serial sections. The specimens were derived from
patients whom he had followed throughout the course of their
treatment. Kernan (1951) was most concerned with illustrating the
insidious nature of subglottic carcinoma and the failures of too
conservative surgery or inappropriate use of radiation therapy as
forms of treatment. Serial sectioning and histologic techniques were
used on the resulting specimens. Kernan (1951) concluded that
treatment failures need to be studied in depth.
Kelemen (1953) investigated congenital laryngeal stridor in four
newborns. He also had a control group consisting of laryngeal
specimens from four normal newborns. Dissections were parallel for
each group. Three larynges were sectioned in the horizontal plane and
the fourth was dissected in the "frontal plane" (p. 246). Specimens
were infiltrated with celloidin before cutting. The horizontal
sectioning resulted in 640, 800, and 900 sections respectively.
Sectioning for the frontal plane required a midsagittal split, with
the right side of the larynx further divided into 340 slices. A
hematoxylin and an eosin stain were used on every tenth horizontal
slice. Staining for the frontal plane employed Van Gieson and Gomori
stains in addition to the previously mentioned hematoxylin and eosin

stains. Kelemen (1953) concluded that anatomical anomalies were
present and accounted for the stridor.
Further Refined Investigative Techniques
8
G.F. Tucker, Jr. (1961) utilized histologic methods to determine
a more precise classification system delineating the limits of
carcinoma. He believed a better system was necessary as some systems
omitted the submucosal structures. Hence, a more universal system
would be desirable. The clinical means of determining the extent of
the lesion depends on the absence of fold mobility. Tucker (1961)
pointed out a classification system based on dissection is far more
specific. For this reason Tucker (1961) conducted a coronal serial
section laryngeal dissection of celloidin embedded specimens.
Specimens were cut on a Spencer microtome following a modified
decalcification, dehydration and embedding procedure. A variety of
different stains was used. Tucker (1961) concluded that coronel
serial sectioning allowed the inspection of a tumor in relation to the
remaining healthy structures. It also permitted speculation as to the
initial disease locale prior to the spread of the disease.
Livingston et al. (1976) developed a rather innovative means of
studying structure. Although concerned with the brain, horizontal
slices were studied via filmed computer graphics. This technique was
applied to various brain structures throughout the horizontal
slices. The advantage of using computer graphics is that it enables
the entire brain to be represented in a three-dimensional fashion as
well as allowing the viewer the flexibility of visualizing the brain
externally or to travel through the inner structures.

9
Michaels and Gregor (1980) conducted a study which compared their
own method of laryngeal preparation and dissection to the more
traditional time proven methods. Their method consisted of fixation
in a 10% buffered formol saline for a minimum of 2 days after which
the specimen was sectioned serially on a meat slicer. Michaels and
Gregor (1980) judged their method superior by virtue of less chemical
intervention as well as the option of leaving the specimen whole prior
to dissection. This technique was used with both normal and diseased
specimens.
Gregor et al. (1980) addressed the efficacy of using computed
tomography (CT) as a noninvasive means of studying the larynx. This
group took various laryngeal sections and compared the pathological
findings via conventional tomography with those obtained by CT scan.
Their results indicated that particular areas were better evaluated
through the use of the CT scan, ". .an accurate assessment of
laryngeal anatomy and involvement by tumor, particularly of the pre-
epiglottic space, paracordal area, anterior commissure, and
cricoarytenoid area [and] . the presence of anterior or posterior
commissure involvement is of paramount importance in precluding the
possibility of conservative laryngeal surgery" (p. 291).
Hicks (1981a, b) made various measurements of 31 laryngeal
specimens to establish normative data documenting changes in the
larynx over the decades of life. His particular hypothesis also
addressed the possibility that these changes occurred as a result of
the aging process. Specimens were derived from both male and female
subjects ranging in age from 47 to 90 years of age. A total of 54

10
separate measures were taken. These measures were primarily linear
although one measure was angular and six concerned weight. Structures
of particular interest were the vocal folds, hyoid bone and laryngeal
cartilages. Hicks (1981a, b) concluded specimens derived from female
subjects were in all cases smaller than that of their male
counterparts. The superior angle of the thyroid cartilage was found
to be under 90 in males and over 90 in females. This finding held
true with all age groups. Lastly, Hicks (1981a, b) concluded changes
in the human voice over the span of decades are not attributable to
changes in the hyoid bone or cartilage.
Mafee, Schild, Valvassori, and Capek (1983) verified the presence
and general extent of carcinoma by using celloidin embedded specimens
to complement the results of computed tomography. Seven specimens,
cut only in the transverse plane, were cut down to the level
appropriate for the computed tomography scan. Results indicated
sectioning did indeed confirm the computed tomography findings. Mafee
et al. (1983) concluded computed tomography scanning to be the best
means of laryngeal integrity assessment available.
Silverman and Korobkin (1983) utilized computed tomography on
normal larynges. The purpose was to scan the larynges in transaxial,
coronal and sagittal planes to demonstrate disease-free laryngeal
anatomy. These data were to serve as a basis of comparison for
obscure anatomical anomalies induced by disease states.
Kahane and Kahn (1984) examined the intrinsic laryngeal
musculature of infants. Particular emphasis was placed on weight,
differences due to gender, and intermuscular interactions. Nine

11
infant larynges were collected. Seven of these subjects died as a
result of sudden infant death syndrome. Five subjects were male and
four were female. Muscles were dissected off, blotted, and weighed on
a Mettler balance. Kahane and Kahn (1984) compared their data to that
of adult data generated by Bowden and Scheure (1960). Kahane and Kahn
(1984) concluded the weights of respective intrinsic muscles
established in infancy, maintained their proportional relationships in
adulthood as well. A consistent finding in both infant and adult
larynges indicated the cricothyroid muscle to have the largest mean
weight. Bowden and Scheure (1960) did not address differences due to
gender in the weight of the adult intrinsic laryngeal musculatures.
However Kahane and Kahn (1984) found no differences due to gender in
their infant intrinsic laryngeal musculature. They further concluded
intermuscular interactions or functions aimed at delineating vocal and
nonvocal laryngeal behaviors would require additional research.
Statement of Purpose
A review of the literature indicates there is little serial
sectioning information available on disease-free larynges. The
purpose of this study was to examine disease-free human larynges in
block following serial dissection. The major thrust of the proposed
study was to delineate specific soft tissue structures and how those
structures appear different depending on the plane of dissection.
Horizontal, coronal, and sagittal serial section planes were employed
as a means to facilitate examination. Six adult male human larynges
were dissected. Comparative measures were made primarily regarding

12
soft tissue. The proposed measurements required the soft tissue
structures be revealed at different sequential levels for the purpose
of viewing and comparing those structures in relation to one another
as well as in relation to hard tissue. Further, this technique allows
the course of particular soft tissue structure(s) to be illustrated.
Serial sectioning best demonstrated the internal configuration of
these structures. The relevance of this study's contribution to the
field of speech pathology is such that these measurements are used to
facilitate a greater understanding of laryngeal anatomy.
This study has been designed to address several questions. In
order to answer these questions the following null hypotheses were
tested:
(1) There are no significant inferences relative to laryngeal
behavior or function which can be postulated based on the
course of muscle fibers demonstrated by this technique.
This hypothesis leads to the question, is it possible to
infer cartilaginous and soft tissue behavior based on the
combined information of the chosen measurements and
illustration?
(2) There is no significant differentiation of tissue in block
when topically stained.
This hypothesis generates a two part question. To what
extent is it possible to differentiate via a stain (a) soft
tissue from cartilage and (b) soft tissue from other soft
tissue?

13
(3) There are no significant demonstrations of accurate real life
measurements of soft tissue structures of interest as a
result of the combined block embedding technique and
photography.
The question generated by this hypothesis reflects a
comparison of techniques. Will the block technique including
photography of the cut block surface demonstrate the
capability of measurements of soft tissue structures?
(4) There are no significant changes in the structures of
interest seen during progressive serial sectioning in one
plane of one specimen in its entirety.
The question is as follows: is it possible to measure
the dimensions of critical structures following the removal
of each slice, by means of scaled photography of the
remaining block, and to demonstrate change in those
dimensions?
(5) There is no significant effect as a result of photographic
and/or illustrative reconstruction of the identified soft
tissue structures in a given specimen.
Is it possible to reconstruct a specimen by photographic
and/or illustrative means?

CHAPTER II
METHODS
The purpose of this study was to determine the viability of
obtaining measurement values of the intrinsic laryngeal musculature
from a photographic slide of the remaining celloidin embedded block at
given intervals following serial sectioning.
Procedures
Specimens
Adult male disease-free specimens were collected from autopsy in
a 10% formalin solution. All specimens were Caucasian and male. The
age of the specimens ranged from 45 to 75 years of age, specifically
46, 48, 62, 68, 69, and 75, respectively. All organ donors expired
due to causes other than that of any form of laryngeal pathology or
compromise.
Chemical Processing
Specimens were allowed to remain fixed in the formalin solution
for 48 to 72 hours after which decalcification procedures were
followed. The formalin solution was poured off and the specimen was
rinsed three times in tap water before being placed in the
decalcification solution.
14

15
Decalcification
Decalcification softens cartilage and bone and allows it to be
cut. Since the specimens were adult larynges in which cartilages are
usually calcified to some extent, decalcification was necessary.
Fresh solution was used every other day. The old solution was poured
off and fresh solution was poured on the specimen. This procedure
generally continued for approximately 2 weeks. Specimens were x-rayed
every fifth day to determine the extent of calcification remaining.
At the end of decalcification, the specimen was rinsed in several
changes of running tap water during a 24 hour period.
Dehydration
Based upon previous research on dehydration (Lillie & Fullmer,
1976; Humason, 1979), specimens were placed in a 70% ethyl alcohol
solution which was changed twice during a 24 hour period. Immediately
afterwards specimens were placed in an 80% solution.
Specimens remained in the 80% ethyl alcohol solution for 12 hours
and then fresh 80% solution was poured on and remained on for the next
12 hours. Immediately afterwards specimens were placed in a 95%
solution.
Specimens remained in the 95% ethyl alcohol solution for 12 hours
and then were placed in fresh 95% solution for 12 subsequent hours.
Immediately afterwards specimens were placed in a 100% solution.
Specimens remained in the 100% (absolute) ethyl alcohol solution,
which was changed twice during a 24 hour period. Lastly, specimens
were immediately placed in a solution consisting of half ether and

16
half absolute ethyl alcohol, referred to as ether alcohol, which was
also changed twice during a 24 hour period.
Following dehydration, the celloidin processing was begun.
Block Preparation and Celloidin Embedding
The specimens selected for sagittal plane sectioning were split
mid-sagittally and dissection proceeded in a medial to lateral
progression, first on one side and then the other. Coronal specimens
were cut in half along the anterior to posterior continuum and then
set up into two separate blocks, an anterior and a posterior block.
Each block was dissected from the central coronal plane of cut on out
anteriorly and posteriorly, respectively. Finally, the two transverse
specimens were cut into superior, medial and inferior blocks. One
specimen had a center sagittal cut, the other did not. In one case
rendering three blocks, superior, medial and inferior, that contained
both right and left structures. In the other case, where the right
and left halves were separated at the median sagittal plane, six
blocks, superior, medial and inferior existed. In one case soft
tissue measures resulted in bilateral representation within the same
block. The other case or second transverse specimen resulted in
unilateral representation of soft tissue structures. In the case of
the six block transverse specimen, the medial blocks contained the
designated structures of interest. The inferior and superior blocks
consisted largely of cartilage and some fat. In all cases the large
block cuts were made with the use of a brain knife or a band-saw.
Specimens were placed in a 5% celloidin solution and remained
there for 2 weeks. Five percent celloidin solution consists of 150

17
grams of nitrocellulose dissolved in 3000 ml of ether alcohol.
Specimens were then placed in a 10% celloidin solution and remained
there for 2 weeks. Ten percent celloidin solution consists of 300
grams of nitrocellulose dissolved in 3000 ml of ether alcohol.
Finally, specimens were placed in a 20% celloidin solution and
remained there for 2 weeks. Twenty percent celloidin solution
consists of 600 grams of nitrocellulose dissolved in 3000 ml of ether
alcohol.
After the six weeks of celloidin processing the specimen was
prepared for cutting or set up into a block. Essentially this was
achieved by several steps. The side or surface of interest of the
specimen was placed face down in the dish. A quantity sufficient to
cover the specimen with 20% celloidin was poured into the dish. A
piece of paper with the autopsy identification number was placed on
the top surface of the specimen. In effect this top surface became
adjacent to the microtome mount and, therefore, in reality was at the
bottom of the mounted specimen block. The identification number was
recorded in pencil, as inks wash out or run. Next, the lid was
loosened and the specimen allowed to dry until it was the consistency
of gelatin. Chloroform was poured over the specimen, sufficient to
cover it, and left overnight. The dish was sealed tightly with
tape. The next day the excess celloidin was cut off around the edges
of the specimen. The specimen was put back in the dish, and fresh
chloroform poured over it. The specimen remained like this for one
hour. This step allowed the portion of the specimen, face down in the
dish, to harden as a part of the block. The block appeared hazy,

18
after it was successfully hardened. If the celloidin had remained
clear, then a celloidin strip would have been cut out of the dish.
This strip would have existed at the lateral margins of the dish,
virtually all the way around the dish. The specimen would have been
covered in chloroform once again, the lid replaced, and left for one
hour. The most significant step was to be sure to place the correct
side face down in the dish. The correct side was the side or surface
intended to be cut first. This side was the top of the block.
Once the specimen was hardened into the block, it was mounted on
the microtome sledge plate. This was achieved as a result of several
steps. The chloroform was poured off. The specimen was placed in a
separate dish and covered with ether alcohol where it remained for 5
minutes. The sledge plate and 20% celloidin were ready for immediate
use. A small amount of ether alcohol, was followed quickly by a small
amount of 20% celloidin poured onto the sledge plate. ¡These solutions
established a mounting base for the specimen. The specimen block was
immediately placed on the solution base and oriented in such a fashion
that it was at an angle to the blade. The purpose was to ease the
blade into the specimen block, thereby reducing the shock to the
specimen. It was also important to note the composition of the
structure encountered first by the blade to avoid bone where
possible. Once the specimen was oriented on the solution base, the
specimen was covered in 20% celloidin to seal the block onto the
sledge. The specimen, sledge and all, was placed in chloroform for
one hour. The specimen should not remain in the chloroform over one
hour, as changes result in the block. The block was mounted on the

19
sliding microtome and dissection began. Specimens not slated for
immediate dissection were hardened into a block and then stored in a
70% ethanol alcohol solution. Slices cut from a dissected block were
placed on individual sheets of numbered bibulous paper and also stored
in 70% ethanol alcohol solution. Storage may be maintained in this
fashion for an indefinite period of time. Additional 70% ethanol
alcohol solution should be periodically poured onto any stored
material.
Dissection
Following the celloidin processing, each specimen was serially
dissected. Some experimentation was necessary to determine the
optimal slice thickness which was determined to be a 35 micron
thickness. Each specimen was cut in its entirety in one plane. The
newly exposed surface of the remaining block was stained and cleared
in order to accentuate muscle, connective tissue and cartilage.
Serial sectioning was documented by photographic means. Specimens
were dissected in units of 5 to 10 microtome passes, 35 microns each
on a sliding microtome. The first specimens to undergo serial
sectioning were photographed after every tenth pass. Subsequent
specimens were photographed in block following the fifth microtome
pass. This alteration in dissection protocol was believed necessary
to observe subtle structural changes. Tables available with this text
(Appendices B-D) clearly demonstrate measures of the structures of
interest did not occur with every photographic slide but rather were
made as deemed necessary. Photographic documentation was used to
record the progression through the larynx and change in intrinsic

20
musculature revealed in serial section. The stain ultimately selected
was Van Gieson stain, and the clearing solution selected was 70
ethanol alcohol.
Van Gieson Stain
A saturated aqueous solution of picric acid consisted of 100 ml
of distilled water and 2 grams of picric acid. While a 1% aqueous
solution of acid fuchsin required 1 gram of acid fuchsin and 100 ml of
distilled water. In order to yield Van Gieson stain, 5 ml of 1%
aqueous solution of acid fuchsin was combined with 100 ml of picric
acid. The Van Gieson stain was chosen because of the multitude of
stains tested it best delineated the structures of interest. Muscle
was expected to take on a yellow hue, while collagen was expected to
be in the red/pink distribution (Humason, 1979; Luna, 1968).
Measurement
Photographic Apparatus
A commercially available copy stand equipped with twin tungsten
lights was mounted with an Olympus (0M2) 35 mm camera and a 90 mm
Vivitar lens. The copy stand was stationed across from the sliding
microtome. The preferred F stop was between 5.6 and 8, while the
preferred shutter speed was 1/30 second. The film selected was
Kodachrome 25 which produced faithful color representation and
contained fine grain emulsion. To facilitate accurate measurement a
1/10 inch grid was present in each photographic slide, adjacent to the
identification number assigned each particular slide. The slide
identification number incorporated the age of the specimen, the roll

21
and number of the exposure on the film, as well as plane markers. The
presence of L or R signals the sagittal plane and either the left or
right side respectively. The presence of A or P signals the coronal
plane and either the anterior or posterior aspect respectively,
whereas the presence of I, M, S or IL, ML, SL signals the transverse
plane and either inferior, medial, superior, or inferior left, medial
left, or superior left aspect respectively.
Instrumentation
Serial sectioning was conducted through the use of a sliding
microtome model number 1400 Leitz. The means of measurement was a
graphics tablet referred to as the Versawriter Tablet, marketed by
Versa Computing, Inc., of Newbury Park, CA. The versawriter was
interfaced with an Apple lie computer. A numerical value appears on
the screen and was accurate to greater than 30/1000 inch. A line
drawing of the structure of interest was displayed on the screen along
with a numerical value. This value was directly proportional to the
value identified utilizing the 1/10 inch grid for calibration. Area
and perimeter values were also determined. In securing measures, the
same procedure or manner in which the measure(s) were made, were
consistently followed, except when not possible due to the limits of
the size of the graphics tablet (8 inches x 12.5 inches). In some
instances the orientation of the tablet had to be changed, as in
measuring the height of the thyroid cartilage. Similarly, this
reorientation was also necessary at times when measuring the distance
between the apexes and prominences of the thyroid cartilages.
Photographic images of the slides in serial section were projected one

22
at a time onto the surface of the tablet for measurement. A standard
screen was cut and secured onto the tablet surface. The photographic
images were projected from a Kodak Ektagraphic slide projector model
AF-2 fitted with a Kodak Ektanar lens.
Structures to Be Measured
Soft tissue measurements were of three basic types: anterior to
posterior, medial to lateral, and superior to inferior. These
measurements were made when appropriate for a particular plane and
applied to specific soft tissue structures. For instance coronal
slices allowed for medial to lateral and superior to inferior measures
(Tucker, 1971), whereas sagittal slices allowed for anterior to
posterior and superior to inferior measures. And transverse slices
allowed for anterior to posterior and medial to lateral measures. The
structures of interest were measured as closely as could be determined
by the delineated boundaries. These values represented apparent
height, width, and depth as opposed to actual height, width, and
depth. Each structure was followed as closely as possible. In the
event that a structure curved, if it was necessary to follow the curve
in order to get a more representative measure, the curve was
followed. Some cartilaginous measures were included (Hicks, 1981b;
Mane, 1971). Obviously not all structures appeared in all planes in
all specimens.
Shrinkage Study
In addition to the processing of the specimens as mentioned
above, it was clear that the numerical values determined from the

23
information on the structures of interest would be altered from what
their actual values were in life. These values were expected to be
altered as a result of shrinkage due to the chemical processing. In
order to have an idea of what that change was, another specimen
separate from the six adult male specimens previously mentioned was
taken fresh from autopsy prior to any fixation in formalin. This
specimen was then processed as each of the other specimens and
measured and weighed (when appropriate) through each phase of the
chemical processing procedure.

CHAPTER III
RESULTS
The current study assessed the utility of the intact celloidin
embedded specimen block as a photographed medium for generating
representative measures of the intrinsic laryngeal musculature.
Serial sectioning of the intact block was conducted in three planes of
dissection, coronal, sagittal, and transverse.
Some Aspects of Measurement
Structures were consistently measured throughout the progression
into or out of the larynx as long as clear boundaries were
identifiable. Absence of a measurement indicated the boundaries were
either obscure or that the structure of interest ceased to exist in a
given specimen. Utilization of the celloidin embedding, serial
sectioning and topical block staining techniques did indeed make it
possible to view and measure the structures of interest in relation to
one another as well as in relation to cartilage. The course of a
given intrinsic laryngeal muscle as well as transition in its size and
shape distribution were revealed via serial sectioning. Changes in
size were corroborated by the area, perimeter, anterior to posterior,
medial to lateral and inferior to superior measures generated. These
values were listed in the attached appendices. For further
demonstration of structural change illustrations were included
24

25
representing each plane. The illustrations in conjunction with the
tabular data clearly depict structural transition. The specimen which
received the most extensive illustrative depiction, including both the
anterior and posterior blocks, was specimen 3. Specific slides were
chosen in the progression through this specimen to convey the effect
of serial sectioning. Examination of additional illustrations
addressing the sagittal (specimen 1) and transverse (specimen 2)
planes displayed some of the same musculature. The plane of
dissection dictated the visual depiction of each muscle. A specific
muscle in one plane was not always easily recognized in another plane.
Originally it was intended that as many soft tissue structures as
possible would be measured. Among the intended was the quadrangular
membrane. This structure was never observed. It was also intended
that muscles known to have separate bundles would be identified by
those bundles. However, since it was not possible to consistently
identify both bundles throughout dissection, the structure was
referred to by the primary muscle name. For instance pars oblique and
pars recta were referred to as cricothyroid. This same format with
few exceptions was followed for the thyroarytenoid and
interarytenoideus muscles. Also the vibratory mass was measured only
on coronal specimens. The mass perimeter was defined as extending
from the medial border of the thyroarytenoid muscle including the
mucosa, measuring laterally to the thyroid cartilage, proceeding
interiorly to the level of the superior border of the cricoid
cartilage, and finally proceeding in a superior-medial progression
consistent with the lower border of the thyroarytenoid muscle.

26
Measurement to the level of the superior border of the cricoid
cartilage was as stated unless there was an obvious muscle boundary
just lateral and inferior to the apex of the cricoid cartilage. This
concept was considered useful since it was considered that more than
the thyroarytenoid musculature vibrated during sound production.
Hence, these measures were taken in an attempt to quantify the
approximate size of such a mass in healthy adult male specimens. It
was of course impossible to state the exact size of such a mass, as
well as to account for individual variation.
The phonatory position was simply a measure of the glottal width
divided in half. In theory each healthy vocal fold did approximate to
midline. The phonatory position therefore represented the distance
each fold moved medially in order to approximate at midline. In
essence this measure quantified the cadaveric position of the vocal
folds and from that point estimated the distance of medial movement
necessary for sound to be generated. It was also necessary to keep in
mind that this potential displacement was merely an approximate value
since the tissue had been altered due to chemical processing, and
shrinkage.
Measures for all structures were generally secured by moving the
tracing point in a superior to inferior, medial to lateral and/or
anterior to posterior direction. Care was taken to proceed slowly to
allow the Apple He computer to keep pace with the Versawriter
Graphics tablet. Consistency in speed or rate of movement of the
tablet arm as well as consistent sensitivity to pressure were
maintained. Periodic reliability checks were made in an effort to

27
monitor speed and sensitivity. Calibration of the Versawriter tablet
with the measurement grid incorporated in each slide occurred at the
beginning of each session. If any movement of the projector occurred,
the program was restarted and recalibrated. In certain planes, due to
the nature of dissection in that plane, certain structures were not
observed. They were, however, identified and measured in a different
plane. This was especially true in the case of ligaments. In all
specimens cartilage was easily distinguished from soft tissue
musculature and ligaments. In most cases fiber tracts were followed
via Kodak 35 mm slide projection without much difficulty. The same
slides, made into prints, showed far less differentiation. Each slide
carried with it the photographic 1/2-inch grid equivalent to 12.7 mm
as well as a slide number. Once again, the slide number was composed
of the age of the specimen, the number of the roll of film thus far
used on that specimen block, and the number of slices which had been
cut into that block.
The data generated by this study established the normative data
base of intrinsic laryngeal musculature in adult male disease-free
specimens. This was a small sample and meant to serve as a data base
with that limitation in mind. These data yield the area, perimeter,
and essentially height, width, and depth values of intrinsic laryngeal
musculature in six adult male specimens.
Shrinkage Study
A specimen from a 45 year old, disease-free, adult male was taken
fresh from autopsy and subjected to each of the chemical processing

28
stages the other specimens had been subjected to prior to serial
sectioning. The rationale was to determine the amount of shrinkage
introduced via chemical processing. This was of significant interest
since no such data could be found concerning the larynx and none
particularly concerning the intrinsic musculature of the larynx.
The initial weight of the specimen was 107.7 grams. The specimen
was then cut sagittally, rendering the right half to be used, weighing
57.4 grams. Polypropylene sutures were sewn in two places,
constructing a backwards "L" configuration. A triangular shape could
actually be discerned. A set of Riefler calipers were used to measure
the sides of the triangle. Volume displacement conducted in a 70%
ethyl alcohol solution yielded 43 ml; while the values of the distance
between sutures were 1.0 mm inferior suture, .7 mm lateral suture, and
1.4 mm hypotenuse.
The specimen was then placed in a formalin solution for 48 hours
and then measured. Weight was 62 grams; the inferior suture was .9
mm; the lateral suture was .6 mm; the hypotenuse was 1.3 mm; volume
displacement was 41 ml. The specimen was then decalcified and
x-rayed. The specimen remained in the decalcification solution with
appropriate changes to fresh solution for 11 days. Weight was then
52.4 grams; inferior suture was .9 mm; lateral suture was .6 mm; the
hypotenuse 1.3 mm; volume displacement was 37 ml.
The specimen was placed in running tap water for 1 day to remove
any acid from the decalcification solution. Weight was 50.5 grams;
inferior suture was .9 mm; lateral suture was .6 mm; the hypotenuse
was 1.3 mm; volume displacement was 41 ml.

29
The specimen was placed in 70% ethyl alcohol solution which was
changed twice during the course of the day. At the end of that 24
hour period the weight was 50.2 grams; inferior suture was .9 mm;
lateral suture was .6 mm; the hypotenuse was 1.3 mm; volume
displacement was 39 ml.
At the end of the dehydration phase the specimen was placed in an
ethyl ether or ether alcohol solution which was changed twice in a 24
hour period. Weight was 38.5 grams; inferior suture was .9 mm;
lateral suture was .6 mm; the hypotenuse was 1.2 mm; volume
displacement was 35 ml. At this point, overall shrinkage for the
inferior suture segment was 10%; for the lateral suture segment, 14%;
and for the hypotenuse segment, 14%. Total overall shrinkage due to
chemical processing was 18% by volume and 21% by weight.
Hypotheses: Empirical Reply
The first hypothesis was concerned with postulated laryngeal
behavior based on muscle fiber course revealed via serial
sectioning. More particularly, was it possible to infer cartilaginous
and soft tissue behavior based on the combined information of the
measurements and illustrations? It was possible to infer behavior and
in fact vibratory behavior was inferred for the vibratory mass (Hirano
et al., 1983). The mass encompassed tissue well beyond the
thyroarytenoid musculature proper as delineated in the coronal
specimens. This conjecture was based on the muscle fiber tracts
observed in the described musculature. However, behavior of the
laryngeal cartilage was not inferred, nor was behavior of any soft

30
tissue intrinsic structure. Although it was possible to observe and
trace intrinsic fiber tracts in most cases, it was not possible to
infer unique locations and behavior beyond the course and functions
already attributed to individual muscles by recognized anatomists
(Bailey & Biller, 1985; Gray, 1985; Hollinshead, 1974; McMinn et al.,
1981; Paff, 1973; Pernkopf, 1963-64; Sobotta & Uhlenhuth, 1957 ;
Zemlin, 1981).
The second hypothesis addressed differentiation of tissue
utilizing the block embedding and staining techniques. Particular
attention was given to the delineation of soft tissue from cartilage
and soft tissue from other soft tissue as a result of staining. The
Van Gieson stain did easily differentiate soft tissue or intrinsic
musculature from cartilage. However, although the Van Gieson stain
was the stain of choice following many trial stains and clearing
procedures, it failed to easily differentiate muscle tissue fiber
tracts in all cases. Fiber tracts were generally discernible, but not
always. Overstaining obscured the course of various tracts. And
although it was not reasonable to expect a stain to selectively and
differentially stain the same type of tissue, in this case the
composition of muscle tissue, still the ability to follow certain
fiber tracts was anticipated. Some color change was evident across
and within specimens. The Van Gieson stain was expected to turn
muscle tissue yellow and collagen tissue hues of red and pink. These
color parameters probably would have been consistent and blatantly
obvious had the medium been paraffin. Some deviation from this color
pattern was anticipated since the clarity of the medium of choice was

31
celloidin rather than paraffin. Celloidin had demonstrated clearer
visualization of tissue in the slice than did paraffin. That is to
say for histologic preparation of microscopic slides celloidin was
preferred over paraffin. When left in block, the specimen was viewed
through the block and in that way the structures soon to be
encountered in the dissection were seen well before they were at the
surface of the block. The intensity of the Van Gieson stain in some
instances tended to obscure the visibility of the individual fiber
tracts. It was believed that this obscurity was in part due to the
nature of the thickness of the block rather than due to the medium
being celloidin. It is likely that some irregularities in staining
were the result of the specimen being stained in block rather than by
the slice. The traditional means of preparation involves a slice,
perhaps 10-15 microns thick, stained via hematoxylin and eosin and
then mounted on a microscopic slide. Hematoxylin and eosin are better
stains for histologic observation. Although the current study was not
a histologic study, the stain choice was more for macroscopic
purposes. Microtome slices for the current study were 35 microns
thick and the remaining stained block was much thicker. Still it is
likely that some of the staining irregularities were due to the block
itself. Each time slices were removed and the block surface stained
and cleared, the surface of the block was changed. In some instances
penetration deep into the block via the clearing medium can result in
staining irregularities. This was not the problem in this case since
the clearing agent was not allowed to remain on the block surface
sufficiently long enough to penetrate deep into the medium and cause

32
undesired change layers below. If that had been the case the
undesired change would have been compounded by each additional
staining and clearing. However, it is likely that the staining
irregularities were the result of surface changes in the block, as
well as constraints of stain absorption time, and finally the
thickness of the block. Another possible contributory factor was the
method of application of the stain. Initially the stain was applied
via a cotton tipped applicator which resulted in some remnants of
cotton on the surface of the block. The cotton tipped applicator was
then abandoned and a suctioned dropper used. Again, certain problems
appear to have resulted from the block itself. The block was
preferred intact to demonstrate the internal configuration of the
intrinsic musculature in relation to one another. The presumption was
made that the configuration would represent actual relationships if
the laryngeal structures was allowed to remain intact in the celloidin
block. Hence, for structural intactness, some sacrifice resulted in
less clearly defined fiber tracts.
The third hypothesis concerned demonstration of accurate life
measurements of soft tissue structures of interest related to the
block embedding technique. Specifically, was the block technique
preferable to the histologic slice technique for purposes of more
accurate depiction and therefore more accurate measurement, i.e.,
closely associated with in vivo specimens? One advantage of the block
technique was the maintenance of the specimens' original shape.
Furthermore, the intrinsic musculature remaining following dissection
was allowed to retain its shape and configuration. There was no

33
evident shearing, tearing, or stretching of the block resulting in
alteration of laryngeal tissue. However, to obtain an approximation
of accurate real life measurements, in as much as is possible, a
shrinkage study was conducted to determine the amount of shrinkage of
laryngeal muscular tissue due to chemical processing. The overall
shrinkage was determined to be 18% by volume and 21% by weight. The
measurement values taken together with the shrinkage data yield a more
accurate representation of structure size and configuration than wou 1 d
have been possible by just the measurements alone.
The fourth hypothesis addressed the possibility of observing
existing change in the structures of interest during progressive
serial sectioning in a given specimen. A specimen sectioned in one
plane throughout its entirety, can easily be examined for structural
transition. The actual question generated considered the ability to
measure the dimensions of critical structures, subsequent to the
removal of each slice, by viewing the remaining block. A second
question generated by this hypothesis concerned the ability to
demonstrate change in the dimensions of trise critical structures. As
a consequence of examination of the attached tabular data, it is
evident that it was possible to measure the critical structures in
block subsequent to serial sectioning and to demonstrate a definite
change in the dimensions of those structures.
The fifth and final hypothesis was concerned with a photographic
and/or illustrative reconstruction of the identified soft tissue
structures. The question generated addressed the reconstruction of a
specimen and the quality of that reconstruction through the use of

34
photographic and/or illustrative means. It was possible to
reconstruct the specimen through either means. This study generated a
total of 792 slides, only some of which were selected for measurement
and illustration. There was sufficient material available for
reconstruction via photographic slides. The illustrations were drawn
from the slides, tracings of those slides, and when available
photographic prints. The illustrations were chosen due to the clarity
of their reproduction.
Tabular Data
The first set of tables is found in Appendix B. Data presented
there are organized according to slide. In other words, slides are
presented in the order in which they were photographed during the
serial sectioning. All intrinsic laryngeal musculature of interest
and cartilage, largely identified as landmarks, appearing in each
consecutive slide were identified and measured. Specimen 1 was
dissected via the sagittal plane and presented with both left and
right sides. These sides were each infiltrated with celloidin and
became celloidin blocks. Sectioning began with the most medial aspect
of each block. The first slide appearing in this set of tables is
75-F1-5L. This was the fifth photographic slide on the first roll of
film. There were five microtome passes at 35 microns each between
each photographic slide. We were, therefore, 25 passes into the left
sagittal block of specimen 1 when this photographic slide was taken.
The only structure of interest appearing in this slide and, therefore,
at the surface of the block was the interarytenoideus muscle. This

35
structure was measured on the graphics tablet which resulted in area,
perimeter, inferior-superior distance, and anterior-posterior distance
measures. The next slide listed in this set of tables is 75-F1-9L,
which contained measurement values for the posterior cricoarytenoid
muscle and the interarytenoideus muscle. This identification and
measurement of structures of interest continued all the way through
the block. The result was a roster of the structures of interest and
their measurement values as they appeared in the specimen organized by
slide. Upon examination of Table B-2 the same information was made
available for the right block of sagittal specimen 1. A progression
through the B set of tables, B-3, presents information on the superior
block of specimen 2. Specimen 2 was dissected in the transverse
plane, resulting in the measurement parameters to be slightly
different. Area, perimeter, and anterior-posterior distance were
still categories; however, medial-1ateral distance was a new
parameter. These parameters were valid for any transverse specimen,
and in this case applicable for both the superior and medial blocks.
The superior block was dissected from its inferior surface on up
through the epiglottis or the top of the superior block. The medial
block was dissected from its superior surface on down through the base
of the cricoid ring. Specimen 3 was a coronal specimen, which
resulted in both an anterior and a posterior block. Dissection began
at the medial aspect for both blocks. The parameters of measurement
dictated by the coronal plane of dissection include area, perimeter,
inferior-superior distance, and also medial-1ateral distance. Every
plane of dissection dictated essentially two directional parameters

36
while one directional parameter was totally void by definition of that
particular plane of dissection. This void in directional parameters
was thought of as the missing dimension. Some advantage did occur as
the result of serial sectioning by plane. Structures were seen in
their appropriate relation to other structures while their
configurations remained intact. The usage of different planes allowed
the same structure(s) to be viewed from different perspectives. The
tabular listings indicated that measures were not made on every
slide. Slides were chosen based on change evidenced in the structures
measured in the preceding slide as compared to how the same structures
appeared in the current slide and for clarity of boundaries.
Essentially Appendix B allows the identification and measurement of
structures on the surface of the remaining block. At any point in the
progression through the larynx, the appearance and/or disappearance of
structures of interest were known. It was as if one was examining the
surface of the remaining block and possessed the ability to proceed or
recede through the dissection.
The second set of tables is given in Appendix C. This set is
organized by the structure of interest. The first table again
addresses the left block of specimen 1, which was dissected in the
sagittal plane. The structure identified initially was that of the
cricothyroid muscle. Two slides are listed, 75-F2-14L and 75-F3-1L,
as containing the cricothyroid muscle in the left block of specimen
1. Measurement values are given for the area, perimeter, inferior-
superior, and anterior-posterior distance of the cricothyroid muscle
as it appeared in those two slides. The next structure of interest

37
listed was the interarytenoideus muscle. Five different slides are
listed as containing the interarytenoideus muscle and appropriate
measurement values are given for each. This procedure is followed
with each of the structures of interest all the way through the left
block of specimen 1. Table C-2 presents the same information, that
is, identification and measurement of the structures of interest
organized by structure for the entire right block of specimen 1.
Table C-3 lists information organized by the structure of
interest on the superior block of specimen 2. Specimen 2 was a
transverse specimen and by virtue of definition of this plane of
dissection slightly different information is given. Measurement
values were generated for area, perimeter, anterior-posterior, and
1ateral-medial distance.
Table C-5 addresses the anterior block of the coronally dissected
specimen 3. Measurement parameters include area, perimeter, inferior-
superior distance, and medial-1ateral distance. Again, since this is
the C set of tables, information is organized by the structures of
interest.
Finally, Appendix D or the D set of tables is organized in a
slightly different fashion. As was indicated earlier, by definition
of a particular plane, a specific parameter of directional information
was absent. Specimens 1 and 4 were sagittal dissection specimens. By
virtue of the sagittal dissection plane no information was given on
the medial-lateral appearance of structures of interest. For
transverse dissection specimens, specimens 2 and 5, no information was
given on the inferior-superior distance of appearance of structures of

38
interest. Specimens subject to the coronal plane of dissection
included specimens 3 and 6. This plane of dissection did not display
anterior-posterior distance on structures of interest. Appendix D
presents a summation of the missing dimension for each plane of
dissection for each specimen. This information was the result of
tabulation of the number of slides in which the structures of interest
appeared in, multiplied by the number of microtome passes occurring
between photographic slides, and multiplied again by the unit of slice
thickness of 35 microns. This value was then converted from microns
to millimeters. The number of microtome passes between slides varied
with the specimen.
Apparent Size of Structures Arranged by Slide
Examination of the available data was that the course of each
particular muscle was visible. Some structures were easily
identifiable in all planes and in all blocks, while others were barely
discernible.
Specimen 1 (Table B-l) demonstrated a definite core of consistent
intrinsic musculature. It also manifested the infrequent appearance
of ligaments, such as the posterior cricoarytenoid ligament and the
anterior cricoarytenoid ligament, as well as the singular entry of the
conus elasticus. Slide by slide, a sequential progression, medial to
lateral, existed through each block of this specimen. Measurement
values were given for the structures of interest. These values
allowed the comparison of structures of interest within a given level
of the remaining block. Size differences were noted and alteration in

39
size from slide to slide for the same and different structures were
also noted. Due to the nature of the consistency of the core a
continuity of pattern was predictable. There was an anticipation of
the appearance of structures thought of as comprising the core of
intrinsic musculature via the sagittal plane.
Specimen 2 (Table B-3) had a slightly different core than did
specimen 1. The consistency of this core depended on how far up or
down into the block dissection had occurred.
Specimen 3 (Table B-5) generated the most data. These measures
are perhaps due to nearly simultaneous bilateral representation. The
core of the initial slide in both the anterior and posterior blocks
was the same. This representation of muscles was expected since the
first slide in each block represents the two medial surfaces that were
in contact prior to embedding. And although the agreement in muscular
representation was anticipated, it was not exactly true for specimen 6
(Table B-ll) which was the second coronally dissected specimen. The
vibratory mass and its associated measurements existed nearly
throughout the entire specimen, that is in both blocks. A coronally
dissected specimen was perhaps the easiest in which to view the
structures of interest in continuity. Due to the bilateral
representation there was generally a symmetrical comparison.
Specimen 4 (Table B-7), although a sagittal dissection specimen,
presented somewhat differently than did specimen 1. A likely reason
for this difference was the number of microtome passes between
photographic slides was twice the number in specimen 4 than those
occurring in specimen 1. This difference was a factor in all the same

40
plane dissection comparisons. Also another possible factor in this
particular case was the initial size of the specimen itself. The
outward appearance of a specimen may be deceiving, perhaps due to the
presence of extensive extrinsic laryngeal musculature.
Specimen 5 (Table B-9), another transverse specimen, was set up
into six different celloidin blocks. Due to the number of blocks in
specimen 2, it was possible to examine for bilateral representation of
musculature. Specimen 5 lacked bilateral representation as a result
of a center cut and each side cut into thirds. Sectioning revealed
the structures of interest were located in the medial blocks. There
was certainly some structural asymmetry present as was clear in the
case of the lateral cricoarytenoid muscle. This structure appeared at
different levels slices apart on the two sides. In part this
difference was due to asymmetry. However it is quite likely that the
structure was present earlier on the right side but with dubious
boundaries. A center cut for transverse specimens is not recommended
for future dissections.
Specimen 6 (Table B-11), a coronal dissection, closely resembled
the anterior block of specimen 3 in terms of appearance of structures
of interest. However the posterior block was somewhat atypical. It
was not possible to measure the distance from the cricoid cartilage to
the true vocal fold. It was equally impossible to assess any glottal
aperture or phonatory position. Again, the number of microtome passes
differed on these two coronal specimens. However, it is unlikely that
this factor alone could account for the absence of the glottal
aperture and true vocal folds in the posterior block. Perhaps the

41
band-saw cut was further posterior on this specimen than it was on
specimen 3. This factor could possibly explain the presence of these
structures in the anterior block alone.
The impact of examination of these tables is such that some
differences and similarities across specimens should be clear. The
entire set of tables in Appendix B or the listing of structures by
slide was the most appropriate for targeting the structures of
interest in relation to one another leaving the internal configuration
intact. Further the concept of a system working together is conveyed.
Apparent Size of Structures Arranged by Structure Across Slides
Appendix C is the most appropriate set of tables for targeting
the specific structures of interest individually, as they appeared in
the slides. Information available herein best indicates change within
a structure. Change was determined by examination of the numerical
extremes in the area measure of a given structure. If an area measure
was not given, then the most and least values of the directional
parameter given were used. Change within a structure was significant
as it addressed the participation, size, or extent of involvement of a
structure. This information further contributed to the normative data
available for each specimen.
The left block of specimen 1 (Table C-l) indicated the structure
exhibiting the most change in size was that of the thyroarytenoid
muscle, while the least change was exhibited by the lateral
cricoarytenoid muscle and the cricothyroid ligament. The right block
of specimen 1 demonstrated the most change in size in the anterior

42
cricoarytenoid ligament, while the structure with the least change was
the lateral cricoarytenoid muscle.
Specimen 2 (Table C-3), a transverse dissection, indicated some
of the same musculature. The most transition or size change within
the superior block occurred in the thyroarytenoid muscle, while the
least transition occurred in the posterior cricoarytenoid ligament.
The medial block of the same specimen indicated the most transition in
the cricothyroid muscle and the least transition in the thyroarytenoid
muscle.
Specimen 3 (Table C-5) was a coronal dissection and was divided
into anterior and posterior blocks. Dissection yielded different
information in these blocks. The most extensive transition occurred
in the thyroarytenoid muscle and the least size transition in the
lateral cricoarytenoid muscle. The posterior block of the same
specimen again indicated the thyroarytenoid muscle as the structure
which demonstrated the most transition, and the lateral cricoarytenoid
muscle, the least transition.
Specimen 4 (Table C-7) was a sagittal specimen split into two
blocks, left and right respectively. The left block presented the
most extensive structural transition in the thyroarytenoid muscle and
the least transition in the anterior cricothyroid ligament. The
distribution of intrinsic musculature in the right block was somewhat
different. The most extensive structural transition occurred in the
cricothyroid muscle and the least in the interarytenoideus.
Specimen 5 (Table C-9) was the second of two transverse
specimens. This specimen was divided into six small blocks and then

43
dissected in serial section. It was determined that the medial block,
bilaterally, contained the structures pertinent to the purposes of
this study. The most transition in size distribution in the left
block implicated two muscles, the posterior cricoarytenoid and the
thyroarytenoid muscles. The least change was indicated in the lateral
cricoarytenoid muscle. Further the thyroarytenoid muscle represented
the most change in the right medial block, while the lateral
cricoarytenoid muscle demonstrated the least change.
The last specimen addressed in the terms of structural transition
was the sixth specimen (Table C-ll). This was the second coronally
dissected specimen presenting with both an anterior and a posterior
block. The greatest size transition, in soft tissue of the anterior
block, occurred in the area of the vibratory mass. However, the
single soft tissue structure which demonstrated the most transition
was the conus elasticus. The least transition was revealed, in the
cricothyroid muscle. Measurement values in the posterior block
demonstrated, assessment of one aspect of the vibratory mass, the
thyroarytenoid muscle to thyroid cartilage, manifested the most
transition. The single structure demonstrating the most change was
the thyroarytenoid muscle. And lastly, the lateral cricoarytenoid
muscle displayed the least transition in a given soft tissue
structure.
Summation: The Missing Dimension Due to Dissection Plane
The last set of tables (Appendix D) is most appropriate for
quantification of the extent of the missing dimension. This

44
previously unavailable directional parameter was assessed by summation
across the number of slides in which a structure was identified. The
information herein presented differs from the soft tissue measures
evidencing the most and least transition within a block as presented
in Appendix C. The current data set was not numerically derived from
a most to least site transition in a structure. Rather, Appendix D
addresses the continued presence, range, or extension of a
structure. The summation, or Appendix D set of tables, of the
previously intangible dimension indicated in specimen 1 (Table D-l)
was the medial to lateral dimension. The most extensive soft tissue
structure in specimen 1 was the thyroarytenoid muscle. The least
extensive range involved two structures, the lateral cricoarytenoid
muscle and the conus elasticus. The right block of specimen 1 (Table
D-2) demonstrated the soft tissue structure of greatest range was the
thyroarytenoid muscle. The structure with the least range was the
posterior cricoarytenoid ligament.
The superior block of transverse specimen 2 (Table D-3) indicated
the thyroarytenoid and the posterior cricoarytenoid ligament as
structures with the greatest and least musculature range
respectively. This was determined by a summation of inferior to
superior dimension. The medial block in this transverse specimen
(Table D-4) indicated two soft tissue structures of equivalent
range. They were the lateral cricoarytenoid muscle and the posterior
cricoarytenoid muscle. The structure of the least range proved to be
the thyroarytenoid muscle.

45
Specimen 3, a coronal dissection, was divided into anterior and
posterior blocks. The previously intangible dimension of specimen 3
entailed a depth measurement as the unknown directional parameter, or
the anterior to posterior distance. The anterior block (Table D-5)
revealed the soft tissue structure of greatest range again represented
two equivalent range structures. Those structures were the
thyroarytenoid and cricoarytenoid muscles. Also the surface of the
true vocal fold demonstrated the same numerical value. However, the
vibratory mass, which extended beyond the limits of a single muscle
was even more extensive. The least range values of two structures
were of equivalent standing. Those structures were the
thyromuscularis and thyrovocalis bundles of the thyroarytenoid muscle.
The posterior block of specimen 3 (Table D-6) presented the
structure of greatest range as the cricothyroid muscle. Whereas the
structure of least range concerned a portion of the vibratory mass.
The portion referenced was the existing distance from the cricoid
cartilage to the true vocal fold. The surface of the cord itself
entailed a minute distance, but the intrinsic laryngeal muscle which
exhibited the least range was the lateral cricoarytenoid muscle.
Specimen 4 was set up into two blocks, left and right
respectively. This specimen was dissected in the sagittal plane from
the medial aspect, outward to the most lateral aspect of the
specimen. The missing dimension was determined by the summation of
the medial to lateral dimension. The soft tissue structure in the
left block (Table D-7) of greatest range was the cricothyroid
muscle. The least range value implicated the posterior cricoarytenoid

46
muscle and the lateral cricoarytenoid muscle. The right block of the
same specimen (Table D-8) evidenced the greatest distance by the
thyroarytenoid muscle and the least distance shared equally between
the lateral cricoarytenoid and the interarytenoideus muscles.
The second and last transverse specimen was specimen 5. It was
dissected in six blocks, two of which contained relevant information
for the current soft tissue study. The intangible dimension in a
transverse specimen again was the inferior to superior dimension. The
left medial block (Table D-9) demonstrated the most and least range in
the posterior cricoarytenoid and the interarytenoideus muscles
respectively. The right medial block of the same specimen (Table
D-10) indicated the most extensive range involved the posterior
cricoarytenoid muscle and the least extensive, the lateral
cricoarytenoid muscle.
The sixth and final specimen was comprised of two blocks,
anterior and posterior dissected in the coronal plane (Table D-ll).
The missing dimension of a coronal dissection once again was the
anterior to posterior distance. This distance was conspicuously
occupied by the thyroarytenoid muscle. However both the area of the
vibratory mass and the distance between the thyroarytenoid muscle and
the thyroid cartilage demonstrated greater values as did the surface
of the true vocal folds. All of these were equivalent measures. The
single intrinsic muscle which demonstrated the least presence was the
cricothyroid muscle. However another soft tissue structure, the conus
elasticus, was even less apparent. The last block of specimen 6
(Table D-12) was the posterior block. The structure of greatest range

47
occurring in this block was the cricothyroid muscle and the structure
of least range was the lateral cricoarytenoid muscle.
The structures identified here as most and least prevalent were
determined by quantifiable range extension. Some of the structures
indicated were also indicated as significant in other data sets. In
summary, the multivariate dissection technique used in this study
allowed a multivariate approach to assessment. The assessment
confirmed the importance of many of the same intrinsic laryngeal
musculature structures throughout the larynx regardless of the
assessment parameter.

CHAPTER IV
DISCUSSION AND CONCLUSIONS
The current investigation determined the plausibility of
generating measurements from a 35 mm slide of the intact celloidin
embedded laryngeal block while leaving the component laryngeal
structures in their proper configurational relationships to one
another.
Interpretation of Results with Graphic Illustrations
Illustrations of specimen 3 graphically demonstrate the intrinsic
musculature of interest. Alteration in size, configuration, and
intermuscular relation are depicted. Specimen 3 was selected for
illustration since it was the better of two specimens subjected to
coronal plane dissection. This dissection approach generally yielded
bilateral muscular representation. Additional illustrations were
included for contrastive purposes of sagittal dissection specimen 1
and transverse dissection specimen 2. The slides measured and
illustrations chosen were not always paired. Slides were chosen for
measurement by an interval of roughly every fourth or fifth
consecutive slide. The selection also depended on the clarity of the
intrinsic structures of interest due to boundary definition, staining,
and block glare or block thickness. Slides selected^ for illustration
were selected on their ability to visually demonstrate change and the
48

49
appearance or disappearance of structure(s). The purpose of the
selection dictated the terms of the choice. Figures 1 through 10 are
depictions of specimen 3. Figure 1 (46-F1-11A) represents the 11th
photographic slide on film one in the anterior block. Specific
structures were identified as present in the remaining block. Those
structures included the left cricothyroid muscle, thyroarytenoid
muscles, conus elasticus, surface of the true vocal fold, cricoid and
thyroid cartilage and vibratory mass. In the event of unclear
boundaries, structures although identifiable as present, were not
measured. This particular figure is also listed in the tabular data,
Appendices B, C and D. Tabular listing was not always the case as not
all illustrated slides were measured.
Figure 2 (46-F1-17A) represents the 17th photographic slide on
film one in the anterior block. Specific structures identified
included the left cricothyroid muscle, thyroarytenoid muscles, conus
elasticus, cricoid and thyroid cartilages, and ventricle of
Morgagni. This specific slide was not chosen for measurement.
However surrounding slides (46-F1-14A; 46-F2-1A) were chosen and
support the identification of the same structures as depicted in this
illustration. Area and perimeter values for the left cricothyroid and
thyroarytenoid muscles, directional parameter measures for the conus
elasticus and the surface width of the true vocal fold, all thyroid
cartilage and phonatory position measures increased from Figure 1 to
slide 46-F1-14A; however, the medial aspect of the thyroarytenoid
muscle to the thyroid cartilage and the area of the vibratory mass
measures both decreased. Examination of slide 46-F2-1A indicated most

Thyroid cartilage
Thyroarytenoid m.
Cricothyroid m. -
Cricoid cartilage
Figure 1
Slide 46-Fl-llA/Specimen 3/Coronal Plane/Anterior Block
cn
o

Ventricle of Morgagni
Thyroid cartilage
Thyroarytenoid m
Cricothyroid m.
Cricoid cartilage
Thyroid cartilage
Thyroarytenoid m.
Cricoid cartilage
Figure 2. Slide 46-Fl-17A/Specimen 3/Coronal Plane/Anterior Block,

52
soft tissue measures declined with the exception of the left conus
elasticus, the area of the right vibratory mass, and the height from
the cricoid cartilage to the true vocal folds which increased
bilaterally. The distance between the thyroid cartilage apexes and
inferior prominences both declined. Phonatory position also
declined. Visual inspection of Figures 1 and 2 do not reveal much
difference between the two illustrations.
Figure 3 (46-F2-4A) represents the fourth photographic slide on
film two in the anterior block. Specific structures identified
included the left cricothyroid muscle, left lateral cricoarytenoid
muscle, thyroarytenoid muscles, conus elasticus, thyroid and cricoid
cartilages and the ventricle of Morgagni. Comparison of the area and
perimeter measures when given, and the directional parameter for those
structures lacking an area measure indicated the alteration in the
soft tissue structures from 46-F2-4A to 46-F2-6A as listed: a
decrease in the lateral cricoarytenoid, cricothyroid, and
thyroarytenoid muscles, as well as a decrease in area of the medial
aspect of the thyroarytenoid muscle to the thyroid cartilage. The
vibratory mass area had decreased on the right and increased on the
left. Whereas the distance of the conus elasticus, surface width of
the true vocal fold, height from the cricoid cartilage to the true
vocal fold increased. Thyroid cartilage measures decreased with the
exception of the height of the left cartilage. Phonatory position
also decreased. Visual depiction indicated a change in shape or
configuration evident in the thyroarytenoid muscle and the left
cricothyroid muscle.

Figure 3. Slide 46-F2-4A/Specimen 3/Coronal Plane/Anterior Block
en
CO

54
Figure 4 (46-F2-12A) represents the 12th photographic slide on
film two in the anterior block. Specific structures identified
included the left cricothyroid muscle, thyroarytenoid muscles, the
left lateral cricoarytenoid muscle, conus elasticus, cricoid and
thyroid cartilages as well as the ventricle of Morgagni. This
specific slide was not chosen for measurement. However, surrounding
slides (46-F2-6A; 46-F2-13A) were chosen and support the
identification of the same structures as depicted in this
illustration. These slides were 35 microtome passes apart at 35
microns each. Intrinsic musculature area and perimeter or directional
parameter transition indicated a decrease in the left lateral
cricoarytenoid and thyroarytenoid muscles and a decrease in the conus
elasticus in both thyroid apexes and prominences, similarly there was
a decrease in height, and a decrement in the medial aspect of the
thyroarytenoid to the thyroid cartilage. However the cricothyroid
muscle and the height value from the cricoid cartilage to the true
vocal fold indicated an increase. In some instances the increased or
decreased values were not altered much from the previous value as
measurements were extended four decimal places. Measurement of the
area or directional parameter of the vibratory mass, phonatory
position and surface width of the true vocal fold were not made due to
lack of boundary clarity. The tabular data indicate change; however,
the visual depiction of Figures 3 and 4 demonstrate a marked
transition in the overall appearance and configuration of Figure 4.
From this point through Figures 5 and 6 marked visual configurational
transition again occurred.

Figure 4. Slide 46-F2-12A/Specimen 3/Coronal Plane/Anterior Block.
en
en

56
Figure 5 (46-F3-2A) represents the second photographic slide on
film three in the anterior block. Specific structures were
identified. The thyroartyenoid muscle became meshed together near
midline. Slides preceding 46-F3-2A presented the thyroarytenoid
muscle as two separate bilaterally distributed muscles. The first
slide listed in the tabular data which followed (46-F3-2A) was
46-F3-5A. Fiber tract discernment in this case allowed the
identification of discrete bundles of the thyroarytenoid muscle.
However when the bundle fiber tracts were not easily discerned the
major muscle label, thyroarytenoid, was again used. Another
bilaterally identified structure was the cricothyroid muscle. However
the conus elasticus at this point had ceased to exist. Measurement
from slides 46-F2-13A, the slide closest to Figure 4, and 46-F3-5A
were examined in order to address transition in Figure 5. The lateral
cricoarytenoid muscle ceased to exist, whereas the right cricothyroid
muscle became clearly measurable. Both bundles of the thyroarytenoid
muscle, thyromuscularis and thyrovocalis, were demarcated in
46-F3-5A. Clarity of the discrete muscular bundle fiber tracts or the
thyroarytenoid muscle only occurred once throughout dissection and
that was at this interval. The boundary of the thyroarytenoid muscle
and the mucosal layer which surrounds it superiorly and medially was
once again obvious. This in turn made possible the resumed
measurement of the surface of the true vocal fold, phonatory position
and the area of the vibratory mass. Since these were resumed
measures, they were not present in 46-F2-13A. However values taken
from slide 46-F2-6A and compared to 46-F3-5A indicated a decrement on

Figure 5. Slide 46-F3-2A/Specimen 3/Coronal Plane/Anterior Block.

58
all three. Measurements of the left cricothyroid muscle on 46-F3-5A
indicated a reduction in area. Thyroid cartilage measures indicated a
decrement in the distance between the superior apexes as well as the
inferior apexes, while height increased. Vibratory mass measures
indicated an increase in the height from the cricoid cartilage to the
true vocal fold and a decrease in the medial aspect of the
thyroarytenoid muscle to the thyroid cartilage. The overall
configuration of the remaining block had become narrowed and the fused
tracheal rings clearly present.
Figure 6 (46-F3-18A) represents the 18th photographic slide on
film three of the anterior block. This slide was so far forward in
the anterior block that all the soft tissue structures of interest
ceased to exist. The "U" shaped thyroid cartilage was the only
identifiable landmark.
Figure 7 (46-F1-3P) represents the third photographic slide on
film one of the posterior block. Identifiable structures included the
cricothyroid and thyroarytenoid muscles bilaterally, conus elasticus,
arytenoid, cricoid and thyroid cartilages and the pyriform sinus were
also identified. This particular slide is listed in the tabular
data. Numerical values of this figure are easily compared to the
values associated with Figure 1, which was the first anterior block
illustration. These figures represent the most medially depicted
aspects of the anterior and posterior blocks respectively.
Measurement indicated the area of the left cricothyroid muscle, conus
elasticus, and the surface width of the right true vocal fold smaller
in Figure 7 than in Figure 1. Also the area of the vibratory mass

Figure
Thyroid cartilage
Thyroid cartilage
. Slide 46-F3-18A/Specimen 3/Coronal Plane/Anterior Block.
cn
vo

Figure 7
Slide 46-Fl-3P/Specimen 3/Coronal Plane/Posterior Block
CT
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61
measures of the cricoid cartilage to the true vocal fold, the medial
aspect of the thyroarytenoid muscle to the thyroid cartilage and the
phonatory position were documented as decreased in Figure 7. No value
was given for the analogous measure of the true vocal fold surface on
the left. '.Jhereas the area of the thyroarytenoid muscles and the area
of the right vibratory mass declined. No value was generated for the
same structure on the left. Finally, the cartilaginous framework
increased in all cases in Figure 7. Visual inspection of Figures 1
and 7 indicate definite configurational changes in musculature,
especially the thyroartenoid muscles. The right cricothyroid muscle
evidenced a definite boundary. The introduction of the arytenoid
cartilages and the pyriform sinus both by their presence indicated
posterior progression in block dissection.
Figure 8 (46-F1-17P) represents the 17th photographic slide on
film one of the posterior block. Specific structures identified
included the right thyroarytenoid muscle, the lateral cricoarytenoid
muscles, cricothyroid muscles, right conus elasticus, arytenoid,
cricoid and thyroid cartilages and the pyriform sinus. Tabular data
indicates the closest slide to Figure 8 (46-FI-17P) was 46-F2-1P.
Structural comparison between the measurement values generated for
Figure 7 (46-F1-3P) and those of slide 46-F2-1P indicated the
following: the left posterior cricoarytenoid muscle had been revealed
through sectioning. Also the lateral cricoarytenoid muscle exhibited
a definite boundary and was once again a measurable structure in the
specimen block. The area of the left cricothyroid and right
thyroarytenoid muscles had increased as had the area of the right

Thyroid cartilage
Arytenoid cartilage
Thyroarytenoid m.
Lateral cricoarytenoid
Cricothyroid m.
Cricoid cartilage
Pyriform sinus
Thyroid cartilage
Arytenoid cartilage
Lateral cricoarytenoid m.
Posterior cricoarytenoid m.
Cricothyroid m.
Cricoid cartilage
Figure 8. Slide 46-Fl-17P/Specimen 3/Coronal Plane/Posterior Block
CT
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63
vibratory mass and the phonatory position. Whereas the presence of
other structures declined. Structures which decreased in size were
the conus elasticus, all thyroid cartilage measures and the medial
aspect of the thyroarytenoid muscle to the thyroid cartilage. Visual
inspection of Figure 8 as compared to Figure 7 demonstrates the folds
of the left pyriform sinus disappeared and were replaced by a
perforation. The left arytenoid cartilage was nearly entirely
exposed. The right side of the specimen revealed the transitional
stage of the peeling away of the thyroarytenoid muscle and the
discovery of the arytenoid cartilage underneath. The larynx itself
had taken on an archway configuration.
Figure 9 (46-F3-2P) represents the second slide on film three of
the posterior block. Specific structures identified included the
right lateral cricoarytenoid, left posterior cricoarytenoid, fragments
of the interarytenoideus muscle, right cricothyroid muscle, articular
facet of the cricothyroid joint and the arytenoid, cricoid and thyroid
cartilages. Slide 46-F2-16P was selected for comparison purposes.
Examination of the tabular data indicates that the right
thyroarytenoid muscle, although present in slide 46-F2-16P, had ceased
to exist in Figure 9. This same muscle was in the process of being
dissected off in Figure 8, and by Figure 9, it had been completely cut
away. Measurement values of the slide closest to Figure 8 (46-F1-17P)
and the slide closest to Figure 9 were selected for comparison. Those
slides were 46-F2-1P and 46-F2-16P respectively. Examination of
tabular data reveals soft tissue structures which had increased in
area were the posterior cricoarytenoid muscle and the medial aspect of

Fragments of
Figure 9. Slide 46-F3-2P/Specimen 3/Coronal Plane/Posterior Block
CT>
4^

65
the thyroarytenoid muscle to the thyroid cartilage. The phonatory
position had also increased. Structures which decreased in size were
the right lateral cricoarytenoid, right cricothyroid, and right
thyroarytenoid muscles as well as the right vibratory mass. The
fragmented interarytenoideus muscle was a new entity in the tabular
data at this level. Cartilaginous framework demonstrated an increase
in the distance between the superior apexes of the thyroid cartilage,
as well as an increase in the distance between the inferior
prominences. Height of the thyroid cartilage increased on the right
and decreased on the left. Visual examination of Figure 9 (46-F3-2P)
reveals the archway effect of the epiglottis to have vanished. The
left arytenoid cartilage was replaced by the seemingly ever expanding
cricoid cartilage. The right lateral cricoarytenoid muscle had
assumed a more lateral position than it had in Figure 8. The conus
elasticus and the right thyroartyenoid muscle had ceased to exist.
The left posterior cricoarytenoid muscle had aligned itself with the
cricoid cartilage. Two final observations which indicated this
particular slide for selection were the presence of the articular
facet of the cricothyroid joint and the fragmented appearance of the
interarytenoideus muscle.
Figure 10 (46-F3-12P) represents the 12th slide on film three of
the posterior block. Specific structures identified included the
interarytenoideus muscle, right cricothyroid muscle, posterior
cricoarytenoid muscles, superior cornu of the thyroid cartilages,
arytenoid, cricoid and thyroid cartilages as well as the inferior
pharyngeal constrictor muscle. The tabular slide data chosen as

Inf. Pharyngeal
'constrictor m.
Thyroid cartilage<
Arytenoid cartilage
Post.Cricoarytenoid m.
Post.Cricoarytenoid m.
Cricothyroid m.
Figure 10. Slide 46-F3-12P/Specimen 3/Coronal Plane/Posterior Block.
cn

67
closest to Figure 10 (46-F3-12P) were that of slide 46-F3-14P. These
data were taken in conjunction with the data presented in slide
46-F2-16P which was previously chosen as closest to Figure 9
(46-F3-2P) and compared. Examination indicated area values for the
posterior cricoarytenoid and interarytenoideus muscles were increased
in Figure 10 as compared to Figure 9, whereas the values for the
cricothyroid muscle decreased. The lateral cricoarytenoid muscle was
no longer present. Cartilaginous measures indicated the distance
between the superior apexes had decreased as had the height of the
thyroid cartilage. Visual inspection revealed the presence of the
inferior pharyngeal constrictor muscle, fragmented thyroid cartilage
with separate superior cornu, the remnants of the right arytenoid
cartilage and a very prevalent cricoid cartilage.
Figure 11 (48-F2-7S) represents the seventh slide on film two of
the superior block of specimen 2. Specimen 2 was a transverse
dissection specimen. Specific structures of interest included the
thyroarytenoid muscles, arytenoid and thyroid cartilages. Since this
was a transverse dissection specimen it was cut into three blocks
before serial sectioning and the surface of least interest was mounted
face down on the block. This block was dissected from its inferior
surface proceeding in a superior direction. Primary structures of
interest were the thyroarytenoid muscles while the arytenoid and
thyroid cartilage served as landmarks. Measurement data were
generated only on the thyroarytenoid muscles. Visual inspection
revealed a winged cartilaginous appearance.

Figure 11. Slide 48-F2-7S/Specimen 2/Transverse Plane/Superior Block
Or
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69
Figure 12 (48-F1-3M) represents the third slide on film one of
the medial block of specimen 2, or an inferior level of the same
specimen depicted in Figure 11. In this instance the medial block was
at issue and dissection proceeded from a superior to an inferior
direction. Tabular data indicates some difference existed between the
surrounding slides (48-F1-2M) and 48-F1-4M). Specific structures of
interest included bilateral distribution of the thyroarytenoid,
lateral cricoarytenoid, and the posterior cricoarytenoid muscles and
the cricoid cartilage. The thyroarytenoid muscle ceased to exist as
dissection proceeded in an inferior direction. As this muscle dropped
out another, the cricothyroid muscle, appeared. Figure 12 (48-F1-3M)
reflects the transition in progress as the lateral cricoarytenoid,
posterior cricoarytenoid, and the thyroartyenoid muscles were depicted
bilaterally with increased area in all lateral and posterior
cricoarytenoid muscles. The cartilaginous framework consisted
primarily of the cricoid cartilage. Visual examination of Figure 12
reveals a ring shaped structure sparingly draped with musculature.
Figure 13 (75-F1-16R) represents the 16th slide on film one of
the right block of specimen 1. Specimen 1 was a sagittal dissection
specimen. Specific structures identified included the thyroarytenoid,
lateral cricoarytenoid, posterior cricoarytenoid muscles, arytenoid,
cricoid, epiglottis and thyroid cartilages. Tabular data indicates
the surrounding slides were (75-F1-14R and 75-F1-18R). Both slides
concurred with Figure 13 as to the presence of the posterior
cricoarytenoid, lateral cricoarytenoid, and thyroarytenoid muscles as
soft tissue structures of interest. Area values for all three

Figure 12. Slide 48-Fl-3M/Specimen 2/Transverse Plane/Medial Block.
o

Figure 13. Slide 75-Fl-16R/Specimen 1/Sagittal Plane/Right Block

72
diminished as dissection proceeded laterally. Visual inspection
revealed the inferior pharyngeal constrictor muscle and what appeared
to be the fragmented beginning of the interarytenoideus muscle while a
nearly midline position was assumed by the arytenoid cartilage.
Figure 14 (75-F2-17R) represents the 17th slide on film two of
the right block of specimen 1. Specific structures identified
included the thyroarytenoid muscle, cricothyroid muscle, posterior
cricoarytenoid muscle, interarytenoideus muscle, arytenoid, cricoid
and thyroid cartilages. Tabular data indicate the closest surrounding
slide of Figure 14 (75-F2-17R) was 75-F2-18R. This slide listed the
interarytenoideus, posterior cricoarytenoid, and cricothyroid muscles
as present. The anterior cricoarytenoid ligament was also
indicated. Comparison of Figures 13 and 14 as a result of compared
tabular data on the slides indicated as closest to the appropriate
figures, 75-F1-18R for Figure 13 and 75-F2-18R for Figure 14
respectively, were as listed. Area measurement indicated the
posterior cricoarytenoid muscle increased, while the cricothyroid and
interarytenoideus muscles were both new additions at the level of
dissection for Figure 14. The area of the thyroarytenoid muscle was
demonstrated as decreased. Figure 14 did not evidence an anterior
cricoarytenoid ligament. Visual examination revealed the most
extensive features were a definite interarytenoideus muscle, and the
unmistakable characteristic shapes of both the arytenoid and cricoid
carti1 age.

Figure 14. Slide 75-F2-17R/Specimen 1/Sagittal Plane/Right Block.
CO

74
Cone!usions
The purpose of this study was to examine disease-free adult male
larynges in block following serial dissection. Amultiplanar approach
to serial sectioning allowed measurement of soft tissue structures of
interest in the remaining specimen block. This study combined three
different empirical phases. All three phases of this study together
indicated significant information. It was determined that the block
technique of laryngeal assessment was a viable method for experimental
studies designed to address the intrinsic laryngeal musculature. It
was also indicated that change in the critical structures of interest
as well as a means for quantifying that change was possible. And
lastly, an empirically derived chemically induced percent shrinkage
estimate was established. This variable was never before quantified
on laryngeal material. The generated basic data base was intended as
incomplete in vivo values. However these values, augmented with the
empirically determined shrinkage values of 10% for measurements taken
along the course of a muscle and 14% for measurements perpendicular to
that course, represent as nearly as possible in vivo values.
Concisely, the triad reflected a proven method with quantifiable
normative data base combined with a now known chemical shrinkage
factor. A series of successive progressive measures contributed to
the resolution of the triad. One step along the continuum allowed by
the method chosen was that structures were viewed in relation to one
another. Specimen blocks were examined for change in soft tissue size
and configuration as indicated by the presence of the illustrations
and tabular data. Further, this method allowed the possibility of

75
tracing the course of a particular muscle while transition in other
structures was noted. Each muscle was treated singularly, but was
viewed in relation to other musculature. Specific muscles were
selected out but not removed from their natural habitats. Each
identifiable soft tissue structure of interest was identified and
measured. This involved area, perimeter and directional parameters of
inferior to superior, medial to lateral and the anterior to posterior
dimensions. Tabular data incorporated in the appendices reflected the
establishment of this basic normative data base. Subsequently the
same treatment was given to all other soft tissue structures of
interest within a given slide of the remaining block. Muscular course
or range was also noted. Although this study addressed intrinsic
laryngeal musculature, certain non-muscular structures such as
cartilages were utilized primarily as landmarks. The vibratory mass
and various aspects of that mass were described in the text but not
demarcated on the illustrations. All together these serial successive
progressive steps resulted in quantifiable data on adult male
intrinsic laryngeal musculature generated to assess the celloidin
block embedding technique.
The information available in the tables clearly indicated
transition occurred in the size of the various intrinsic
musculature. The illustrations, to some degree, capture the
configurational transition in some of the same structures. Although
these transitions perhaps would have been more evident if it had been
possible to include all'the available Kodak 35mm slides of each
specimen in serial section, and thereby witness the quantitative

76
change, per specific muscle. It was, however, not possible to include
the bulk of the Kodak 35mm slides as a part of this text. It was
anticipated that the combination of the illustrations in addition to
the measures of each muscle would jointly convey these transitions
effectively. In reviewing the various available anatomy texts, it was
clear that in many the larynx was given light cursory treatment.
Descriptions of laryngeal musculature as previously mentioned were
generally relegated to a few paragraphs. One had to ponder why the
larynx apparently was such an unimportant organ. Perhaps, the
significance of such an organ grew due to increased instrumentation
capabilities which in turn allowed a means of putting to task various
questions. This was most evident via the engineering and radiological
literature (Damste et al., 1968; Hirano, 1977 ; Hirano et al ., 1981;
Run and Chung, 1983). Although the engineers' proclivity for the true
vocal folds was an exhaustive pursuit to capture and mathematically
catalog the very essence of the true folds, other investigators'
quests have addressed the true folds as well as other intrinsic
musculature (Hirano et al., 1983). Other means of describing and
cataloguing were sometimes preferred as mathematical formulas did not
always facilitate resolution (Cooper, 1985; Mueller & Sweeney,
1985). Surely the true vocal folds do not accomplish phonation alone,
without assistance from other structures (Hirano, 1974, 1977; Hirano
et al., 1981, 1983). Although the true vocal folds can be considered
critical for phonation, the surrounding musculature likely contributed
to the overall structure and function, including phonation, of the
larynx. Since the present study was not geared to elucidate

77
phonation, nor the possible function of a given muscle during
phonation, the structures were viewed concommitantly.
Implications for Future Research
Certain aspects of the method chosen for this study deserve
refinement. Block thickness may be altered by designating smaller
specimen blocks. Perhaps a smaller block would reduce obscurity due
to block thickness and improve visibility. Care, however, must be
taken to quantify the actual size of the whole specimen and markers
drawn on the specimen denoting the points of intended cut. It is
recommended that documentation occur as a result of actual measurement
and a photographic record made establishing the size of the whole
specimen prior to brain-knife cut. Slides should also be used to
demonstrate the areas on the specimen targeted for brain-knife cut and
lastly a photographic record should depict the specimen after the
block cuts have been established. This will display the actual
placement of the cut and assist in determination of what structures
are on the fresh surface of the cut. Another aspect of refinement
concerns the block surface. Alterations in the block surface perhaps
can be controlled for by careful monitoring of staining and clearing
procedures to insure consistency. It is also recommended that two
different types of trials be conducted, a stain absorption time trial
and then a clearing agent trial to better establish the optimal
conditions for staining and clearing to avoid any irregularities in
the block surface and the resulting stain. Lastly, it is also
recommended that two photographic half inch measurement grids be in

78
each photographic slide. The suggested placement is one on each side
of the block. This will obviate any irregularities in camera angle
and insure an accurate scale of measure. Apart from suggestions
concerning improvements in the methodology utilized in the current
study, other research implications include the application of the
methodology indicated in additional investigations. One possible
study concerns the usage of the celloidin embedded block technique in
cases of laryngeal carcinoma. A far more descriptive study would
involve determination of the subject's vocal frequency prior to and
during a given disease state. Subsequent modeling attempts could best
be attempted by an engineer concerned with tissue thickness,
elasticity, mass differential and curve fitting to describe the
properties of the mass and therefore possible implications concerning
vibratory function.
In summary, the block embedding method and photography of the
exposed surface of the specimen, as opposed to the traditional
histological slice technique, was demonstrated to be a viable method
for laryngeal investigation. Though this method was not absolved of
all problems, there existed certain advantages in assessment of
structures in an intact specimen block. Soft tissue structures of
interest and cartilage maintained their proper relationships to one
another, while the course and configurational transitions were
revealed through serial sectioning. It was possible to consider
intrinsic musculature separately or as a group. The block was not
subject to tearing although certain stresses were undoubtedly
introduced onto the surface of the block from the microtome blade

79
during dissection. Secondly, a generated normative data base was
established regarding laryngeal intrinsic musculature in adult
disease-free male specimens. This was a small sample size and data
were to be viewed with an awareness of that limitation. Lastly, an
empirically derived shrinkage estimate was established in an attempt
to assess laryngeal tissue shrinkage as a result of chemical
processing. Thereby, a closer approximation of actual in vivo values
was possible. Essentially, the celloidin embedding method made
possible the preparation of specimens in order that said data were
extracted. This in turn was combined with the shrinkage factor which
in turn facilitated an approach to elucidate structural dimensions in
the living.

APPENDIX A
STRUCTURES OF INTEREST
1. Posterior Cricoarytenoid Muscle
2. Lateral Cricoarytenoid Muscle
3. Interarytenoids
a. Transverse Arytenoid Muscle
b. Oblique Arytenoid Muscle
4. Cricothyroid Muscle
a. Pars Oblique
b. Pars Recta
5. Thyroarytenoid Muscle
a. Thyromuscularis
b. Thyrovocalis
6. Conus Elasticus
a. Cricothyroid Ligament
b. Cricothyroid Membrane
7. Quadrangular Membrane
8. Cricoarytenoid Ligaments
a. Anterior Cricoarytenoid Ligament
b. Posterior Cricoarytenoid Ligament
*9. Surface width of TVF
* In the sagittal plane of dissection, this structure is referred to as
"height of the TVF."
80

81
10. Thyroid Cartilage
a. Distance between superior apexes
b. Distance between inferior prominences
c. Height
11. Vibratory Mass Measures
a. Height from Cricoid cartilage to TVF
b. Phonatory position (glottal width/2)
c. Medial aspect of Thyroarytenoid muscle to Thyroid cartilage
d. Area

APPENDIX B
APPARENT SIZE OF STRUCTURES ARRANGED BY SLIDE

Table B-l. Apparent Size of Structures/Specimen 1/Sagittal Plane/Left
Block
SI ide #
Structure
Area
(Sq. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior'
Posterio
(Inch)
75-F1-5L
Interarytenoideus Muscle
.0707
1.1431
.3068
.2682
75-F1-9L
Posterior Cricoarytenoid
Muscle
.0332
1.0662
.3837
.0565
Interarytenoideus Muscle
.0684
1.2454
.2647
.2664
75-F1-13L
Posterior Cricoarytenoid
Muscle
.0718
1.2962
.4913
.0689
Interarytenoideus Muscle
.0645
1.1818
.3184
.1771
Thyroarytenoid Muscle
.0461
.8798
.3342
.1285
Posterior Cricoarytenoid
Li gainent
.2190
75-F1-18L
Posterior Cricoarytenoid
Muscle
.0711
1.5063
.6244
.1040
Interarytenoideus Muscle
.0560
1.1498
.4497
.0619
Thyroarytenoid Muscle
.1093
1.2671
.2326
.4155
Posterior Cricoarytenoid
Ligament
.2091
75-F2-5L
Posterior Cricoarytenoid
Muscle
.0710
1.3485
.5375
.1034
Interarytenoideus Muscle
.0127
.5903
.1846
.0216
Thyroarytenoid Muscle
.3625
2.6739
.2630
1.0387
Posterior Cricoarytenoid
Ligament
.0629
75-F2-9L
Posterior Cricoarytenoid
Muscle
.0753
1.4958
.6256
.1011
Thyroarytenoid Muscle
.5553
2.9600
.5425
1.1944
83

84
Table B-l--continued.
Slide ft
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
75-F2-9L
(cont.)
Posterior Cricoarytenoid
Ligament
.1099
75-F2-14L
Posterior Cricoarytenoid
Muscle
.0626
1.5335
.6680
.1079
Lateral Cricoarytenoid
Muscle
.0497
1.1466
.2128
.3146
Cricothyroid Muscle
.3260
2.6021
.3953
1.0607
Thyroarytenoid Muscle
.3379
2.3723
.7633
.4423
Conus Elasticus --
Cricothyroid Ligament
.3567
75-F3-1L
Posterior Cricoarytenoid
Muscle
.0464
.9284
.3931
.1044
Cricothyroid Muscle
.2912
2.4133
.6381
.4925
Thyroarytenoid Muscle
.0723
1.2612
.2320
.4319
75-F3-5L
Thyroarytenoid Muscle
.2114
2.0595
.3273
.7110
75-F3-10L
Thyroarytenoid Muscle
.1304
1.9755
.1641
.6557
75-F3-14L
Thyroarytenoid Muscle
.2928
2.6509
.4667
.7022

85
Table B-2. Apparent Size of Structures/Specimen 1/Sagittal Plane/Right
Block
SIide #
Structure (Sq
Area
.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
75-F1-7R
Thyroarytenoid Muscle
.1318
2.0219
.2949
.6773
75-F1-10R
Posterior Cricoarytenoid
Muscle
.0468
.8388
.2694
.1151
Thyroarytenoid Muscle
.2292
2.4642
.3717
.9157
Thyroid Cartilage
1.0628
75-F1-14R
Posterior Cricoarytenoid
Muscle
.0528
.9230
.2926
.1077
Lateral Cricoarytenoid
Muscle
.0381
.8314
.2240
.0606
Thyroarytenoid Muscle
.2855
2.5105
.4953
.7123
Thyroid Cartilage
1.1093
75-F1-18R
Posterior Cricoarytenoid
Muscle
.0395
.8420
.2545
.1254
Lateral Cricoarytenoid
Muscle
.0087
.4817
.0866
.0932
Thyroarytenoid Muscle
.2517
2.5753
.3719
.7938
Anterior Cricoarytenoid
Ligament
.5944
Thyroid Cartilage
1.0378
75-F2-3R
Posterior Cricoarytenoid
Muscle
.0439
.8940
.3089
.1116
Lateral Cricoarytenoid
Muscle
.0368
1.0733
.2972
.2483
Thyroarytenoid Muscle
.2595
2.5892
.3084
.6724
Anterior Cricoarytenoid
Ligament
.6189

86
Table B-2--continued.
SIide #
Structure (Sq
Area
. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
75-F2-3R
(cont.)
Thyroid Cartilage
.9614
75-F2-9R
Posterior Cricoarytenoid
Muscle
.0489
.9773
.2760
.1361
Cricothyroid Muscle
.0511
1.2982
.5173
.0828
Thyroarytenoid Muscle
.2747
1.999
.4168
.5179
Anterior Cricoarytenoid
Ligament
.3941
Thyroid Cartilage
.9306
75-F2-13R
Posterior Cricoarytenoid
Muscle
.0211
.6673
.1951
.0819
Cricothyroid Muscle
.0745
1.2826
.4429
.1122
Thyroarytenoid Muscle
.3309
2.2542
.6543
.4656
Thyroid Cartilage
1.0544
75-F2-18R
Interarytenoideus Muscle
.0346
1.0269
.4081
.0629
Posterior Cricoarytenoid
Muscle
.0859
1.8817
.7122
.1023
Cricothyroid Muscle
.0531
1.0358
.3938
.1174
Thyroarytenoid Muscle
.0741
1.4425
.1536
.4873
Anterior Cricoarytenoid
Ligament
.7455
Thyroid Cartilage
.7618
75-F3-6R
Posterior Cricoarytenoid
Muscle
.0749
1.4190
.6045
.1129
Interarytenoideus Muscle
.0324
.9207
.3433
.0300

87
Table B-2--continued.
SI ide #
Structure (Sq
Area
. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
75-F3-6R
(cont.)
Cricothyroid Muscle
.0671
1.0945
.3199
.1495
Thyroarytenoid Muscle
.1499
1.7387
.1725
.6242
Anterior Cricoarytenoid
Ligament
.5145
Thyroid Cartilage
.9296
75-F3-9R
Posterior Cricoarytenoid
Muscle
.0972
1.6961
.6931
.1149
Interarytenoideus Muscle
.0258
1.1329
.4390
.0446
Thyroarytenoid Muscle
.0902
1.3978
.4474
.1639
Thyroid Cartilage
.9534
75-F3-13R
Posterior Cricoarytenoid
Muscle
.0672
1.2091
.4379
.1514
Interarytenoideus Muscle
.0725
1.2628
.4163
.1019
Cricothyroid Muscle
.0605
1.2089
.4756
.1551
Thyroarytenoid Muscle
.0747
1.1475
.2457
.3353
Anterior Cricoarytenoid
Ligament
.0733
Posterior Cricoarytenoid
Ligament
.0640
Thyroid Cartilage
.8256
75-F3-17R
Posterior Cricoarytenoid
Muscle
.0784
1.4652
.5421
.0909
Interarytenoideus Muscle
.0214
.6236
.1524
.0650
Cricothyroid Muscle
.0978
1.5023
.6228
.1260

88
Table B-2--continued.
Slide ft
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
75-F3-17R
(cont.)
Thyroarytenoid Muscle
.0626
.9493
.1423
.2108
Thyroid Cartilage
.8343
75-F4-3R
Thyroid Cartilage
.9030
75-F4-6R
Thyroid Cartilage
1.1037

89
Table B-3. Apparent Size of Structures/Specimen 2/Transverse
Piane/Superior Block
SI ide ft
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
48-FI-IS
Posterior Cricoarytenoid
Muscle
.0320L*
.0197R
1.0162L
.7225R
.102 5 L
0767R
.3930L
.2932R
Lateral Cricoarytenoid
Muscle
.0345R
1.5641R
6469R
.0444R
Interarytenoideus Muscle
.1064L
.0760R
1.8258L
1.6346R
.6315L
.65 67 R
. 1581L
. 1489R
48-F1-3S
Posterior Cricoarytenoid
Muscle
.0255 L
.0090R
.77 7 7 L
.4071R
.0713 L
.0544R
.2946L
.217 7 R
Lateral Cricoarytenoid
Muscle
.0330L
0402R
1.6164L
1.4805R
. 6423 L
.6240R
. 06 21L
.0344R
Thyroarytenoid Muscle
.0964L
.1040R
1.9906L
1.7785R
.8567L
. 6959R
.1750L
.1241R
48-F1-5S
Posterior Cricoarytenoid
Muscle
. 017 0 L
.0060R
.77 7 6 L
.4200R
.0524L
.0359R
- 3097 L
. 1717 R
Lateral Cricoarytenoid
Muscle
. 05 7 0 L
.0480R
1.4869L
1.5244R
.6105 L
.6732R
. 0855 L
.0499R
Thyroarytenoid Muscle
.2059L
.1520R
2.5773L
2.1371R
.3108L
.87 37 R
.2413 L
. 17 7 3 R
48-F1-7S
Posterior Cricoarytenoid
Muscle
0092L
.0020R
.6432L
.2769R
0139L
.0142R
.254 6 L
.1242R
Lateral Cricoarytenoid
Muscle
. 1457L
.0897R
2.2453L
1.7136R
1.0320L
.7249R
. 1370L
.1619R
Thyroarytenoid Muscle
.0906L
0682R
2.4542L
1.4426R
1.0513L
5567R
. 1072L
-1351R

90
Table B-3--continued.
SI ide #
Structure
Area
(Sq.Inch)
Peri -
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial-
Lateral
(Inch)
48-F1-9S
Posterior Cricoarytenoid
Muscle
.0075 L
. 5468L
.0211L
.2009L
Thyroarytenoid Muscle
.1448L
.1629R
2.1263L
1.9569R
8937L
. 7534R
.2528L
. 1991R
48-F1-11S
Interarytenoideus Muscle
.0641
1.5353
.1575
.5488
Thyroarytenoid Muscle
.2008L
.1700R
2.4097L
1.9276R
.8879L
.7193R
. 23 27 L
.1691R
Posterior Cricoarytenoid
Ligament
.0520
1.3507
.2008
.3505
48-F1-13S
Interarytenoideus Muscle
.1213
1.8233
.1381
.7961
Thyroarytenoid Muscle
.15 2 9L
.1054R
2.8661L
1.9985R
.77 6 2 L
.9418R
.25 2 7 L
. 1583R
48-F1-15S
Interarytenoideus Muscle
.0955
1.6081
.1082
.5586
Thyroarytenoid Muscle
. 1034 L
.0835R
2.1327L
1.8802R
. 8983 L
.7590R
.2468L
. 1946R
48-F2-1S
Interarytenoideus Muscle
.0873
1.6997
.0909
.7681
Thyroarytenoid Muscle
. 1179 L
.1266R
2.2061L
2.1804R
7507L
.8851R
. 1385L
. 1336R
48-F2-3S
Interarytenoideus Muscle
.0597
1.5798
.0721
.6667
Thyroarytenoid Muscle
0996L
.1087R
1.7850L
1.8041R
. 6382 L
.6907R
.1225 L
.1489R
48-F2-5S
Interarytenoideus Muscle
.0432
1.4788
.0930
.6529
Thyroarytenoid Muscle
. 1378L
.0802R
2.2892L
1.8075R
9084L
8836R
. 1250L
.0832R
48-F2-7S
Thyroarytenoid Muscle
. 1390L
. 1487R
2.1711L
2.1528R
.9096L
.825 7 R
.1854L
. 115 5 R

91
Table B-3--continued.
Slide #
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
48-F2-9S
Thyroarytenoid
Muscle
.0950L
.0719R
2.0835L
1.5469R
.7782L
. 6469R
.1755L
- 0931R
48-F2-11S
Thyroarytenoid
Muscle
.0518L
0812R
1.1320L
1.3308R
.4329L
.4815R
.1263L
.1596R
* L = left
, R = right; no
i letter =
neither L
nor R is
indicated

92
Table B-4. Apparent Size of Structures/Specimen 2/Transverse
Plane/Medial Block
Slide #
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial-
Lateral
(Inch)
48-FI-2M
Posterior Cricoarytenoid
Muscle
0466L*
.0279R
1.1083L
.8675R
. 1314 L
.0664R
.4178L
.3010R
Lateral Cricoarytenoid
Muscle
.0282L
.0124R
1.1542L
.7009R
.3064 L
.2680R
.0321L
.0485R
Thyroarytenoid Muscle
.0357L
1.1863L
.4688L
.0552L
48-F1-4M
Posterior Cricoarytenoid
Muscle
.0540 L
.0394R
1.3120L
1.1178R
.1415 L
.1263R
.6152 L
4763R
Lateral Cricoarytenoid
Muscle
.0316 L
.0418R
1.1355L
1.1833R
.57 90L
.3971R
.07 07 L
. 2564R
Cricothyroid Muscle
.0951L
.0557R
1.9443L
1.6339R
.7280L
.7107 R
.1401L
. 1087R
48-F1-6M
Posterior Cricoarytenoid
Muscle
.0481L
.0366R
1.1443L
1.0786R
.1418L
.1202R
. 5226L
.4 64 2 R
Lateral Cricoarytenoid
Muscle
.0317 L
.0320R
1.1873L
1.2678R
.5499L
4924R
.1168L
.1328R
Cricothyroid Muscle
.1165L
1.9706L
8813L
.1294L
48-F1-8M
Posterior Cricoarytenoid
Muscle
.02 7 7 L
.02 79R
.8981L
8293R
.0741L
.0580R
.36 91L
.3159R
Lateral Cricoarytenoid
Muscle
. 027 7 L
.0267R
.9813 L
1.1356R
.33 76 L
.4038R
.0784L
.0655R
Cricothyroid Muscle
.0744L
1.9001L
.7335L
.0680L

93
Table B-4--continued.
Slide It Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial-
Lateral
(Inch)
48-FI-1OM Posterior Cricoarytenoid
Muscle
- 0319L
.0204R
. 99 22 L
.7256R
- 0616 L
.0954R
.3884 L
.2921R
Lateral Cricoarytenoid
Muscle
. 0221L
.9665 L
.3392L
.067 3 L
Cricothyroid Muscle
.0945L
.0341R
2.3980L
1.8636R
.8588L
9708R
.0808L
. 0417 R
48-F1-12M Posterior Cricoarytenoid
Muscle
.0386L
.0309R
1.1756L
1.1624R
.1067L
.0361R
. 4907 L
.5470R
Lateral Cricoarytenoid
Muscle
0405L
1.1063L
. 3854 L
. 1163L
Cricothyroid Muscle
0758L
0499R
2.2403L
2.0943R
.9797L
. 915 OR
.0558L
0364R
48-F1-14M Posterior Cricoarytenoid
Muscle
. 02 92 L
. 02 97R
1 0321L
1.2766R
.1147 L
.0285R
. 4699L
.5856R
Lateral Cricoarytenoid
Muscle
.037 2 L
.97 68 L
.3903 L
. 145 4 L
Cricothyroid Muscle
.0876L
. 0216 R
2.3492L
1.2152R
1.1252L
.4292R
.0515L
.0174 R
48-F1-16M Posterior Cricoarytenoid
Muscle
.0224 L
.0191R
.95 35 L
1.1222R
.0817 L
.0274R
. 3226L
.5717R
Lateral Cricoarytenoid
Muscle
.0290L
8346L
- 3131L
. 1355L
Cricothyroid Muscle
.0599L
. 0181R
2.1333L
1.1947R
8408L
5432R
.0388L
. 0512 R
48-F1-18M Posterior Cricoarytenoid
Muscle
-0252L
.0195R
. 9875 L
1.0592R
.0413L
.0238R
.3616L
.3796R

94
Table B-4--continued.
SI ide #
Structure
Area
(Sq.Inch)
Peri -
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
48-F1-18M
(cont.)
Lateral Cricoarytenoid
Muscle
. 025 9 L
.7413 L
.1990L
. 1191L
Cricothyroid Muscle
.0534L
0382R
1.7257L
1.6771R
.6689L
.0993R
.0505L
.762 2 R
48-F2-2M
Posterior Cricoarytenoid
Muscle
.0241L
. 0121R
1.0599L
.9365R
0628L
.0161R
.3658 L
.3215R
Lateral Cricoarytenoid
Muscle
.0134 L
. 707 7 L
. 1642L
.0712 L
Cricothyroid Muscle
.0442L
.0368R
1.6849L
1.8994R
. 6191L
. 861 OR
.0633L
0744R
48-F2-4M
Posterior Cricoarytenoid
Muscle
.0198L
.0116R
.95 6 7 L
.7490R
.4076L
.3073R
.0616L
.0140R
Lateral Cricoarytenoid
Muscle
.0320L
1.0130L
.3191L
0938L
Cricothyroid Muscle
.0504L
.0654R
1.5878L
2.1769R
.5061L
.3238R
.0423L
.0685R
* L = left, R = right; no letter = neither L nor R is indicated

95
Table B-5. Apparent Size of Structures/Specimen 3/Coronal
Piane/Anterior Block
Slide If
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
46-F1-4A
Cricothyroid Muscle
.0908L*
1.5171L
.6043L
. 2764L
Thyroarytenoid Muscle
0646L
.0172R
1.2746L
.6164R
.4120L
.2143R
5223L
. 1261R
Conus Elasticus
.4542L
. 5153 R
Surface Width of TVF
.2002L
. 1925R
Thyroid Cartilage
-- Distance between
Superior Apexes
1.1285
-- Distance between
Inferior Prominences
1.2552
-- Height
1.2024L
1.2296R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
Phonatory Position
(glottal width/2)
.34 76L
.4152R
.0878
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
3186L
. 2229R
-- Area of Vibratory Mass
.1898L
.1388R
1.8356L
1.4779R
.4141L
.2924L
.3934R
.5136L
3926L
.2554R
46-F1-8A
Cricothyroid Muscle
.0794L
1.4152L
.5114L
. 1684L
Thyroarytenoid Muscle
.0984L
.0608R
1.2688L
1.1227R
.3064 L
.3632R
. 2287 L
. 1768R

96
Table B-5--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
46-F1-8A
) Conus Elasticus
.47 64 L
. 5 311R
Surface Width of TVF
. 1908L
. 1868R
Thyroid Cartilage
-- Distance between
Superior Apexes
1.0641
-- Distance between
Inferior Prominences
1.2651
-- Height
1.1018L
1.0777R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
.3 5 35 L
.421OR
-- Phonatory Position
(glottal width/2)
.0667
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
. 3201L
.2064R
-- Area of Vibratory Mass
. 16 51L
. 1384 R
1.5717L
1.4454R
.3560L
4099R
.3683 L
.2742R
11A Cricothyroid Muscle
.0328L
1.2800L
5131L
. 1669L
Thyroarytenoid Muscle
. 07 76 L
.0690R
1.1051L
1.0829R
. 3325L
.3823R
. 2914L
.1982R
Conus Elasticus
. 4 716 L
.55 91R
Surface Width of TVF .1489L
.1563R

97
Table B-5--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
46-FI-11A
(cont.) Thyroid Cartilage
-- Distance between
Superior Apexes
-- Distance between
Inferior Prominences
-- Height
Vibratory Mass Measures
-- Height from Cricoid
to TVF
-- Phonatory Position
(glottal width/2)
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
-- Area of Vibratory Mass
46-F1-14A Cricothyroid Muscle
Thyroarytenoid Muscle
Conus Elasticus
Surface Width of TVF
Thyroid Cartilage
-- Distance between
Superior Apexes
1.1126
1.2332
1.2295L
1.1238R
.2 961L
. 3691R
.0886
. 3009L
. 2470R
1185L
1.2637L
.3550L
.3378L
1360R
1.4678R
.3487 R
.264 9 R
0829L
1.4870L
.5604L
.1924L
0831L
1.2322L
.3168L
.2833 L
0537R
1.0832R
.3600R
.1873R
.4869L
.54 97 R
.1997L
.1908R
1.1497

98
Table B-5--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
46-F1-14A
(cont.) Thyroid Cartilage
-- Distance between
Inferior Prominences
-- Height
Vibratory Mass Measures
-- Height from Cricoid
to TVF
Phonatory Position
(glottal width/2)
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
-- Area of Vibratory Mass
46-F2-1A Lateral Cricoarytenoid
Mus cle
Cricothyroid Muscle
Thyroarytenoid Muscle
Conus Elasticus
Surface Width of TVF
Thyroid Cartilage
-- Distance between
Superior Apexes
1.3148
1.2341L
1.0196R
.3546L
.4081R
.0926
.2 94 7 L
.2206R
1518L
1534R
1.5276L
1.5675R
.4133L
. 5938R
.3516L
.24 91R
0057L
.30 71L
.0846L
.0736L
0412L
.9792L
.3256L
.1243L
0637L
0604R
1.0864L
1.1418R
.3312 L
.4266R
.2587 L
.2246R
.4 9 98 L
.5140R
.1731L
.1090R
1.0305

99
Table B-5--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
46-F2-1A
(cont.) Thyroid Cartilage
-- Distance between
Inferior Prominences
-- Height
Vibratory Mass Measures
-- Height from Cricoid
to TVF
-- Phonatory Position
(glottal width/2)
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
-- Area of Vibratory Mass
46-F2-6A Lateral Cricoarytenoid
Muscle
Cricothyroid Muscle
Thyroarytenoid Muscle
Conus Elasticus
Surface Width of TVF
Thyroid Cartilage
-- Distance between
Superior Apexes
1.1919
1.3601L
1.1250R
.4183L
.5035 R
.0893
.2722 L
.1851R
1402L
1553R
1.4657L
1.7744R
4280L
.6815 R
.3187L
. 2117R
0137L
. 4907 L
. 1605L
- 1544L
0219L
8010L
.3072L
.0976L
0633L
0449R
.9813L
1.2506R
.2964L
1.5469R
. 2549L
.1903R
.5855L
.5341R
.2057L
.2380R
.9390

100
Table B-5continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide $ Structure (Sq.Inch) (Inch) (Inch) (Inch)
46-F2-6A
(cont.) Thyroid Cartilage
-- Distance between
Inferior Prominences
-- Height
Vibratory Mass Measures
-- Height from Cricoid
to TVF
-- Phonatory Position
(glottal width/2)
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
-- Area of Vibratory Mass
46-F2-13A Lateral Cricoarytenoid
Muscle
Cricothyroid Muscle
Thyroarytenoid Muscle
Conus Elasticus
Thyroid Cartilage
-- Distance between
Superior Apexes
-- Distance between
Inferior Prominences
-- Height
1.1598
1.3680L
1.1036R
.4 220 L
.5214R
.0710
.2666L
.1685R
1506L
1063R
1.7656L
1.3258R
.4801L
.5412 R
. 3004L
. 2147R
0170L
.5369L
. 1573L
-1123L
0295L
.8304L
.3870L
.0931L
0462L
0343R
.9206 L
.7473R
. 3387 L
. 28 HR
.27 32 L
.1597R
.4976R
.7440
.8972
1.2130L
1.0039R

101
Table B-5--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
46-F2-13A
(cont.) Vibratory Mass Measures
-- Height from Cricoid
to TVF .5190L
.5857R
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.2372 L
.1584R
46-F2-18A Thyroarytenoid Muscle
.0567L
.0304R
.9853L .2903L
. 8816 R 354 5 R
.14761
.1389R
Conus Elasticus
.6277L
. 6235 R
Surface Width of TVF
.1885L
. 1923R
Thyroid Cartilage
-- Distance between
Superior Apexes
.5776
-- Distance between
Inferior Prominences
.6686
-- Height
1.2609L
1.0358R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
.6422L
.6880R
-- Phonatory Position
(glottal width/2)
.0127
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
. 1608L
.0670R

102
Table B-5--continued.
SIide #
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
46-F2-18A
(cont.)
Area of Vibratory Mass
-1048 L
.0768R
1.3948L
1.2301R
.47 OIL
4454R
.2195 L
. 1356R
46-F3-5A
Cricothyroid Muscle
.0288L
. 0154R
.6632L
. 52 28R
. 17 71L
.14 91R
. 1231L
.0742 R
Thyroarytenoid Muscle
(Thyromuscularis)
.0294L
.0179R
8176L
.654 6 R
. 2998L
2903R
. 0898L
. 051OR
Thyrovocalis Muscle
.3465L
. 2925 R
.1185 L
.0864R
Surface Width of TVF
.1683L
.191OR
Thyroid Cartilage
-- Distance between
Superior Apexes
.4799
-- Distance between
Inferior Prominences
.4602
-- Height
1.1228L
9953R
Vibratory Mass Measures
Height from Cricoid
to TVF
. 6247L
. 7314R
Phonatory Position
(glottal width/2)
.0140
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
0769L
.0628R
-- Area of Vibratory Mass
.0502L
. 0633R
.9391L
. 12287R
3079L
.3050R
. 1294L
. 1161R

103
Table B-5--continued.
Slide If
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
46-F3-9A
Cricothyroid Muscle
.0248L
.0104 R
.5790L
.45 95 R
.1228L
. 116 9 R
.1313L
. 0663R
Thyroarytenoid Muscle
.0184L
.0205R
. 6306L
. 7587 R
.2201L
.27 54 R
.0440L
. 1577R
Surface Width of TVF
. 1431L
. 1760R
Thyroid Cartilage
-- Distance between
Superior Apexes
.4235
-- Distance between
Inferior Prominences
.3998
-- Height
1.0588L
. 9675 R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
.6906L
.7 041R
-- Phonatory Position
(glottal width/2)
.0006
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.0440L
. 1577R
-- Area of Vibratory Mass
.0458L
.0383R
.9668L
- 9387 R
.2947L
3000R
.1682L
.157 7 R
46-F3-14A Thyroid Cartilage
-- Distance between
Superior Apexes
.4123
-- Distance between
Inferior Prominences
.3175

104
Table B-5--continued.
SIide #
Area
Structure (Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial-
Lateral
(Inch)
46-F3-14A
(cont.)
Thyroid Cartilage
-- Height
1.0165L
.9474R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
-- Phonatory Position
(glottal width/2)
. 1656L
. 1488R
.0060
46-F4-2A
Thyroid Cartilage
-- Distance between
Superior Apexes
.3962
-- Distance between
Inferior Prominences
.1519
-- Height
.9398L
. 9642R
46-F4-7A
Thyroid Cartilage
-- Distance between
Superior Apexes
.3595
-- Distance between
Inferior Prominences
.2040
-- Height
.7190L
- 6855 R
46-F4-12A Thyroid Cartilage
-- Distance between
Superior Apexes
.3856
-- Distance between
Inferior Prominences
.1908
-- Height
.7071L
. 7077R
* L = left, R = right; no letter = neither L nor R is indicated.

105
Table B-6. Apparent Size of Structures/Specimen 3/Coronal
Plane/Posterior Block
Slide §
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
46-F1-3P
Cricothyroid Muscle
.0458L*
. 04 91R
.9319L
1.0776R
.3385L
.3490R
.0982L
. 1036R
Thyroarytenoid Muscle
-1157L
. 1004R
1.3751L
1.3007R
.3095L
.42 5 7 R
. 3482 L
.2123 R
Conus Elasticus
. 4653L
. 3877 R
Surface Width of TVF
.0890R
Thyroid Cartilage
-- Distance between
Superior Apexes
1.6395
-- Distance between
Inferior Prominences
1.5893
-- Height
1.5106L
1.3498R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
.3419R
-- Phonatory Position
(glottal width/2)
.0609
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
. 5178L
.3509R
-- Area of Vibratory Mass
.1409R
1.6238R
.3616R
. 3195R
46-FI-9 P
Cricothyroid Muscle
.03 7 9 L
.0545R
.8679L
1.2233R
. 35 92L
.5716R
-1145 L
.1491R
Thyroarytenoid Muscle
.0614
0854R
1.1498
1.2700R
.2413
.251 OR
.2704
2872R
Conus Elasticus
.3438R

106
Table B-6--continued.
SIide #
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
46-F1-9P
(cont.)
Thyroid Cartilage
-- Distance between
Superior Apexes
1.7539
-- Distance between
Inferior Prominences
1.6197
-- Height
.7042L
1.5368R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
.2797R
-- Phonatory Position
(glottal width/2)
.0713
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.4674L
. 3478R
-- Area of Vibratory Mass
.1868R
1.6161R
.4423R
.3801R
46-FI-14 P
Posterior Cricoarytenoid
Muse!e
.02 06 L
. 6157 L
. 1877L
. 1700L
Lateral Cricoarytenoid
Muscle
.0280L
.0420R
. 7091L
.8419R
.3240L
.2482R
. 1757L
.2527R
Cricothyroid Muscle
.0493L
.0874R
1.2822L
1.4708R
4014L
. 6906 R
.2366L
. 2346 R
Thyroarytenoid Muscle
.0800L
.14 2 5 R
1.3600L
1.6227R
.2111L
. 4342 R
. 3331L
. 3659R
Conus Elasticus .3137R
Thyroid Cartilage
Distance between
Superior Apexes 1.7439

107
Table B-6--continued.
Slide H
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
46-F1-14P
(cont.)
Thyroid Cartilage
-- Distance between
Inferior Prominences
1.5995
-- Height
1.2618L
1.5103R
Vibratory Mass Measures
-- Phonatory Position
(glottal width/2)
.0837
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.4193L
.3631R
-- Area of Vibratory Mass
. 1337R
1.4625R
.3399R
.3958R
46-F2-1P
Posterior Cricoarytenoid
Muscle
0224L
. 6647 L
. 27 76 L
. 1189L
Lateral Cricoarytenoid
Muscle
. 0597 R
1.0220R
.2618R
.32 96 R
Cricothyroid Muscle
.0645R
1.3436R
.5986R
.1585R
Thyroarytenoid Muscle
. 2169R
1.8345R
. 5997 R
5212R
Conus Elasticus
.2040R
Thyroid Cartilage
-- Distance between
Superior Apexes 1.5532
Distance between
Inferior Prominences 1.2922
Height
1.3136L
.8739R

108
Table B-6--continued.
Slide #
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
46-F2-IP
(cont.)
Vibratory Mass Measures
-- Phonatory Position
(glottal width/2)
.0794
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
. 1055L
- 297 OR
-- Area of Vibratory Mass
.1728R
1.6224R
.4211R
. 3592R
46-F2-6P
Posterior Cricoarytenoid
Muscle
. 0114L
. 4692 L
. 1849L
. 0731L
Lateral Cricoarytenoid
Muscle
.0211R
7150R
. 1880R
. 1836R
Cricothyroid Muscle
.0600R
1.3137R
.5853R
.2284R
Thyroarytenoid Muscle
.061OR
1.1619R
.2981R
2892R
Conus Elasticus
.2064R

Thyroid Cartilage
-- Distance between
Superior Apexes
1.5327
-- Distance between
Inferior Prominences
1.2827
-- Height
1.3113L
1.0926R
Vibratory Mass Measures
-- Phonatory Position
(glottal width/2)
.0853
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.3660R
-- Area of Vibratory Mass
.2076R
1.9591R
.4165R
4196R

109
Table B-6--contiruied.
Slide #
Structure
Area
(Sq. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial-
Lateral
(Inch)
46-F2-11P
Posterior Cricoarytenoid
Muscle
.02 7 6 L
.9311L
.4446L
.0999L
Lateral Cricoarytenoid
Muscle
.02 32 R
.73 93 R
.2003R
. 1538R
Cricothyroid Muscle
.057 3R
1.1898R
.5385R
.2024R
Thyroarytenoid Muscle
. 0581R
1.46 5 7 R
2459R
. 3140R
Conus Elasticus
.1763R
Thyroid Cartilage
Distance between
Superior Apexes
1.5598
-- Distance between
Inferior Prominences
1.2531
-- Height
1.2664L
1.0713R
Vibratory Mass Measures
-- Phonatory Position
(glottal width/2)
.0652
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
. 3582 R
-- Area of Vibratory Mass
.1850R
1.8736R
.3316R
.3887 R
46-F2-16P
Posterior Cricoarytenoid
Muscle
. 0465 L
1.1882L
. 5848L
.0968L
Lateral Cricoarytenoid
Muscle
0208R
.5632R
. 1742R
.1839R
Interarytenoideus Muscle
.0776
1.7639
.3120
.2592
Cricothyroid Muscle
.06 3 7 R
1.3206R
.6024R
.2009R
Thyroarytenoid Muscle
.0414R
.8371R
.2948R
.2300R

no
Table B-6--continued.
Peri- Inferior- Medial -
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
46-F2-16P
(cont.) Thyroid Cartilage
-- Distance between
Superior Apexes 1.7542
-- Distance between
Inferior Prominences 1.2983
45-F3-4P
-- Height
1.3072L
1.1630R
Vibratory Mass Measures
-- Phonatory Position
(glottal width/2)
.0977
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.3331R
-- Area of Vibratory Mass
. 1292R
1.7040R
.3720R
.3411R
Posterior Cricoarytenoid
Muscle
.06 2 7 L
.0208R
1.5894L
.6511R
.8020L
.2971R
. 1249L
.0980R
Interarytenoideus Muscle
.1340
1.7089
.3489
.6986
Cricothyroid Muscle
.05 27 R
1.2340R
.56 02 R
1599R
Thyroid Cartilage
-- Distance between
Superior Apexes
1.8488
-- Distance between
Inferior Prominences
1.2735
-- Height
.8954L
1.0996R
Vibratory Mass Measures
-- Phonatory Position
(glottal width/2) .0900

Ill
Table B-6--continued.
Slide #
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
46-F3-9P
Posterior Cricoarytenoid
Muscle
.0805 L
.0190R
1.9273L
.5728R
. 915 7 L
. 2407R
.1144 L
.1043R
Interarytenoideus Muscle
.1096
1.6641
.2559
.6781
Cricothyroid Muscle
.02 74 R
1.0486R
. 37 74 R
. 1290R
Thyroid Cartilage
-- Distance between
Superior Apexes
1.8120
-- Distance between
Inferior Prominences
1.3809
-- Height
.6944L
1.1018R
Vibratory Mass Measures
-- Phonatory Position
(glottal width/2)
.0814
46-F3-14P
Posterior Cricoarytenoid
Muscle
. 0754L
.0069R
1.8037L
.5042R
. 8635 L
.2408R
.1321L
.0452R
Interarytenoideus Muscle
.1031
1.4920
.3221
.5809
Cricothyroid Muscle
.02 2 6 R
1.1492R
. 17 3 7 R
. 1301R
Thyroid Cartilage
-- Distance between
Superior Apexes
1.7285
-- Height
1.1483R
46-F4-6P
Posterior Cricoarytenoid
Muscle
.0431L
.0300R
1.4604L
1.0539R
.65 23 L
. 4636R
. 0993 L
.0656R

112
Table B-6--continued.
SI ide #
Area
Structure (Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
46-F4-6P
(cont.)
Interarytenoideus Muscle .0719
1.7179
.1880
.7449
Thyroid Cartilage
-- Height
1.2995R
46-F4-IIP
Thyroid Cartilage
-- Height
1.1614R
* L = left, R = right; no letter = neither L nor R is indicated.

113
Table B-7. Apparent Size of Structures/Specimen 4/Sagittal Plane/Left
Block
SIide #
Structure
Area
(Sq. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
68-F1-7L
Interarytenoideus Muscle
.0495
.8900
.2848
.1033
68-F2-1L
Interarytenoideus Muscle
.0428
.8404
.2947
.8329
68-F2-3L
Interarytenoideus Muscle
.0459
.9125
.3169
.1038
68-F2-6L
Interarytenoideus Muscle
.0581
.9788
.2992
.1193
68-F2-7L
Interarytenoideus Muscle
.1773
1.7639
.5951
.2457
Anterior Cricothyroid
Ligament
.7165
68-F3-2L
Posterior Cricoarytenoid
Muscle
.4321
4.353
1.9810
.2372
Interarytenoideus Muscle
.1630
1.7196
.6144
.2793
Thyroarytenoid Muscle
.2357
2.0103
.2410
.7152
Thyroid Cartilage
1.8108
68-F3-4L
Posterior Cricoarytenoid
Muscle
.1318
2.9374
1.4187
.0866
Interarytenoideus Muscle
.1793
1.9606
.5772
.2059
Thyroarytenoid Muscle
.6754
4.5848
.3556
1.3031
Posterior Cricoarytenoid
Ligament
.4594
Thyroid Cartilage
2.3446
68-F3-7L
Posterior Cricoarytenoid
Muscle
.0578
1.7806
.7988
.0780
Interarytenoideus Muscle
.0517
1.0700
.3136
.1055
Thyroarytenoid Muscle
.1712
2.4115
.1829
.6706
Posterior Cricoarytenoid
Ligament
.3945

114
Table B-7continued.
SI ide ft
Structure
Area
(Sq. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
68-F3-7L
(cont.)
Thyroid Cartilage
1.0239
68-F3-9L
Posterior Cricoarytenoid
Muscle
.0657
1.7648
.8414
.0916
Interarytenoideus Muscle
.0610
1.2134
.4784
.1085
Thyroarytenoid Muscle
.1721
2.0446
.6399
.2792
Posterior Cricoarytenoid
Ligament
.3785
Thyroid Cartilage
1.2068
68-F4-3L
Posterior Cricoarytenoid
Muscle
.0932
1.6160
.6677
.1424
Interarytenoideus Muscle
.0166
.7302
.3086
.0420
Thyroarytenoid Muscle
.0359
.9992
.0810
.4415
Thyroid Cartilage
.9510
68-F4-5L
Posterior Cricoarytenoid
Muscle
.0959
1.6117
.7362
.1255
Interarytenoideus Muscle
.0221
.7896
.3417
.0462
Thyroarytenoid Muscle
.0558
1.4561
.6850
.0907
Thyroid Cartilage
.9909
68-F4-8L
Posterior Cricoarytenoid
Muscle
.0880
1.8637
.7293
.1305
Interarytenoideus Muscle
.0102
.6754
.0152
.2687
Thyroarytenoid Muscle
.0514
1.1416
.1184
.4433
Thyroid Cartilage
.9218

115
Table B-7--continued.
Slide ff
Structure
Area
(Sq. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
68-F5-1L
Posterior Cricoarytenoid
Muscle
.0468
1.0279
.4040
.1050
Lateral Cricoarytenoid
Muscle
.0123
.5366
.0906
.1869
Cricothyroid Muscle
.0690
1.3063
.3597
.0953
Thyroarytenoid Muscle
.0846
1.3717
.1658
.4468
Thyroid Cartilage
.8860
68-F5-2L
Posterior Cricoarytenoid
Muscle
.0212
.6847
.2662
.0521
*
Lateral Cricoarytenoid
Muscle
.0087
.4292
.0394
.1271
Cricothyroid Muscle
.0370
1.5676
.6593
.1272
Thyroarytenoid Muscle
.0436
.8598
.1377
.3597
Thyroid Cartilage
.9072
58-F5-5L
Cricothyroid Muscle
.1881
1.6636
.4965
.5172
Thyroid Cartilage
.7418
68-F5-7L
Cricothyroid Muscle
.1656
1.5977
.3919
.3931
Thyroid Cartilage
1.1713
68-F5-9L
Cricothyroid Muscle
.1779
1.7146
.3168
.5183
Thyroid Cartilage
1.1249

116
Table B-8. Apparent Size of Structures/Specimen 4/Sagittal Plane/Right
Block
Slide If
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
68-F6-1R
Posterior Cricoarytenoid
Muscle
.0285
.7277
.2650
.0831
Thyroarytenoid Muscle
.1149
1.4336
.1771
.5012
Height of TVF
.4631
Thyroid Cartilage
.8610
68-F6-3R
Thyroarytenoid Muscle
.1291
1.6192
.2558
.6081
Height of TVF
.3803
)
68-F7-1R
Thyroid Cartilage
.9480
Thyroarytenoid Muscle
.0942
1.4417
.1571
.5287
Height of TVF
-
.5032
Thyroid Cartilage
1.0284
68-F7-4R
Cricothyroid Muscle
.0289
.8556
.3545
.0675
Thyroarytenoid Muscle
.0374
1.5047
.2434
.4779
Height of TVF
.4478
Thyroid Cartilage
.8895
68-F7-7R
Posterior Cricoarytenoid
Muscle
.0277
.6718
.2507
.0696
Cricothyroid Muscle
.0698
1.6629
.8011
.1493
Thyroarytenoid Muscle
.0487
.8649
.2137
.2536
Thyroid Cartilage
.9436
68-F8-1R
Posterior Cricoarytenoid
Muscle
.0642
1.2864
.4503
.0932
Lateral Cricoarytenoid
Muscle
.0940
1.1921
.3628
.2443

117
Table B-8--continued.
SIide #
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
68-F8-1R
(cont.)
Interarytenoideus Muscle
.0425
1.1795
.5188
.0984
Cricothyroid Muscle
.0779
1.5064
.6775
.3314
Thyroarytenoid Muscle
.0460
.8098
.1858
.1665
Thyroid Cartilage
.9631
68-F8-4R
Posterior Cricoarytenoid
Muscle
.0717
1.2321
.4847
.1335
1
Lateral Cricoarytenoid
Muscle
.0295
.8147
.1923
.1437
Interarytenoideus Muscle
.0624
1.4129
.7587
.0870
Cricothyroid Muscle
.1831
1.8536
.3061
.5543
Thyroid Cartilage
.9244
68-F8-7R
Cricothyroid Muscle
.1221
1.3845
.4053
.2317
Thyroid Cartilage
.9961
68-F8-10R
Cricothyroid Muscle
.1241
1.3515
.4710
.2860
68-F8-13R
Cricothyroid Muscle
.1901
1.8359
.5042
.4823

118
Table B-9. Apparent Size of Structures/Specimen 5/Transverse Plane/Left
Medial Block
Slide #
Structure (Sq
Area
. Inch)
Peri
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
62-F2-1M
Posterior Cricoarytenoid
Muscle
.0058
.4541
.0141
.1405
62-F2-3M
Posterior Cricoarytenoid
Muscle
.0096
.5274
.0276
.2162
62-F2-5M
Posterior Cricoarytenoid
Hus cle
.0160
.6688
.0451
.2666
Lateral Cricoarytenoid
Muscle
.0143
.6651
.1827
.0320
62-F2-7M
>
Posterior Cricoarytenoid
Muscle
.0225
.7393
.0493
.2608
Lateral Cricoarytenoid
Muscle
.0084
.5535
.1622
.0226
62-F2-9M
Posterior Cricoarytenoid
Muscle
.0227
.7190
.0748
.2652
Lateral Cricoarytenoid
Muscle
.0062
.4439
.1112
.0155
62-F2-11M
Posterior Cricoarytenoid
Muscle
.0397
.9535
.0956
.3781
Lateral Cricoarytenoid
Muscle
.0136
.6975
.1886
.0133
62-F2-13M
Posterior Cricoarytenoid
Muscle
.0420
.9842
.0686
.3898
Lateral Cricoarytenoid
Muscle
.0144
1.1044
.4619
.0290
62-F2-15M
Posterior Cricoarytenoid
Muscle
.0341
.8048
.0717
.2475
Lateral Cricoarytenoid
Muscle
.0150
.9551
.3989
.0137

119
Table B-9--continued.
SI ide ff
Structure (Sq
Area
. Inch)
Peri -
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
62-F2-17M
Posterior Cricoarytenoid
Muscle
.0433
.9551
.0745
.3749
Lateral Cricoarytenoid
Muscle
.0244
.8588
.3100
.0411
62-F3-2M
Interarytenoideus Muscle
.0932
1.2657
.2003
.4230
Lateral Cricoarytenoid
Muscle
.0150
.8103
.3901
.0380
Posterior Cricoarytenoid
Muscle
.0446
1.0855
.0854
.3811
Thyroarytenoid Muscle
.0157
.5862
.0790
.1386
62-F3-5M
Interarytenoideus Muscle
.0607
1.1562
.0820
.4177
Lateral Cricoarytenoid
Muscle
.0163
.8377
.2537
.0269
Thyroarytenoid Muscle
.0160
.5640
.1166
.1348
62-F3-8M
Posterior Cricoarytenoid
Muscle
.0760
1.2209
.2011
.3641
Interarytenoideus Muscle
.0305
.8941
.0605
.3622
Cricothyroid Muscle
.0760
1.2209
.2076
.5351
Thyroarytenoid Muscle
.0478
.8976
.2535
.2468
62-F3-11M
Posterior Cricoarytenoid
Muscle
.1009
1.2970
.2449
.4290
Cricothyroid Muscle
.0361
1.1687
.4584
.0980
Thyroarytenoid Muscle
.0489
.8583
.2020
.2186
62-F3-15M
Posterior Cricoarytenoid
Muscle
.0894
1.2260
.1889
.4069
Cricothyroid Muscle
.0308
1.0243
.3922
.0287

120
Table B-9--continued.
SI ide #
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
62-F3-15M
(cont.)
Thyroarytenoid
Muscle
.0557
1.0647
.2301
.1138
62-F3-18M
Cricothyroid Muscle
.0110
.7686
.3361
.0233
Thyroarytenoid
Muscle
.0922
1.7482
.6422
.2916
62-F4-3M
Thyroarytenoid
Muscle
.0827
1.4783
.6461
.2065

121
Table B-10. Apparent Size of Structures/Specimen 5/Transverse
Plane/Right Medial Block
Slide #
Structure (Sq
Area
. Inch)
Peri
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
62-F2-10M
Posterior Cricoarytenoid
Muscle
.0145
.7847
.0591
.3591
Interarytenoideus Muscle
.0585
1.0400
.2115
.3359
62-F2-14M
Posterior Cricoarytenoid
Muscle
.0397
1.2562
.0749
.5051
Interarytenoideus Muscle
.0827
1.2952
.1416
.4848
62-F2-18M
Posterior Cricoarytenoid
Muscle
.0399
1.1909
.0813
.5852
Lateral Cricoarytenoid
Muscle
.0246
.7528
.3042
.0648
Interarytenoideus Muscle
.0816
1.3716
.5896
.2332
62-F3-4M
Posterior Cricoarytenoid
Muscle
.0537
1.2480
.0673
.5628
Lateral Cricoarytenoid
Muscle
.0321
1.0137
.4225
.0598
Interarytenoideus Muscle
.0854
1.3716
.2248
.5448
Thyroarytenoid Muscle
.0618
1.0381
.4014
.1302
62-F3-8M
Posterior Cricoarytenoid
Muscle
.0512
1.2649
.0724
.6040
Lateral Cricoarytenoid
Muscle
.0316
1.0164
.4298
.0643
Interarytenoideus Muscle
.0952
1.3919
.2488
.5082
Thyroarytenoid Muscle
.0904
1.2385
.3856
.2549
62-F3-12M
Posterior Cricoarytenoid
Muscle
.0519
1.2667
.0540
.6394
Lateral Cricoarytenoid
Muscle
.0092
.5452
.2434
.0343

122
Table B-10--continued.
SI ide ft
Structure (Sq
Area
. Inch)
Peri -
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
62-F3-12M
(cont.)
Interarytenoideus Muscle
.0900
1.2977
.1981
.5041
Thyroarytenoid Muscle
.0666
1.0906
.3607
.1465
62-F3-16M
Posterior Cricoarytenoid
Muscle
.0512
1.1885
.0960
.5795
Interarytenoideus Muscle
.0943
1.3961
.2515
.5366
Thyroarytenoid Muscle
.1198
1.7964
.6236
.2418
62-F4-2M
Posterior Cricoarytenoid
Muscle
.0458
1.1529
.0688
.4735
Thyroarytenoid Muscle
.0557
1.1424
.3796
.1388
62-F4-6M
Posterior Cricoarytenoid
Muscle
.0480
1.5524
.7461
.0453
Thyroarytenoid Muscle
.1440
1.8049
.7477
.1486
62-F4-10M
Posterior Cricoarytenoid
Muscle
.0279
1.0450
.0308
.4792
Thyroarytenoid Muscle
.1483
1.9740
.8886
.1927

123
Table B-ll. Apparent Size of Structures/Specimen 6/Coronal
Piane/Anterior Block
SIide #
Structure (Sq
Area
. Inch)
Peri- Inferior-
meter Superior
(Inch) (Inch)
Medial -
Lateral
(Inch)
69-F1-3A
Cricothyroid Muscle
.0423L
.0257R'
1.0559L
. 7850R
. 4241L
. 2821R
.1644L
.17 88 R
Conus Elasticus
4850L
.4 95 0 R
Surface Width of TVF
.0886L
.1360R
Thyroid Cartilage
-- Distance between
Superior Apexes
.8727
-- Distance between
Inferior Prominences
.9503
-- Height
1.0979L
1.0200R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
.45 31L
.3224R
-- Phonatory Position
(glottal width/2)
.0491
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
. 2636L
.2 7 22 R
-- Area of Vibratory Mass
. 1505L
. 1349R
1.6719L
1.7276R
.5861L
. 5781R
.2778L
. 27 57 R
69-F1-6A
Cricothyroid Muscle
.0361L
0375R
.8898L
8846R
.3675L
3619R
.1518L
. 17 7 3 R
Thyroarytenoid Muscle
.0970L
. 0616R
1.4748L
1.2871R
.6581L
.5517 R
. 2606L
.2035 R
Conus Elasticus
4298L
.4656R

124
Table B-ll--continued.
SI ide #
Structure (Sq
Area
.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial-
Lateral
(Inch)
69-F1-6A
(cont.)
Surface Width of TVF
.0856L
.1039R
Thyroid Cartilage
-- Distance between
Superior Apexes
.9350
Distance between
Inferior Prominences
.7585
-- Height
.9975L
1.0020R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
.4000L
. 321OR
Phonatory Position
(glottal width/2)
.0435
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.24 05 L
.2411R
-- Area of Vibratory Mass
.1467L
.1280R
1.7024L
1.6996R
.7069L
6406R
.2443L
.2622 R
69-F1-9A
Cricothyroid Muscle
.0407L
.0188R
.9085L
.5578R
.3779L
.2314R
.1390L
.104 6 R
Thyroarytenoid Muscle
.0884L
.05 78 R
1.3891L
1.0025R
-6411L
.35 95 R
.2156L
. 1749R
Conus Elasticus
.5050R
Surface Width of TVF
. 1027L
.1045R

125
Table B-ll--contiruied.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
69-F1-9A
(cont.) Thyroid Cartilage
-- Distance between
Superior Apexes
-- Distance between
Inferior Prominences
-- Height
Vibratory Mass Measures
-- Height from Cricoid
to TVF
-- Phonatory Position
(glottal width/2)
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
-- Area of Vibratory Mass
69-FI-11A Cricothyroid Muscle
Thyroarytenoid Muscle
Surface Width of TVF
Thyroid Cartilage
-- Distance between
Superior Apexes
-- Distance between
Inferior Prominences
.8642
.6616
.9866L
1.0183 R
. 5661L
.4 996 R
.0496
. 1752L
. 1858R
1068L
1.4632L
.5427L
.2 247 L
1304R
1.5296R
. 5089R
.2268 R
0413L
.862 9L
.277 9L
.1984L
0386R
. 9445 R
.365 3 R
0920R
0529L
1.2082L
.4700L
.1618L
0567R
1.1407R
4605R
1532R
. 1224L
. 1294R
.7961
.4373

126
Table B-ll--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
69-FI-11A
(cont.) Thyroid Cartilage
-- Height
Vibratory Mass Measures
-- Height from Cricoid
to TVF
Phonatory Position
(glottal width/2)
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
-- Area of Vibratory Mass
69-F1-14A Thyroarytenoid Muscle
Surface Width of TVF
Thyroid Cartilage
-- Distance between
Superior Apexes
-- Distance between
Inferior Prominences
-- Height
Vibratory Mass Measures
-- Height from Cricoid
to TVF
1.0981L
1.0571R
. 6472L
. 65 99 R
.0422
. 1699L
. 1313 R
1340L
2.0242L
.7109L
. 2117 L
1649R
2.1098R
.8595R
. 1547R
0581L
1.2176L
.55111
.1658L
0422R
1.1760R
. 5 3 7 5 R
.1134 R
.1248L
.8022
.2930
1.1902L
1.1634R
.4968L
.5458R

127
Table B-ll--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
69-F1-14A
(cont.) Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage -151SL
.1030R
-- Area of Vibratory Mass
.0860L
. 1257R
1.7673L
1.9662R
.6670L
7596R
.1542L
. 1804R
69-FI-18A
Thyroarytenoid Muscle
.0248L
.0262R
.7825L
.8543 R
.3381L
.321 OR
. 1272L
. 0722 R
Surface Width of TVF
-1143L
. 1203R
Thyroid Cartilage
-- Distance between
Superior Apexes
.6770
-- Height
1.1302L
1.1622R
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.132 3 L
.1322R
-- Area of Vibratory Mass
.0481L
.0444R
.9124L
.87 2 7 R
.3049L
3020R
.1341L
. 13 71R
69-F2-3A
Thyroarytenoid Muscle
.0117L
. 0071R
.49 23L
4632R
.2081L
1566R
.0608L
.0402R
Surface Width of TVF .0791L
.0454R
Thyroid Cartilage
-- Distance between
Superior Apexes .5754

128
Table B-ll--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
69-F2-3A
(cont.) Thyroid Cartilage
-- Height 1.0327L
9248R
Height .1013L
.0703R
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage 1013L
.0703R
-- Area of Vibratory Mass
.0377L
0438R
.9847L
1.0827R
.4050L
. 3659R
.1498L
. 1623R
69-F2-7A
Thyroarytenoid Muscle
.0091L
.0063R
.6005L
. 4941R
.2796L
.1882R
.0443L
.0847R
Surface Width of TVF
. 1312L
.0771R
Thyroid Cartilage
-- Distance between
Superior Apexes
.6030
-- Height
1.0652L
1.1009R
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.1513 L
. 1465R
-- Area of Vibratory Mass
.0218L
0168R
.62 77L
. 5663 R
.1611L
.1620R
.1621L
. 1489 R
69-F2-10A
Thyroid Cartilage
-- Height
.96 74 L
1.0363R
* L = left, R = right; no letter = neither L nor R is indicated.

129
Table B-12. Apparent Size of Structures/Specimen 6/Coronal
Plane/Posterior Block
SI ide ff
Structure (Sq
Area
. Inch)
Peri- Inferior-
meter Superior
(Inch) (Inch)
Medial-
Lateral
(Inch)
69-F1-2P
Lateral Cricoarytenoid
Mus cle
. 0185 R
.69 55 R
. 15 7 7 R
- 22 76 R
Cricothyroid Muscle
.0472R
1.0663R
.4063R
.1974R
Thyroarytenoid Muscle
. 1022 R
1.5688R
5638R
. 37 66 R
Conus Elasticus
. 5098R
Thyroid Cartilage
-- Distance between
Superior Apexes
1.1672
-- Distance between
Inferior Prominences
1.0454
-- Height
1.1427L
9682R
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.37 66 R
-- Area of Vibratory Mass
.1725R
2.0100R
.5812R
.4071R
69-F1-4P
Lateral Cricoarytenoid
Muscle
.0124 R
.5409R
.0883R
.1424 R
Cricothyroid Muscle
.0428R
.9725R
.3665R
.1464R
Thyroarytenoid Muscle
.06 26 L
.0878R
1.1856L
1.3114R
.3766 L
.4027R
.2166 L
.2693R
Conus Elasticus
.4962 L
. 405 7 R
Thyroid Cartilage
-- Distance between
Superior Apexes
1.0519
Distance between
Inferior Prominences
.9038

130
Table B-12--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide ft Structure (Sq.Inch) (Inch) (Inch) (Inch)
69-F1-4P
(cont.)
69-F1-7P
Thyroid Cartilage
-- Height
.90 7 6 L
.84 7 7 R
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.324 6 L
.3558R
-- Area of Vibratory Mass
.1393L
.1650R
1.7387L
1.7960R
.5517L
.4415 R
.3498L
3558R
Lateral Cricoarytenoid
Muscle
0265R
.6778R
. 1593R
.1709R
Cricothyroid Muscle
.0546L
.0717 R
1.7088L
1.4 901R
.7649L
. 7 311R
.1398L
. 1264R
Thyroarytenoid Muscle
.0943L
.07 7 6 R
1.2069L
1.0273R
.3271L
.2211R
.3216L
. 2745 R
Conus Elasticus
.5012L
.3709R
Thyroid Cartilage
-- Distance between
Superior Apexes
-- Distance between
Inferior Prominences
-- Height
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
1.1302
.9197
.9845L
.7946R
. 3545 L
. 3877R

131
Table B-12--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide H Structure (Sq.Inch) (Inch) (Inch) (Inch)
69-F1-7P
(cont.)
Area of Vibratory Mass
1630L
.1237R
1.8518L
1.4590R
. 5286 L
. 3384R
.5006 L
.3960R
69-F1-9P
Posterior Cricoarytenoid
Muscle
.0127 R
.52 71R
. 1523R
1274R
Lateral Cricoarytenoid
Muscle
.0184L
.0250R
.5942 L
.5931R
. 1774L
. 1783R
. 1243L
.1297R
Cricothyroid Muscle
.0544L
.0407R
1.4229L
1.1372R
.6149L
. 507 3R
.1108L
.0981R
Thyroarytenoid Muscle
.0855L
.0430R
1.1624L
. 97 50R
.2908L
. 2072R
.3078L
.3886R
Conus Elasticus
.3667L
.2841R
Thyroid Cartilage
-- Distance between
Superior Apexes
.9925
-- Distance between
Inferior Prominences
.8742
-- Height
.8591L
7325R
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
2654L
. 2974R
-- Area of Vibratory Mass
. 1527L
.1989R
1.7791L
2.0116R
.5105L
.47 38 R
.3318L
.3112R
69-F1-13P
Posterior Cricoarytenoid
Muscle
0085R
. 4965 R
.2889R
.03 74 R

132
Table B-12--continued.
SI ide a
Structure (Sq
Area
.Inch)
Peri- Inferior-
meter Superior
(Inch) (Inch)
Medial -
Lateral
(Inch)
69-FI-13P
(cont.)
Cricothyroid Muscle
.0493L
.0697R
1.3687L
1.4686R
.6040L
.6230R
.0844L
.1000R
Thyroarytenoid Muscle
.1440L
. 0911R
1.6525L
1.3250R
.43681
. 2666 R
. 3540L
. 2842 R
Conus Elasticus
.3120L
. 1821R
Thyroid Cartilage
-- Distance between
Superior Apexes
.9274
Distance between
Inferior Prominences
.8687
-- Height
.85 51L
.7860R
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.37 03 L
.3425R
-- Area of Vibratory Mass
.1847L
. 1865 R
2.2236L
2.0105R
.47 5 2L
.4171R
.4684 L
. 3842 R
69-F1-18P
Posterior Cricoarytenoid
Muscle
.0019R
.1735R
.06 32 R
.0361R
Interarytenoideus Muscle
.0824
1.5325
.6664
.1463
Cricothyroid Muscle
.0385L
.0194R
1.1740L
.6718R
.5107 L
.1797R
.08291
.0704R
Thyroarytenoid Muscle
.0440L
.9372L
.2278L
. 2197L
Conus Elasticus
.37 2 2 L
. 1670R

133
Table B-12--continued.
Peri- Inferior- Medial -
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
69-F1-18P
(cont.) Thyroid Cartilage
-- Distance between
Superior Apexes
-- Distance between
Inferior Prominences
-- Height
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
-- Area of Vibratory Mass
69-F2-3P Posterior Cricoarytenoid
Muscle
Interarytenoideus Muscle
Cricothyroid Muscle
Thyroarytenoid Muscle
Conus Elasticus
1.1156
.9310
8246L
1.0152R
.2259L
0769L
1.3278L
.2761L
. 2284L
0116R
. 67 76 R
.2680R
.0492R
0812
1.4533
.1294
.5563
0395L
0368R
1.2494L
1.2353R
. 5163 L
.4214R
. 1039L
.0647R
0340L
0257R
.8465L
. 7607R
.2457L
. 1025R
. 2336L
. 2301R
. 2258L
.1003 R
Thyroid Cartilage
-- Distance between
Superior Apexes 1.0556
Distance between
Inferior Prominences 1.0116
-- Height
.7179L
1.0053R

134
Table B-12--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide If Structure (Sq.Inch) (Inch) (Inch) (Inch)
69-F2-3P
(cont.) Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage .2497L
.1874R
-- Area of Vibratory Mass
.0768L
1.2560L
.2480L
.3079L
69-F2-6P
Posterior Cricoarytenoid
Muscle
0103L
.0154R
.4830L
5618R
. 1873L
. 2439R
.07 21L
0313R
Interarytenoideus Muscle
.0665
1.4223
.1470
.6689
Cricothyroid Muscle
.022 6L
.0320R
.97 95 L
.9225R
.4768L
.3552R
.1005 L
.09 33R
Thyroarytenoid Muscle
.0267R
.7566R
.2215R
.2202R
Thyroid Cartilage
Distance between
Superior Apexes
1.1492
Distance between
Inferior Prominences
1.0263
-- Height
1.2155R
69-F2-10P
Posterior Cricoarytenoid
Muscle
.0182L
.0453R
. 5877 L
1.2600R
.1988L
.5153R
0847L
.1030R
Cricothyroid Muscle
.0253L
.0949R
.9155L
2.0353R
.3621L
.6819R
.0865L
. 194 5 R
Thyroid Cartilage
-- Distance between
Inferior Prominences 1.0663
-- Height
3500R

135
Table B-12--continued.
SI ide ff
Structure
Area
(Sq.Inch)
Peri
meter :
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
69-F2-15P
Posterior Cricoarytenoid
Muscle
0207L
.0343R
.65 91L
1.1502R
2227L
.4287R
0828L
.0591R
Interarytenoideus Muscle
.0117
1.3473
.0565
.5235
Cricothyroid Muscle
.03 71L
1.0632L
.387 7 L
. 07 54 L
69-F2-18P
Posterior Cricoarytenoid
Muscle
. 0169L
.0507R
. 5623L
1.3550R
.1866L
5274R
.0788L
.0707R
Cricothyroid Muscle
.0266L
.8715L
.2922L
.0657L
69-F3-3P
Posterior Cricoarytenoid
Muscle
.0431R
1.3322R
.72 5 5 R
.0525R
* L = left
, R = right; no letter =
neither L
nor R is
indicated


APPENDIX C
APPARENT SIZE OF STRUCTURES
ARRANGED BY STRUCTURE ACROSS SLIDES

Table C-l. Apparent Size of Structures/Specimen 1/Sagittal Plane/Left
Block
Structure
Slide ff (Sq
Area
. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior
Posterio
(Inch)
Cricothyroid Muscle
75-F2-14L
.3260
2.6021
.3953
1.0607
75-F3-1L
.2912
2.4133
.6381
.4925
Interarytenoideus Muscle
75-F1-5L
.0707
1.1431
.3068
.2682
75-F1-9L
.0684
1.2454
.2647
.2664
75-F1-13L
.0645
1.1818
.3184
.1771
75-F1-18L
.0560
1.1498
.4497
.0619
75-F2-5L
.0127
.5903
.1846
.0216
Lateral Cricoarytenoid
Muscle
75-F2-14L
.0497
1.1466
.2128
.3146
Posterior Cricoarytenoid
Muscle
75-F1-9L
.0332
1.0662
.3837
.0565
75-F1-13L
.0718
1.2962
.4913
.0689
75-F1-18L
.0711
1.5063
.6244
.1040
75-F2-5L
.0710
1.3485
.5375
.1034
75-F2-9L
.0753
1.4958
.6256
.1011
75-F2-14L
.0626
1.5335
.5680
.1079
75-F3-1L
.0464
.9284
.3931
.1044
Thyroarytenoid Muscle
75-F1-13L
.0461
.8798
.3342
.1285
75-F1-18L
.1093
1.2671
.2326
.4155
75-F2-5L
.3525
2.6789
.2630
1.0387
75-F2-9L
.5553
2.9600
.5425
1.1944
75-F2-14L
.3379
2.3723
.7633
.4423
137

138
Table C-l--continued.
Structure
SI ide # (Sq
Area
.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
Thyroartenoid Muscle
(cont.)
75-F3-1L
.0723
1.2612
.2320
.4319
75-F3-5L
.2114
2.0595
.3273
.7110
75-F3-10L
.1304
1.9755
.1641
.6557
75-F3-14L
.2928
2.6509
.4667
.7022
Conus Elasticus --
Cricothyroid Ligament
75-F2-14L
.3567
Posterior Cricoarytenoid
Ligament
75-F1-13L
.2190
75-F1-18L
.2091
75-F2-5L
.0629
75-F2-9L
.1099

139
Table C-2. Apparent Size of Structures/Specimen 1/Sagittal Plane/Right
Block
Peri- Inferior- Anterior-
Area meter Superior Posterior
Structure Slide# (Sq.Inch) (Inch) (Inch) (Inch)
Cricothyroid Muscle 75-F2-9R
75-F2-13R
75-F2-18R
75-F3-6R
75-F3-13R
75-F3-17R
Interarytenoideus Muscle 75-F2-18R
75-F3-6R
75-F3-9R
75-F3-13R
75-F3-17R
Lateral Cricoarytenoid
Muscle 75-F1-14R
75-F1-18R
75-F2-3R
75-F1-10R
75-F1-14R
75-F1-18R
75-F2-3R
75-F2-9R
75-F2-13R
75-F2-18R
0511
1.2982
.5173
.0828
0745
1.2826
.4429
.1122
0531
1.0358
.3938
.1174
0671
1.0945
.3199
.1495
0605
1.2089
.4766
.1551
0978
1.5023
.6228
.1260
0346
1.0269
.4031
.0629
0324
.9207
.3433
.0300
0258
1.1329
.4390
.0446
0725
1.2628
.4163
.1019
0214
.6236
.1524
.0650
0381
.8314
.2240
.0606
0037
.4817
.0866
.0932
0368
1.0733
.2972
.2483
0468
.8388
.2694
.1151
0528
.9230
.2926
.1077
0395
.8420
.2545
.1254
0439
.8940
.3089
.1116
0489
.9773
.2760
.1361
0211
.6673
.1951
.0819
0859
1.8817
.7122
.1023
Posterior Cricoarytenoid
Muscle

140
Table C-2--continued.
Peri- Inferior- Anterior-
Area meter Superior Posterior
Structure Slide # (Sq.Inch) (Inch) (Inch) (Inch)
Posterior Cricoarytenoid
Muscle (cont.) 75-F3-6R
75-F3-9R
75-F3-13R
75-F3-17R
Thyroarytenoid Muscle 75-F1-7R
75-F1-10R
75-F1-14R
75-F1-18R
75-F2-3R
75-F2-9R
75-F2-13R
75-F2-18R
75-F3-6R
75-F3-9R
75-F3-13R
75-F3-17R
75-F1-18R
75-F2-3R
75-F2-9R
75-F2-18R
0749
1.4190
.6045
.1129
0972
1.6961
.6931
.1149
0672
1.2091
.4379
.1514
0784
1.4652
.5421
.0909
1318
2.0219
.2949
.6773
2292
2.4642
.3717
.9157
2855
2.5105
.4953
.7123
2517
2.5753
.3719
.7938
2595
2.5892
.3084
.6724
2747
1.999
.4168
.5179
3309
2.2542
.6543
.4656
0741
1.4425
.1536
.4873
,1499
1.7387
.1725
.6242
0902
1.3978
.4474
.1639
,0747
1.1475
.2457
.3353
,0626
.9493
.1428
.2108
5944
6189
3941
7455
Anterior Cricoarytenoid
Li gament

141
Table C-2continued.
Peri- Inferior- Anterior-
Area meter Superior Posterior
Structure Slide ft (Sq.Inch) (Inch) (Inch) (Inch)
Anterior Cricoarytenoid
Ligament (cont.)
Posterior Cricoarytenoid
Ligament
Thyroid Cartilage
75-F3-6R .5145
75-F3-13R .0733
75-F3-13R .0640
75-FI-1 OR
1.0628
75-F1-14R
1.1093
75-F1-18R
1.0378
75-F2-3R
.9614
75-F2-9R
.9306
75-F2-13R
1.0544
75-F2-18R
.7618
75-F3-5R
.9296
75-F3-9R
.9534
75-F3-13R
.8256
75-F3-17R
.8343
75-F4-3R
.9030
75-F4-6R
1.1037

142
Table C-3. Apparent Size of Structures/Specimen 2/Transverse
Plane/Superior Block
Peri- Anterior- Lateral-
Structure
SIide H (Sq
Area
. Inch)
meter Posterior
(Inch) (Inch)
Medial
(Inch)
Interarytenoideus Muscle
48-FI-IS
.1064L*
.0760R
1.8258L
1.6346R
.6315L
. 65 6 7 R
.1581L
.1489R
48-FI-11S
.0641
1.5353
.1575
.5488
48-F1-13S
.1213
1.8233
.1381
.7961
48-F1-15S
.0955
1.6081
.1082
.6586
48-F2-1S
.0873
1.6997
.0909
.7681
48-F2-3S
.0597
1.5798
.0721
.6667
48-F2-5S
.0432
1.4788
.0930
.6529
Lateral Cricoarytenoid
Muscle
48-FI-IS
. 0345 R
1.5641R
6469R
.0444R
48-F1-3S
.0330L
. 0402R
1.6164L
1.4805R
.6423L
. 6240R
.06 21L
.0344R
48-F1-5S
.0570L
0480R
1.4869L
1.5244R
.6105L
.6732R
.0855L
. 0499R
48-F1-7S
. 1457L
.0897 R
2.2453L
1.7136R
1.0320L
7249R
.1370L
. 1619R
Posterior Cricoarytenoid
Muscle
48-F1-1S
.03 2 0L
.0197R
1.0162L
.7225R
1025 L
.07 67R
.3930L
.2932R
48-F1-3S
.0255L
.0090R
. 7777L
.40 71R
.0713L
.0544R
.2 946 L
.2177 R
48-F1-5S
.0170L
.0060R
.7776L
.4200R
.0524L
. 035 9 R
.3097L
.1717R
48-F1-7S
.0092L
.0020R
.6432L
2769R
.0189L
0142R
.2546L
. 1242 R
48-F1-9S
.007 5 L
.5468L
.0211L
.2009L

143
Table C-3--continued.
Area
Peri- Anterior-
meter Posterior
Lateral -
Medial
Structure
SIide ff
(Sq.Inch)
(Inch)
(Inch)
(Inch)
Thyroarytenoid Muscle
48-F1-3S
.0964L
. 1040R
1.9906L
1.7785R
.8567L
. 695 9 R
.1750L
. 1242R
48-F1-5S
.2059L
.1620R
2.5773L
2.1371R
.8108L
.87 3 7 R
.2413L
. 1773R
48-F1-7S
.0906L
.0682R
2.4542L
1.4426R
1.0513L
.55 67 R
.1072L
.1351R
48-F1-9S
.1448L
. 1629R
2.1263L
1.9569R
.8937L
.75 34R
2528L
. 1991R
48-FI-11S
.2008L
.17 00R
2.4097L
1.9276R
.8879L
.7193 R
.2327 L
. 1691R
48-F1-13S
.1529L
. 1054R
2.8661L
1.9985R
.7762L
.9418R
. 2527L
.1583R
48-F1-15S
.1034L
.0835R
2.1327L
1.8802R
8983L
. 75 90R
.2468L
1946R
48-F2-1S
.1179L
.1266R
2.2061L
2.1804R
.7507L
. 8851R
. 1385L
. 1336R
48-F2-3S
.0996L
.1087R
1.7850L
1.8041R
.6382L
. 6907 R
. 1225L
. 1489R
43-F2-5S
.1378L
.0802R
2.2892L
1.8075R
.9084L
.8836R
. 1250L
.0832R
48-F2-7S
.1390L
. 1487R
2.1711L
2.1528R
9096L
.8257 R
.1854L
.1155 R
48-F2-9S
.0950L
0719R
2.0835L
1.5469R
.7782L
6469R
. 1755L
.0931R
48-F2-11S
0518L
.0812 R
1.1320L
1.3308R
.4329L
.4815 R
.1263L
.15 96 R
Posterior Cricoarytenoid
Ligament
48-F1-11S
.0520
1.3507
.2008
.3505
* L = 1 eft, R = right; no
letter =
neither L
nor R is
indicated


144
Table C-4. Apparent Size of Structures/Specimen 2/Transverse
Plane/Medial Block
Peri- Anterior- Lateral -
Area meter Posterior Medial
Structure Slide # (Sq.Inch) (Inch) (Inch) (Inch)
Cricothyroid Muscle
Lateral Cricoarytenoid
Muscle
48-F1-4M
.0951L*
.055 7 R
1.9443L
1.6339R
.7280L
.7107 R
.1401L
. 1087 R
48-F1-6M
.1165L
1.9706L
.8813L
.1294L
48-F1-8M
. 07 44 L
1.9001L
. 7335L
.0680L
48-F1-10M
.0945L
.0341R
2.3980L
1.8636R
8588L
.97 08 R
.0808L
. 0417 R
48-FI-12M
.0758L
.04 99 R
2.2403L
2.0943R
.9797L
. 9150R
.0558L
0364R
48-F1-14M
0876L
.0216R
2.3492L
1.2152R
1.1252L
.42 92 R
.0515 L
.0174R
48-F1-16M
.0599L
.0181R
2.1333L
1.1947R
.8408L
.54 32 R
.0388L
.0512R
48-F1-18M
.0534L
.0382R
1.7257L
1.6771R
.6689L
0993R
.0505L
. 7622R
48-F2-2M
.0442L
.03 68 R
1.6849L
1.8994R
. 6191L
8610R
.0633L
.0744R
48-F2-4M
.0504L
.0654 R
1.5878L
2.1769R
.5061L
3238R
.0423L
.0685R
48-F1-2M
.0282L
.0124R
1.1542L
.7009R
3064L
. 2680R
.03 21L
.0485R
48-F1-4M
.0316L
.0418R
1.1355L
1.1833R
.5790L
. 3971R
.07 07 L
. 2564R
48-F1-6M
.0317L
.0320R
1.1373L
1.2678R
5499L
. 4924R
.1168L
.13 28 R
48-F1-8M
.0277L
.0267R
.9313L
1.1356R
.3376L
.4038R
0784L
. 0655 R

Table C-4--continued
Peri- Anterior- Lateral-
Structure
SI ide If (Sq
Area
.Inch)
meter Posterior
(Inch) (Inch)
Medial
(Inch)
Lateral Cricoarytenoid
Muscle (cont.)
48-FI-1OM
.02 21L
.9665 L
.33 92 L
.06 7 3 L
48-FI-12M
.0405L
1.1063L
.3854L
. 1163L
48-F1-14M
. 03 7 2 L
.9768L
. 3903L
. 1454L
48-F1-16M
.0290L
8346L
.3131L
. 1355L
48-F1-18M
. 02 5 9 L
.7413 L
.1990L
. 1191L
48-F2-2M
. 0184L
.7077L
.1642L
.0712L
48-F2-4M
. 03 2 0 L
1.0130L
. 3191L
. 0938L
Posterior Cricoarytenoid
Muscle
48-F1-2M
. 04 66 L*
.0279R
1.1083L
.8675R
.1314L
.0664R
.4178L
.301OR
48-F1-4M
.0540L
.0394 R
1.3120L
1.1178R
.1415L
1263R
.6152 L
4763R
48-F1-6M
.0481L
.03 66 R
1.1443L
1.0786R
.1418L
1202R
.5226L
.4642R
48-F1-8M
.0277L
.0279R
.8 981L
8293R
.0741L
.0580R
. 3691L
. 3159R
48-F1-10M
.0319L
.02 04 R
. 9922L
.72 5 6 R
.0616L
.0954R
.3884L
. 2921R
48-FI-12M
.0386L
.0309R
1.1756L
1.1624R
.1067L
. 03 61R
.4907 L
. 54 7 OR
48-F1-14M
.0292L
- 02 97 R
1.0321L
1.2766R
.1147L
.0285R
.4699L
. 585 6 R
48-FI-16M
.0224L
.0191R
.9535L
1.1222R
.0817L
0274R
.3226L
.5717 R

146
Table C-4--continued.
Structure
SI i de #
Area
(Sq.Inch)
Peri- i
meter
(Inch)
Anterior-
Posterior
(Inch)
Lateral -
Medial
(Inch)
Posterior Cricoarytenoid
Muscle (cont.)
48-FI-18M
. 0252 L
.0195R
. 987 5 L
1.0592R
.0418L
.0238R
. 3616L
.3796R
48-F2-2M
.0241L
- 0121R
1.0599L
- 9365 R
.0628L
.0161R
.3658L
.3215 R
48-F2-4M
. 0198L
0116R
.9567L
.7490R
.40761
.307 3 R
.0616L
0140R
Thyroarytenoid Muscle
48-F1-2M
.0357L
1.1863L
.4688L
.0552L
* L = left, R = right; no
letter =
neither L
nor R is
indicated


147
Table C-5. Apparent Size of Structures/Specimen 3/Coronal
Plane/Anterior Block
Structure
SI ide ft
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral -
(Inch)
Cricothyroid Muscle
46-F1-4A
.0908L*
1.5171L
.6043L
.2764L
46-F1-8A
0794L
1.4152L
.5114L
.1684 L
46-FI-11A
.0828L
1.2800L
.5131L
.1669L
46-FI-14A
0829L
1.4870L
. 5604 L
.1924 L
46-F2-1A
.0412L
.9792L
. 3256L
. 1243L
46-F2-6A
.0219L
.8010L
. 307 2 L
.0976 L
46-F2-13A
.0295L
8304L
.3870L
.0931L
46-F3-5A
0288L
.0154R
6632L
.5228R
.1771L
.1491R
. 1231L
.0742R
46-F3-9A
.0248L
.0104 R
.5790L
.45 95 R
.1228L
1169R
.1313L
.0663R
Lateral Cricoarytenoid
Muscle
46-F2-1A
.0057 L
.3071L
0846L
.07 3 6 L
46-F2-6A
.0137L
.4907L
.1605L
.1544L
46-F2-13A
.0170 L
.5369L
1573L
. 1123 L
Thyroarytenoid Muscle
46-F1-4A
.0646L
.017 2 R
1.2746L
6164R
.4120L
2143R
.5223L
. 1261R
46-F1-8A
.0984L
.0608R
1.2688L
1.1227R
.3064L
. 3632R
. 2287L
. 1768R
46-FI-11A
.0776L
0690R
1.1051L
1.0829R
.3325L
.38 23 R
. 2914 L
. 1982 R

148
Table C-5continued.
Structure
SI ide ft
Area
(Sq. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral -
(Inch)
Thyroarytenoid Muscle
(cont.)
46-FI-14A
. 0831L
.0537R
1.2322L
1.0832R
. 3168L
.3600R
. 2833 L
.1873R
46-F2-1A
.0687L
.0604R
1.0864L
1.1418R
.3312L
.42 66 R
.2587L
2246R
46-F2-6A
.0633L
.0449R
.9813L
1.2506R
.2964L
1.5469R
. 2549L
. 1903R
46-F2-13A
.0462L
.034 3 R
.9206L
.7473R
.3387L
.2811R
.27 32 L
. 1597R
46-F2-18A
.0567L
.0304R
. 9853L
8816R
.2903L
.3545R
.1476L
. 1389 R
(Thyromuscularis)
46-F3-5A
.0294L
.0179 R
.8176L
.6546R
.2998L
.2 903 R
.0898L
.051OR
46-F3-9A
.0184L
.02 05 R
6306L
. 7587 R
.2201L
- 2754 R
.0440L
. 1577R
(Thyrovocalis Muscle)
46-F3-5A
.3465L
.2 925 R
.1185L
.0864R
Conus Elasticus
46-F1-4A
.4542 L
. 5153 R
46-F1-8A
.47 64 L
.5311R
46-FI-11A
.4716L
.55 91R
46-F1-14A
4869L
. 5497 R
46-F2-1A
.4998L
. 5140R
46-F2-6A
.5855L
. 5341R
A

149
Table C-5--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral -
Structure Slide # (Sq.Inch) (Inch) (Inch) (Inch)
Conus Elasticus
(cont.) 46-F2-13A .4976R
46-F2-18A .6277L
.6235R
Surface Width of TVF 46-F1-4A .2002L
.1925R
46-F1-8A .1908L
1868R
46-FI-11A .1489L
1563R
46-F1-14A .1997 L
.1908R
46-F2-1A .17 31L
1090R
46-F2-6A .2057L
.2380R
46-F2-18A .1885L
.1923R
46-F3-5A .1683L
1910R
46-F3-9A .1431L
. 1760R
Thyroid Cartilage
-- Distance between
Superior Apexes 46-F1-4A 1.1285
45-F1-8A 1.0641
46-F1-11A
1.1126

150
Table C-5--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral -
Structure Slide ff (Sq.Inch) (Inch) (Inch) (Inch)
Thyroid Cartilage
-- Distance between
Superior Apexes
(cont.) 46-F1-14A
46-F2-1A
46-F2-6A
46-F2-13A
46-F2-18A
46-F3-5A
46-F3-9A
46-F3-14A
46-F4-2A
46-F4-7A
46-F4-12A
1.1497
1.0305
.9390
.7440
.5776
.4799
.4235
.4123
.3962
.3595
.3856
- Distance between
Inferior Prominences 46-F1-4A
46-F1-8A
46-F1-11A
46-FI-14A
46-F2-1A
46-F2-6A
46-F2-13A
1.2552
1.2651
1.2332
1.3148
1.1919
1.1598
.8972
46-F2-18A
.6636

151
Table C-5--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral -
Structure Slide if (Sq.Inch) (Inch) (Inch) (Inch)
Thyroid Cartilage
-- Distance between
Inferior Prominences
(cont.)
-- Height
46-F3-5A
.4602
46-F3-9A
.3993
46-F3-14A
.3175
46-F4-2A
.1519
46-F4-7A
.2040
46-F4-12A
.1908
46-F1-4A
1.2024L
1.2296R
46-F1-8A
1.1018L
1.0777R
46-FI11A
1.2295L
1.1238R
46-F1-14A
1.2341L
1.0196R
46-F2-1A
1 36 01L
1.1250R
46-F2-6A
1.3680L
1.1036R
46-F2-13A
1.2130L
1.0039R
46-F2-18A
1.2609L
1.0358R
46-F3-5A
1.1228L
.9953R

152
Table C-5--continued.
Area
Structure Slide tf (Sq.Inch)
Peri- Inferior- Medial-
meter Superior Lateral-
(Inch) (Inch) (Inch)
Thyroid Cartilage
-- Height
(cont.) 46-F3-9A
1.0588L
. 9675R
46-F3-14A
1.0165L
.9474R
46-F4-2A
.9398L
.9642R
46-F4-7A
. 7190L
. 6855 R
45-F4-12A
.7071L
. 707 7 R
Vibratory Mass Measures
-- Height from Cricoid
to TVF 46-F1-4A
. 34 76 L
.4152 R
46-F1-8A
.3535L
.421OR
46-FI-11A
.2961L
- 36 91R
46-F1-14A
.3546L
4081R
46-F2-1A
.4183 L
. 5035R
46-F2-6A
.4220L
.5214R
46-F2-13A
.5190L
.585 7 R
46-F2-18A
.6422L
6880R

153
Table C-5continued.
Peri- Inferior- Medial -
Area meter Superior Lateral-
Structure Slide # (Sq.Inch) (Inch) (Inch) (Inch)
Vibratory Mass Measures
-- Height from Cricoid
to TVF
(cont.)
46-F3-5A
. 6247 L
.7314R
46-F3-9A
.6906L
.7 041R
46-F3-14A
. 1656L
.1488R
-- Phonatory Position
(glottal width/2)
46-F1-4A
.0878
46-F1-8A
.0667
46-FI-11A
.0886
46-F1-14A
.0926
46-F2-1A
.0893
46-F2-6A
.0710
46-F2-18A
.0127
46-F3-5A
.0140
46-F3-9A
.0006
46-F3-14A
.0060
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
46-F1-4A
. 3186 L
. 2229R
46-F1-8A
.3201L
.2064 R

154
Table C-5--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral -
Structure Slide# (Sq.Inch) (Inch) (Inch) (Inch)
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
(cont.) 46-FI-11A 3009L
. 2470R
46-F1-14A 2947 L
. 2206R
46-F2-1A 2722L
.1851R
46-F2-6A
.2666L
. 1685 R
46-F2-13A
46-F2-18A
46-F3-5A
46-F3-9A
-- Area of Vibratory Mass 46-F1-4A
46-F1-3A
45-F1-11A
46-F1-14A
.2372L
. 1584R
. 1608L
0670R
.0769L
.0628R
.0440L
. 1577R
1898L
1.8356L
.4141L
.5136L
.2924 L
. 3926L
1388R
1.4779R
.3934R
. 2554R
1651L
1.5717L
.3560L
.3683L
1384R
1.4454R
4099R
. 2742R
1185L
1.2637L
.3550L
.3378L
1360R
1.4678R
.3487 R
.2649R
1518L
1.5276L
.4133L
.3516L
1534R
1.5675R
.5933R
. 2491R

155
Table C-5--continued.
Structure
SIide §
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral -
(Inch)
Vibratory Mass Measures
-- Area of Vibratory Mass
(cont.)
46-F2-1A
-1402 L
.1553R
1.4667 L
1.7744R
4280L
.6815R
. 3187 L
. 2117 R
46-F2-6A
.1506L
. 1063R
1.7656L
1.3258R
.4801L
.5412 R
.30041
. 2147R
46-F2-18A
.1048L
0768R
1.3948L
1.2301R
.47 OIL
.4454R
.2195 L
. 1356R
45-F3-5A
.0502L
0633R
9391L
.12287R
.3079L
.3050R
.1294L
. 1161R
46-F3-9A
.0458L
.0383R
.9668L
. 9337 R
.2947L
.3000R
. 1682L
. 1577 R
* L = left, R = right; no letter = neither L nor R is indicated

156
Table C-6. Apparent Size of Structures/Specimen 3/Coronal
Plane/Posterior Block
Structure
Slide # i
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral -
(Inch)
Cricothyroid Muscle
46-F1-3P
.0458L*
. 04 91R
.9319L
1.0776R
.3385L
.3490R
.0982L
. 1036R
46-F1-9P
.0379L
. 0545 R
.8679L
1.2233R
.3592L
.5716R
. 1145L
. 1491R
46-F1-14P
.0493L
.0874R
1.2822L
1.4708R
.4014L
.69 06 R
.2366L
. 2346R
46-F2-1P
.0645R
1.3436R
.5986R
. 1585R
46-F2-6P
.0600R
1.3137R
. 5853 R
.2284 R
46-F2-IIP
.0573R
1.1898R
.5385R
.2024R
45-F2-16P
.0637R
1.3206R
.6024 R
.2009R
46-F3-4P
.0527R
1.2340R
.5602R
.1599R
46-F3-9P
. 027 4 R
1.0486R
.37 74 R
.1290R
46-F3-14P
0226R
1.1492R
.1737R
.1301R
Interarytenoideus Muscle
46-F2-16P
.0776
1.7639
.3120
.2592
46-F3-4P
.1340
1.7089
.3489
.6986
46-F3-9P
.1096
1.6641
.2559
.6781
46-F3-14P
.1031
1.4920
.3221
.5809
46-F4-6P
.0719
1.7179
.1880
.7449
Lateral Cricoarytenoid
Muscle
46-F1-14P
.0230L
.0420R
.7091L
.8419R
3240L
.2482R
.175 7 L
.2527R
46-F2-1P
.0597R
1.0220R
.2618R
.3296R
46-F2-6P
.0211R
. 715 OR
.1880R
1836R

157
Table C-6--continued.
Structure
SI ide ff
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial-
Lateral -
(Inch)
Lateral Cricoarytenoid
Muscle (cont.)
46-F2-11P
.0232R
.7393R
.2003 R
. 1538R
46-F2-16P
0208R
. 5632R
.1742R
.1839R
Posterior Cricoarytenoid
Muscle
46-FI-14 P
.02 06 L
. 6157 L
. 187 7 L
. 1700L
46-F2-1P
.0224L
.66471
.277 6L
.1189L
45-F2-6P
.0114 L
.4692L
. 1849L
. 07 81L
46-F2-11P
.0276L
. 9 311L
4446L
.0999L
46-F2-16P
.0465 L
1.1882L
.5848L
. 0968 L
46-F3-4P
.0627L
.0208R
1.5894L
.6511R
.8020L
. 2971R
.1249L
.0980R
46-F3-9P
.0805L
.0190R
1.9273L
5728R
.9157L
.2407R
. 1144L
. 1043R
46-F3-14P
.0754L
.0069 R
1.8037L
. 5042R
8635L
.2408R
.1321L
.0452R
46-F4-6P
.0431L
.0300R
1.4604L
1.0539R
.6523L
.4636R
.0993L
. 0656 R
Thyroarytenoid Muscle
46-F1-3P
.1157L
. 1004 R
1.3751L
1.3007R
.3095L
. 4257 R
.3482L
. 2123R
46-F1-9P
.0614
.0854R
1.1498
1.2700R
.2413
. 251 OR
.2704
.287 2 R
46-FI-14 P
.0800L
.14 2 5 R
1.3600L
1.6227R
. 2111L
.4342R
.3331L
.3659R
46-F2-1P
.2169R
1.8345R
.5997R
.5212R
46-F2-6P
0610R
1.1619R
.2 981R
.2892 R

158
Table C-6--continued.
Structure
Area
SI ide # (Sq. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral -
(Inch)
Thyroarytenoid Muscle
(cont.)
46-F2-11P 0581R
1.4657R
. 245 9 R
. 3140R
46-F2-16P .0414R
- 8371R
.2948R
.2300R
Conus Elasticus
46-F1-3P
4653L
.3877 R
46-F1-9P
.3438R
46-F1-14P
.3137R
46-F2-1P
.2040R
46-F2-6P
.2064R
46-F2-11P
.1763R
Surface Width of TVF
46-F1-3P
0890R
Thyroid Cartilage
-- Distance between
Superior Apexes
46-F1-3P
1.6395
46-F1-9P
1.7539
46-F1-14P
1.7439
46-F2-1P
1.5532
46-F2-6P
1.5327
46-F2-11P
1.5598
46-F2-16P
1.7542
46-F3-4P
1.8488
46-F3-9P
1.8120
46-F3-14P
1.7285

159
Table C-6--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral -
Structure Slide ff (Sq.Inch) (Inch) (Inch) (Inch)
Thyroid Cartilage
(cont.)
-- Distance between
Inferior Prominences
-- Height
46-F1-3P
1.5893
46-F1-9P
1.6197
46-FI-14 P
1.5995
46-F2-1P
1.2922
46-F2-6P
1.2827
46-F2-IIP
1.2531
46-F2-16P
1.2983
45-F3-4P
1.2735
46-F3-9P
1.3809
46-F1-3P
1.5106L
1.3498R
46-F1-9P
.7042L
1.5368R
46-F1-14P
1.2618L
1.5103 R
46-F2-1P
1.3136L
.87 3 9 R
46-F2-6P
1.3113L
1.0926R
46-F2-11P
1.2664L
1.0713R
46-F2-15P
1.3072L
1.1530R

160
Table C-6--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral -
Structure Slide # (Sq.Inch) (Inch) (Inch) (Inch)
Thyroid Cartilage
(cont.)
Height 46-F3-4P
46-F3-9P
46-F3-14P
46-F4-6P
46-F4-IIP
.8954L
1.0996R
.6 944 L
1.1018R
1.1483R
1.2995R
1.1614R
Vibratory Mass Measures
-- Height from Cricoid
to TVF 46-F1-3P .3419R
46-F1-9P .27 97 R
- Phonatory Position
(glottal width/2) 46-F1-3P .0609
46-F1-9P .0713
46-F1-14P .0837
46-F2-1P .0794
46-F2-6P .0853
46-F2-IIP .0652
46-F2-16P .0977
46-F3-4P .0900
46-F3-9P
.0814

161
Table C-6--continued.
Structure
Slide # l
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial-
Lateral-
(Inch)
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
46-F1-3P
.5178R
.3509R
46-F1-9P
. 4674L
3478R
46-FI-14 P
.4193 L
.3631R
46-F2-1P
.1055L
.2970R
46-F2-6P
.3660R
46-F2-11P
. 3582 R
46-F2-16P
.3331R
-- Area of Vibratory Mass
46-F1-3P
. 1409R
1.6238R
3616R
.3195 R
46-F1-9P
.1868R
1.6161R
.4423R
.3801R
46-FI-14 P
. 1337R
1.4625R
.33 99 R
.3958 R
46-F2-1P
.1728R
1.6224R
.4211R
.3592R
46-F2-6P
. 20 76 R
1.9591R
. 4165 R
.4196R
46-F2-11P
.1850R
1.8736R
.3316R
.3887R
46-F2-16P
.1292R
1.7040R
.3720R
. 34 HR
* L = 1 eft, R = right; no
letter =
neither L
nor R is
; indicated


162
Table C-7. Apparent Size of Structures/Specimen 4/Sagittal Plane/Left
Block
Structure
SI ide If
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
Cricothyroid Muscle
63-F5-1L
.0690
1.3063
.3597
.0953
68-F5-2L
.0870
1.5676
.6593
.1272
68-F5-5L
.1881
1.6636
.4965
.5172
68-F5-7L
.1656
1.5977
.3919
.3931
68-F5-9L
.1779
1.7146
.3168
.5183
Interarytenoideus Muscle
68-F1-7L
.0495
.8900
.2848
.1033
68-F2-1L
.0428
.8404
.2947
.8329
68-F2-3L
.0459
.9125
.3159
.1038
68-F2-6L
.0581
.9788
.2992
.1193
68-F2-7L
.1773
1.7639
.5951
.2457
68-F3-2L
.1630
1.7196
.6144
.2793
68-F3-4L
.1793
1.9606
.5772
.2059
68-F3-7L
.0517
1.0700
.3136
.1055
68-F3-9L
.0610
1.2134
.4784
.1085
63-F4-3L
.0166
.7302
.3086
.0420
68-F4-5L
.0221
.7896
.3417
.0462
68-F4-8L
.0102
.6754
.0152
.2687
Lateral Cricoarytenoid
Muse!e
68-F5-1L
.0123
.5366
.0906
.1869
68-F5-2L
.0087
.4292
.0394
.1271

163
Table C-7--continued.
Structure
Slide #
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
Posterior Cricoarytenoid
Muscle
68-F3-2L
.4321
4.353
1.9810
.2372
68-F3-4L
.1318
2.9374
1.4187
.0866
68-F3-7L
.0578
1.7806
.7988
.0780
68-F3-9L
.0657
1.7648
.8414
.0916
63-F4-3L
.0932
1.6160
.6677
.1424
68-F4-5L
.0959
1.6117
.7362
.1255
68-F4-8L
.0880
1.8637
.7293
.1305
68-F5-1L
.0468
1.0279
.4040
.1050
68-F5-2L
.0212
.6847
.2662
.0521
Thyroarytenoid Muscle
68-F3-2L
.2357
2.0103
.2410
.7152
68-F3-4L
.6754
4.5848
.3556
1.3031
68-F3-7L
.1712
2.4115
.1829
.6706
68-F3-9L
.1721
2.0446
.6399
.2792
63-F4-3L
.0359
.9992
.0810
.4415
68-F4-5L
.0558
1.4561
.6860
.0907
68-F4-8L
.0514
1.1416
.1184
.4433
68-F5-1L
.0846
1.3717
.1658
.4468
68-F5-2L
.0436
.8598
.1377
.3597

164
Table C-7--continued.
Peri- Inferior- Anterior-
Area meter Superior Posterior
Structure
Slide # (Sq.Inch)
(Inch) (Inch)
Anterior Cricothyroid
Ligament
68-F2-7L
.7165
Posterior Cricoarytenoid
Ligament
68-F3-4L
.4594
68-F3-7L
.3945
63-F3-9L
.3785
Thyroid Cartilage
68-F3-2L
1.8108
68-F3-4L
2.3446
68-F3-7L
1.0239
68-F3-9L
1.2068
63-F4-3L
.9510
68-F4-5L
.9909
68-F4-8L
.9218
68-F5-1L
.8860
68-F5-2L
.9072
68-F5-5L
.7418
68-F5-7L
1.1713
68-F5-9L
1.1249

165
Table C-8. Apparent Size
Block
of Structures/Specimen 4/Sagittal Plane/Right
Structure
SI ide ff
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
Cricothyroid Muscle
68-F7-4R
.0289
. 8556
.3545
.0675
68-F7-7R
.0698
1.6629
.8011
.1493
68-F8-1R
.0779
1.5064
.6775
.3314
68-F8-4R
.1831
1.8536
.3061
.5543
68-F8-7R
.1221
1.3845
.4053
.2317
68-F8-10R
.1241
1.3515
.4710
.2860
V
68-F8-13R
.1901
1.8359
.5042
.4823
Interarytenoideus Muscle
68-F8-1R
.0426
1.1795
.5188
.0984
68-F8-4R
.0624
1.4129
.7587
.0870
Lateral Cricoarytenoid
Musclfe
68-F8-1R
.0940
1.1921
.3628
.2443
68-F8-4R
.0295
.8147
.1923
.1437
Posterior Cricoarytenoid
Muscle
68-F6-1R
.0285
.7277
.2650
.0831
68-F7-7R
68-F8-1R
68-F8-4R
.0277
.0642
.0717
.6718
1.2864
1.2321
.2507
.4503
.4847
.0696
.0932
.1335
68-F6-1R
.1149
1.4336
.1771
68-F6-3R
.1291
1.6192
.2558
68-F7-1R
.0942
1.4417
.1571
68-F7-4R
.0874
1.5047
.2434
.5012
.6081
.5287
.4779
Thyroarytenoid Muscle

166
Table C-8--continued.
Peri-
Inferior-
Anterior-
Area
meter
Superior
Posterior
Structure
SI ide #
(Sq. Inch)
(Inch)
(Inch)
(Inch)
Thyroarytenoid Muscle
(cont.)
68-F7-7R
.0487
.8649
.2137
.2536
68-F8-1R
.0460
.8098
.1858
.1665
Height of TVF
68-F6-1R
.4631
68-F6-3R
.3803
68-F7-1R
.5032
68-F7-4R
.4478
Thyroid Cartilage
68-F6-1R
.8610
68-F6-3R
.9480
68-F7-1R
1.0234
68-F7-4R
.8895
68-F7-7R
.9436
68-F8-1R
.9631
68-F8-4R
.9244
68-F8-7R
.9961

167
Table C-9. Apparent Size of Structures/Specimen 5/Transverse Plane/Left
Medial Block
Structure
Slide if (Sq
Area
Inch)
Peri -
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
Cricothyroid Muscle
62-F3-8M
.0760
1.2209
.2076
.5351
62-F3-11M
.0361
1.1687
.4584
.0980
62-F3-15M
.0308
1.0243
.3922
.0287
62-F3-18M
.0110
.7686
.3361
.0233
Interarytenoideus Muscle
62-F3-2M
.0932
1.2657
.2003
.4230
62-F3-5M
.0607
1.1562
.0820
.4177
62-F3-8M
.0305
.8941
.0605
.3622
Lateral Cricoarytenoid
Muscle
62-F2-5M
.0143
.6651
.1827
.0320
62-F2-7M
.0084
.5535
.1622
.0226
62-F2-9M
.0062
.4439
.1112
.0155
62-F2-11M
.0136
.6975
.1886
.0133
62-F2-13M
.0144
1.1044
.4619
.0290
62-F2-15M
.0150
.9551
.3989
.0137
62-F2-17M
.0244
.8588
.3100
.0411
62-F3-2M
.0150
.8103
.3901
.0380
62-F3-5M
.0163
.8377
.2537
.0269
Posterior Cricoarytenoid
Muscle
62-F2-1M
.0058
.4541
.0141
.1405
62-F2-3M
.0096
.5274
.0276
.2162
62-F2-5M
.0160
.6688
.0451
.2666

168
Table C-9--continued.
Structure
Slide ft 1
Area
(Sq.Inch)
Peri -
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial-
Lateral -
(Inch)
Posterior Cricoarytenoid
Muscle (cont.)
62-F2-7M
.0225
.7393
.0493
.2608
62-F2-9M
.0227
.7190
.0748
.2652
62-F2-11M
.0397
.9585
.0956
.3781
62-F2-13M
.0420
.9842
.0686
.3893
62-F2-15M
.0341
.8048
.0717
.2475
62-F2-17M
.0433
.9551
.0745
.3749
62-F3-2M
.0446
1.0855
.0854
.3811
62-F3-8M
.0760
1.2209
.2011
.3641
62-F3-11M
.1009
1.2970
.2449
.4290
62-F3-15M
.0894
1.2260
.1889
.4069
Thyroarytenoid Muscle
62-F3-2M
.0157
.5862
.0790
.1386
62-F3-5M
.0160
.5640
.1166
.1348
62-F3-8M
.0478
.8976
.2535
.2468
62-F3-11M
.0489
.8583
.2020
.2186
62-F3-15M
.0557
1.0647
.2301
.1138
62-F3-18M
.0922
1.7482
.6422
.2916
62-F4-3M
.0827
1.4783
.6461
.2065

169
Table C-10. Apparent Size of Structures/Specimen 5/Transverse
Plane/Right Medial Block
Structure
Slide ^ (Sq
Area
. Inch)
Peri -
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
Interarytenoideus Muscle
62-F2-10M
.0585
1.0400
.2115
.3359
62-F2-14M
.0827
1.2952
.1416
.4848
62-F2-18M
.0816
1.3716
.5896
.2332
62-F3-4M
.0854
1.3716
.2248
.5448
62-F3-8M
.0952
1.3919
.2488
.5082
62-F3-12M
.0900
1.2977
.1981
.5041
62-F3-16M
.0943
1.3961
.2515
.5366
Lateral Cricoarytenoid
Muscle
62-F2-18M
.0246
.7528
.3042
.0648
62-F3-4M
.0321
1.0137
.4225
.0598
62-F3-8M
.0316
1.0164
.4298
.0643
62-F3-12M
.0092
.5452
.2434
.0348
Posterior Cricoarytenoid
Muscle
62-F2-10M
.0145
.7847
.0591
.3591
62-F2-14M
.0397
1.2562
.0749
.5051
62-F2-18M
.0399
1.1909
.0813
.5852
62-F3-4M
.0537
1.2480
.0673
.5628
62-F3-8M
.0512
1.2649
.0724
.6040
62-F3-12M
.0519
1.2667
.0540
.6394
62-F3-16M
.0512
1.1885
.0960
.5795
62-F4-2M
.0458
1.1529
.0688
.4735
62-F4-6M
.0480
1.5524
.7461
.0453

170
Table C-10--continued.
Structure
Area
SI ide # (Sq.Inch)
Peri- Anterior-
meter Posterior
(Inch) (Inch)
Medial -
Lateral
(Inch)
Posterior Cricoarytenoid
Muscle (cont.)
62-F4-10M
.0279
1.0450
.0308
.4792
Thyroarytenoid Muscle
62-F3-4M
.0618
1.0381
.4014
.1302
62-F3-8M
.0904
1.2385
.3856
.2549
62-F3-12M
.0666
1.0906
.3607
.1465
62-F3-16M
.1198
1.7964
.6236
.2418
62-F4-2M
.0557
1.1424
.3796
.1388
62-F4-6M
.1440
1.8049
.7477
.1486
62-F4-10M
.1483
1.9740
.8886
.1927

171
Table C-ll. Apparent Size of Structures/Specimen 6/Coronal
Plane/Anterior Block
Peri- Inferior- Medial -
Area meter Superior Lateral-
Structure Slide H (Sq.Inch) (Inch) (Inch) (Inch)
Cricothyroid Muscle 69-F1-3A
69-F1-6A
69-F1-9A
69-FI11A
Thyroarytenoid Muscle 69-F1-6A
69-F1-9A
69-FI-11A
69-F1-14A
69-F1-18A
69-F2-3A
69-F2-7A
Conus Elasticus 69-F1-3A
69-F1-6A
69-F1-9A
0423L
0257R
1.0559L
.785 OR
.4241L
.2821R
. 1644L
. 1788 R
0361L
0375R
.88 98L
8846R
.3675L
.3619R
.1618L
. 1773 R
0407L
0188R
.9085L
5578R
.3779L
.2314R
.1390L
1046R
0413L
0386R
8529L
. 9445 R
.2779L
.36 5 3 R
.1984L
. 0920R
0970L
0616R
1.4748L
1.2871R
. 6581L
.5517 R
.2606L
.2035 R
0884L
0578R
1.3891L
1.0025R
-6411L
.35 95 R
.2156L
.174 9 R
0529L
0567R
1.2082L
1.1407R
.47 00L
.4605 R
. 1618L
. 1532 R
0581L
0422R
1.2176L
1.1760R
.5511L
.5 3 75 R
. 1658L
.1134 R
0248L
0262R
.7825L
. 8543R
.3381L
.321 OR
.1272L
- 07 2 2 R
0117 L
0071R
.4923L
. 46 32 R
.2081L
. 15 6 6 R
.0608L
0402R
0091L
0063R
.6005L
.4941R
.2796L
. 1882 R
.0443L
0847R
.4850L
4950R
.4298L
. 465 6 R
.5050R

172
Table C-ll--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral -
Structure Slide # (Sq.Inch) (Inch) (Inch) (Inch)
Surface Width of TVF
69-FI-3A
.0886L
.1360R
69-F1-6A
.0856L
.1089R
69-F1-9A
.1027L
.104 5 R
69-FI-11A
.1224L
.1294R
69-F1-14A
.1248L
69-F1-18A
. 1143 L
.1203R
69-F2-3A
.0791L
.0454R
Thyroid Cartilage
-- Distance between
69-F2-7A
.1312L
.0771R
Superior Apexes 69-F1-3A
69-F1-6A
69-F1-9A
69-FI-11A
69-F1-14A
69-F1-18A
69-F2-3A
.8727
.9350
.8642
.7961
.8022
.6770
.5754
69-F2-7A
6030

173
Table C-ll--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral-
Structure Slide# (Sq.Inch) (Inch) (Inch) (Inch)
Thyroid Cartilage
Distance between
Inferior Prominences
(cont.)
-- Height
69-F1-3A
.9503
69-F1-6A
.7585
69-F1-9A
.6616
69-FI-11A
.4373
69-F1-14A
.2930
69-F1-3A
1.0979L
1.0200R
69-F1-6A
.9975L
1.0020R
69-F1-9A
.9866L
1.0183R
69-FI-11A
1.0981L
1.0571R
69-F1-14A
1.1902L
1.1634R
69-F1-18A
1.1302L
1.1622R
69-F2-3A
1.0327L
.9248R
69-F2-3A
. 1013L
.0703R
69-F2-7A
1.0652L
1.1009R

174
Table C-ll--continued.
Structure
Peri- Inferior- Medial-
Area meter Superior Lateral -
Slide # (Sq.Inch) (Inch) (Inch) (Inch)
Thyroid Cartilage
-- Height
(cont.)
69-F2-10A .9674 L
1.0363R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
69-F1-3A .4531L
.3224R
69-F1-6A .4000L
. 321 OR
69-F1-9A .5661L
. 4996R
69-FI-11A .6472L
.65 99 R
69-F1-14A .4968L
.5458R
-- Phonatory Position
(glottal width/2)
69-F1-3A .0491
69-F1-6A .0435
69-F1-9A .0496
69-FI-11A .0422
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
69-F1-3A .2636 L
.27 22R
69-F1-6A .2405L
. 24 HR
69-F1-9A
1752L
1858R

175
Table C-ll--continued.
Structure
Slide § (Sq
Area
.Inch)
Peri
meter !
(Inch)
Inferior-
juperior
(Inch)
Med i a 1 -
Lateral -
(Inch)
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
(cont.)
69- FI -11A
. 1699L
.1313R
69-F1-14A
. 1518L
1030R
69-F1-18A
.1323L
. 1322 R
69-F2-3A
. 1013 L
.0703R
69-F2-7A
. 1513 L
. 1465 R
-- Area of Vibratory Mass
69-F1-3A
.1505L
.1349R
1.6719L
1.7276R
.5861L
. 5781R
.2778L
.27 5 7 R
69-F1-6A
.1467L
1280R
1.7024L
1.6996R
.7069L
.6406R
. 2443L
.2622 R
69-F1-9A
.1068L
. 1304R
1.4632L
1.5296R
.5427L
5089R
.2247L
.2268R
69-FI-11A
.1340L
.1649R
2.0242L
2.1098R
.7109L
.85 95 R
.2117 L
. 1547R
69-F1-14A
.0860L
. 1257R
1.7673L
1.9662R
.667 OL
7596R
.1542L
. 1804R
69-F1-18A
.0481L
.0444R
.9124L
.87 2 7 R
.3049L
.3020R
. 1341L
.1371R
69-F2-3A
.0377L
.0438R
.9847L
1.0827R
.4050L
.3659R
.1498L
.1623R

176
Table C-ll--continued.
Peri-
Inferior-
Medial-
Area
meter
Superior
Lateral -
Structure
SIide #
(Sq.Inch)
(Inch)
(Inch)
(Inch)
Vibratory Mass Measures
-- Area of Vibratory Mass
(cont.)
69-F2-7A
- 0218L
.6277L
. 1611L
.1621L
.0168R
.5663R
.1620R
.1489R
* L = left, R = right; no
letter =
neither L
nor R is
indicated

177
Table C-12. Apparent Size of Structures/Specimen 6/Coronal
Plane/Posterior Block
Structure
SI ide § (Sq
Area
.Inch)
Peri
meter !
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
Cricothyroid Muscle
69-F1-2P
.0472R
1.0663R
.4063R
. 1974R
69-F1-4P
.0428R
.97 25 R
. 3665 R
. 1464R
69-F1-7P
.0546L
.0717 R
1.7088L
1.4901R
.7649L
- 7 311R
. 1398L
. 1264R
69-F1-9P
.0544L
.0407R
1.4229L
1.1372R
.6149L
.50 7 3 R
.1108L
.0981R
69-F1-13P
.0493L
.0697 R
1.3687L
1.4686R
.6040L
.6230R
.0844L
.1000R
69-F1-18P
.0385L
0194R
1.1740L
.6718R
.5107L
. 1797R
.0829L
.0704R
69-F2-3P
.0395L
.0368R
1.2494L
1.2353R
.5163L
. 4214R
.1039L
0647R
69-F2-6P
.0226L
.0320R
.9795L
.9225R
4768L
. 35 52 R
.1005L
0933R
69-F2-10P
.0253L
.0949R
.9155 L
2.0353R
.3621L
.6819R
.0865L
. 1945 R
69-F2-15P
.0371L
1.0632L
.3877L
.0754L
69-F2-18P
.0266L
.8715 L
. 2922 L
.065 7 L
Interarytenoideus Muscle
69-F1-18P
.0824
1.5325
.6664
.1463
69-F2-3P
.0812
1.4533
.1294
.5563
69-F2-6P
.0665
1.4223
.1470
.6689
69-F2-15P
.0117
1.3473
.0565
.5235
Lateral Cricoarytenoid
Muscle
69-F1-2P
0185R
. 6965 R
. 1577 R
. 22 76 R

178
Table C-12--continued.
Structure
SI ide If (Sq
Area
. Inch)
Peri- Inferior-
meter Superior
(Inch) (Inch)
Medial -
Lateral
(Inch)
Lateral Cricoarytenoid
Muscle (cont.)
69-F1-4P
.0124R
. 5409R
.0883R
. 1424R
69-F1-7P
.0265R
.6778R
.1593R
.1709R
69-F1-9P
.0184 L
.0250R
.5942 L
.5981R
. 1774 L
.1783R
. 1243L
.1297R
Posterior Cricoarytenoid
Muscle
69-F1-9P
.0127 R
.52 71R
.1523R
.12 74 R
69-F1-13P
.0085R
.4 965 R
.2889R
.0374R
69-F1-18P
.0019R
.1735R
.06 3 2 R
.0361R
69-F2-3P
.0116R
.6776R
.2680R
.0492R
69-F2-6P
. 0103L
.0154R
.4830L
.56I8R
. 187 3L
.'2439R
. 07 21L
.0813R
69-F2-10P
.0182L
.0453R
.5877L
1.2600R
.1988L
.5153R
.0847L
.1030R
69-F2-15P
.0207L
.0343R
.6591L
1.1502R
.2227L
.4287 R
.0828L
.0591R
69-F2-18P
.0169L
.0507R
.5623L
1.3550R
.1866L
. 5274R
0788L
.0707R
69-F3-3P
.0431R
1.3322R
.7255R
.0525R
Thyroarytenoid Muscle
69-F1-2P
.1022R
1.5688R
5638R
. 3766R
69-F1-4P
.0626L
.0878R
1.1856L
1.3114R
.3766L
- 4027 R
.2166L
2693R
69-F1-7P
.0943L
.07 7 6 R
1.2069L
1.0273R
.3271L
.2211R
.3216L
. 2745 R
69-F1-9P
.0855L
.0430R
1.16241
- 9750R
.2908L
.2072 R
.3078L
.3886R

179
Table C-12--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral-
Structure
SIide # (Sq
. Inch)
(Inch)
(Inch)
(Inch)
Thyroarytenoid Muscle
(cont.)
69-F1-13P
. 1440L
. 09 HR
1.6525L
1.3250R
.4368L
.2666R
. 3540L
. 2842R
69-F1-18P
.0440L
.9372L
.2278L
.21971
69-F2-3P
.0340L
.0257R
.8465L
.7607R
2457 L
.1025R
.23361
. 2301R
69-F2-6P
.0267R
.7566R
.2215R
.2202R
Conus Elasticus
69-F1-2P
.5098R
69-F1-4P
.4962L
.4057R
69-F1-7P
.5012L
.3709R
69-F1-9P
.3667L
.2841R
69-F1-13P
.3120L
. 1821R
69-F1-18P
.37 22 L
. 167 OR
69-F2-3P
.2258L
.1003R
Thyroid Cartilage
Distance between
Superior Apexes
69-F1-2P
1.1672
69-F1-4P
1.0519
69-F1-7P
1.1302
69-F1-9P
.9925

180
Table C-12--continued.
Area
Structure Slide ft (Sq.Inch)
Peri- Inferior- Medial-
meter Superior Lateral -
(Inch) (Inch) (Inch)
Thyroid Cartilage
-- Distance between
Superior Apexes
(cont.) 69-F1-13P
.9274
69-F1-18P
1.1156
69-F2-3P
1.0556
69-F2-6P
1.1492
-- Distance between
Inferior Prominences 69-F1-2P
1.0454
69-F1-4P
.9038
69-F1-7P
.9197
69-F1-9P
.8742
69-FI-13 P
.8687
69-F1-18P
.9310
69-F2-3P
1.0116
69-F2-6P
1.0263
69-F2-10P
1.0663
Height 69-F1-2P
1.1427L
9682R
69-F1-4P
.9076L
. 847 7 R
69-F1-7P
.9845L
.7946 R
69-F1-9P
.8591L
.7325R

181
Table C-12--continued.
Peri- Inferior- Medial -
Area meter Superior Lateral -
Structure Slide ft (Sq.Inch) (Inch) (Inch) (Inch)
Thyroid Cartilage
-- Height
69-F1-13P
.85 51L
.7860R
69-F1-18P
.8246L
1.0152R
69-F2-3P
.7179L
1.0053R
69-F2-6P
1.2155R
69-F2-10P
.3500R
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
69-F1-2P
. 37 66R
69-F1-4P
. 3246L
.3558R
69-F1-7P
.3545L
3877R
69-F1-9P
. 2 6 54 L
. 2974 R
69-F1-13P
.3703L
.3425R
69-F1-18P
.2259L
69-F2-3P
2497 L
.1874R
-- Area of Vibratory Mass
69-F1-2P
.1725R
2.0100R
.5812R
.4071R
59-F1-4P
. 1393L
.1650R
1.7387L
1.7960R
- 5517 L
.4415R
.3498L
.3558R

Table C-12--continued
Structure
SI ide if
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral -
(Inch)
Vibratory Mass Measures
-- Area of Vibratory Mass
(cont.)
69-F1-7P
. 1630L
.1287R
1.8518L
1.4590R
. 5286 L
.3384R
.5006L
.3960R
69-F1-9P
.1527L
.1989R
1.7791L
2.0116R
.5105L
.4738R
.3318L
3112R
69-F1-13P
.1847L
.1865R
2.2236L
2.0105R
.4752L
.4171R
4684L
. 3842 R
69-F1-18P
.0769L
1.3278L
.2761L
.2284L
69-F2-3P
.07 68L
1.2560L
.2480L
. 3079L
* L = left, R = right; no letter = neither L nor R is indicated

SUMMATION:
APPENDIX D
THE MISSING DIMENSION DUE TO DISSECTION PLANE

Table D-l. Apparent Size of Structure/Specimen 1/Sagittal Plane/Left
Block
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Medial
to Lateral
Distance
Cricothyroid Muscle
75-F2-14L
to
75-F3-1L
5
35
microns
1050 microns
or
1.05 mm
Interarytenoideus Muscle
75-F1-5L
to
75-F2-5L
5
35
microns
3325 microns
or
3.325 mm
Lateral Cricoarytenoid
Muscle
75-F2-14L
(only in
1 slide)
5
35
microns
175 microns
or
.175 mm
Posterior Cricoarytenoid
Muscle
75-F1-9L
to
75-F3-1L
5
35
microns
1925 microns
or
1.925 mm
Thyroarytenoid Muscle
75-F1-13L
to
75-F3-14L
5
35
microns
6650 microns
or
6.65 mm
Conus Elasticus
75-F2-14L
5
35
microns
175 microns
or
.175 mm
Posterior Cricoarytenoid
Li gament
75-F1-13L
to
75-F2-9L
5
35
microns
2625 microns
or
2.625 mm
NOTE: Sagittal Plane: The missing dimension
the medial-1ateral distance. This table is a
dictated by
summation of
this plane is
that
distance.
184

185
Table D-2. Apparent Size
Block
of Structure/Specimen
1/Sagittal
PI ane/Right
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Medial
to Lateral
Distance
Cricothyroid Muscle
75-F2-9R
to
75-F3-17R
5
35
microns
4725 microns
or
4.725 mm
Interarytenoideus Muscle
75-F2-18R
to
75-F3-17R
5
35
microns
3150 microns
or
3.15 mm
Lateral Cricoarytenoid
Muscle
75-F1-14R
to
75-F2-3R
5
35
microns
1400 microns
or
1.4 mm
Posterior Cricoarytenoid
Muscle
75-F1-10R
to
75-F3-17R
5
35
microns
7700 microns
or
7.7 mm
Thyroarytenoid Muscle
75-F1-7R
to
75-F3-17R
5
35
microns
8225 microns
or
8.225 mm
Anterior Cricoarytenoid
Li gament
75-F1-18R
to
75-F3-13R
5
35
microns
5600 microns
or
5.6 mm
Posterior Cricoarytenoid
Li gament
75-F3-13R
5
35
microns
175 microns
or
.175 mm
Thyroid Cartilage
75-F1-10R
to
75-F4-6R
5
35
microns
8925 microns
or
8.925 mm
NOTE: Sagittal Plane: The missing dimension dictated by this plane is
the medial-1ateral distance. This table is a summation of that
distance.

186
Table D-3. Apparent Size of Structure/Specimen 2/Transverse
Piane/Superior Block
Structure
SI i de
Range
Number of
Microtome
Passes
Unit of
Measure
Total Inferior
to Superior
Distance
Interarytenoideus Muscle
48-F1-1S
to
48-F2-5S
10
35
microns
8050 microns
or
8.05 mm
Lateral Cricoarytenoid
Muscle
48-FI-IS
to
48-F1-7S
10
35
microns
2450 microns
or
2.45 mm
Posterior Cricoarytenoid
Muscle
48-FI-IS
to
48-F1-9S
10
35
microns
3150 microns
or
3.15 mm
Thyroarytenoid Muscle
48-F1-3S
to
48-F2-11S
10
35
microns
9450 microns
or
9.45 mm
Posterior Cricoarytenoid
Ligament
48-F1-11S
10
35
microns
350 microns
or
.35 mm
NOTE: Transverse Plane: The missing dimension dictated by this plane
is the inferior-superior distance. This table is a summation of that
distance.

187
Table D-4. Apparent Size of Structure/Specimen 2/Transverse
Plane/Medial Block
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Inferior
to Superior
Distance
Cricothyroid Muscle
48-F1-4M
to
48-F2-4M
10
35
microns
6650 microns
or
6.65 mm
Lateral Cricoarytenoid
Muscle
48-F1-2M
to
48-F2-4M
10
35
microns
7350 microns
or
7.35 mm
Posterior Cricoarytenoid
48-F1-2M
to
48-F2-4M
10
35
microns
7350 microns
or
7.35 mm
Thyroarytenoid Muscle
48-F1-2M
10
35
microns
350 microns
or
.35 mm
NOTE: Transverse Plane: The missing dimension dictated by this plane
is the inferior-superior distance. This table is a summation of that
distance.

188
Table D-5. Apparent Size
Block
of Structure/Specimen
3/Coronal
PIane/Anterior
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Anterior
to Posterior
Distance
Cricothyroid Muscle
46-F1-4A
to
46-F3-9A
5
35
microns
7350 microns
or
7.35 mm
Lateral Cricoarytenoid
Muscle
46-F2-1A
to
46-F2-13A
5
35
microns
2275 microns
or
2.275 mm
Thyroarytenoid Muscle
46-F1-4A
to
46-F3-9A
5
35
microns
7350 microns
or
7.35 mm
Thyromuscularis Bundle
of Thyroarytenoid
46-F3-5A
5
35
microns
175 microns
or
.175 mm
Thyrovocalis Bundle
of Thyroarytenoid
46-F3-5A
5
35
microns
175 microns
or
.175 mm
Conus Elasticus
46-F1-4A
to
46-F2-18A
5
35
microns
5775 microns
or
5.775 mm
Surface of TYF
46-F1-4A
to
46-F3-9A
5
35
microns
7350 mcirons
or
7.35 mm
Thyroid Cartilage--
Superior Apexes Present
46-F1-4A
to
46-F4-12A
5
35
microns
11025 microns
or
11.025 mm
Thyroid Cartilage-
Inferior Prominences
Present
46-F1-4A
to
46-F4-12A
5
35
microns
11025 microns
or
11.025 mm
Body of Thyroid Cartilage
46-F1-4A
to
45-F4-12A
5
35
microns
11025 microns
or
11.025 mm

189
Table D-5continued.
Structure
SI i de
Range
Number of
Microtome
Passes
Unit of
Measure
Total Anterior
to Posterior
Distance
Vibratory Mass-
Cricoid to TVF
46-F1-4A
to
46-F3-14A
5
35
microns
8225 microns
or
8.225 mm
Phonatory Position-
Presence of Glottal
Aperture
46-F1-4A
to
46-F3-14A
5
35
microns
8225 microns
or
8.225 mm
Vibratory Mass-
Thyroarytenoid to
Thyroid Cartilage
46-F1-4A
to
46-F3-9A
5
35
microns
7350 microns
or
7.35 mm
Area of Vibratory Mass
46-F1-4A
to
46-F3-9A
5
35
microns
7350 microns
or
7.35 mm
NOTE: Coronal Plane: The missing dimension dictated by this plane is
the anterior-posterior distance. This table is a summation of that
distance.

190
Table D-6. Apparent Size of Structure/Specimen 3/Coronal
Plane/Posterior Block
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Anterior
to Posterior
Distance
Cricothyroid Muscle
46-F1-3P
to
46-F3-14P
5
35
microns
8400 microns
or
8.4 mm
Interarytenoideus Muscle
46-F2-16P
to
46-F4-6P
5
35
microns
4725 microns
or
4.725 mm
Lateral Cricoarytenoid
Muscle
46-F1-14P
to
45-F2-16P
5
35
microns
3675 microns
or
3.675 mm
Posterior Cricoarytenoid
Muscle
46-F1-14P
to
46-F4-6P
5
35
microns
8225 microns
or
8.225 mm
Thyroarytenoid Muscle
46-F1-3P
to
46-F2-16P
5
35
microns
5600 microns
or
5.6 mm
Conus Elasticus
46-F1-3P
to
46-F2-11P
5
35
microns
4725 microns
or
4.725 mm
Surface TVF
46-F1-3P
5
35
microns
175 microns
or
.175 mm
Thyroid Cartilage--
Superior Apexes Present
46-F1-3P
to
46-F3-14P
5
35
microns
8400 microns
or
8.4 mm
Thyroid Cartilage--
Inferior Prominences
Present
46-F1-3P
to
46-F3-9P
5
35
microns
7525 microns
or
7.525 mm
Body of Thyroid Cartilage
46-F1-3P
to
46-F4-11P
5
35
microns
11025 microns
or
11.025 mm
Vibratory Mass--
Cricoid to TVF
46-F1-3P
to
46-F1-9P
5
35
microns
350 microns
or
.35 mm

191
Table D-6--continued.
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Anterior
to Posterior
Distance
Phonatory Position-
Presence of Glottal
Aperture
46-F1-3P
to
46-F3-9P
5
35
microns
7525 microns
or
7.525 mm
Vibratory Mass-
Thyroarytenoid to
Thyroid Cartilage
46-F1-3P
to
46-F2-16P
5
35
microns
5600 microns
or
5.6 mm
Area of Vibratory Mass
46-F1-3P
to
46-F2-16P
5
35
microns
5600 microns
or
5.6 mm
NOTE: Coronal Plane: The missing dimension dictated by this plane is
the anterior-posterior distance. This table is a summation of that
distance.

192
Table D-7. Apparent Size
Block
of Structure/Specimen
4/Sagittal
Plane/Left
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Medial
to Lateral
Di stance
Cricothyroid Muscle
68-F5-1L
to
68-F5-9L
10
35
microns
31500 microns
or
31.5 mm
Interarytenoideus Muscle
68-F1-7L
to
68-F4-8L
10
35
microns
19600 microns
or
19.6 mm
Lateral Cricoarytenoid
Muscle
68-F5-1L
to
68-F5-2L
10
35
microns
700 microns
or
.7 mm
Posterior Cricoarytenoid
Muscle
68-F3-2L
to
68-F5-2L
10
35
microns
12950 microns
or
12.95 mm
Thyroarytenoid Muscle
68-F3-2L
to
68-F5-2L
10
35
microns
12950 microns
or
12.95 mm
Anterior Cricothyroid
Ligament
68-F2-7L
10
35
microns
350 microns
or
.35 mm
Posterior Cricothyroid
Ligament
68-F3-4L
to
68-F3-9L
10
35
microns
2100 microns
or
2.1 mm
Thyroid Cartilage
68-F3-2L
to
68-F5-9L
10
35
microns
15400 microns
or
15.4 mm
NOTE: Sagittal Plane: The missing dimension dictated by this plane is
the medial-lateral distance. This table is a summation of that
distance.

193
Table D-8. Apparent Size
Block
of Structure/Specimen
4/Sagittal
Plane/Right
Structure
SI i de
Range
Number of
Microtome
Passes
Unit of
Measure
Total Medial
to Lateral
Distance
Cricothyroid Muscle
68-F7-4R
to
68-F8-13R
10
35
microns
9800 microns
or
9.8 mm
Interarytenoideus Muscle
68-F8-1R
to
68-F8-4R
10
35
microns
1400 microns
or
1.4 mm
Lateral Cricoarytenoid
Muscle
68-F8-1R
to
68-F8-4R
10
35
microns
1400 microns
or
1.4 mm
Posterior Cricoarytenoid
Muscle
68-F6-1R
to
68-F8-4R
10
35
microns
14000 microns
or
14 mm
Thyroarytenoid Muscle
68-F6-1R
to
68-F8-1R
10
35
microns
12950 microns
or
12.95 mm
Height of TVF
68-F6-1R
to
68-F7-4R
10
35
microns
7700 microns
or
7.7 mm
Thyroid Cartilage
63-F6-1R
to
68-F8-7R
10
35
microns
15050 microns
or
15.05 mm
NOTE: Sagittal Plane: The missing dimension dictated by this plane is
the medial-lateral distance. This table is a summation of that
distance.

194
Table D-9. Apparent Size of Structure/Specimen 5/Transverse Plane/Left
Medial Block
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Inferior
to Superior
Distance
Cricothyroid Muscle
62-F3-8M
to
62-F3-18M
5
35
microns
1925 microns
or
1.925 mm
Interarytenoideus Muscle
62-F3-2M
to
62-F3-8M
5
35
microns
1225 microns
or
1.225 mm
Lateral Cricoarytenoid
Muscle
62-F2-5M
to
62-F3-5M
5
35
microns
3325 microns
or
3.325 mm
Posterior Cricoarytenoid
Muscle
62-F2-1M
to
62-F3-15M
5
35
microns
5775 microns
or
5.775 mm
Thyroarytenoid Muscle
62-F3-2M
to
62-F4-3M
5
35
microns
3500 microns
or
3.5 mm
NOTE: Transverse Plane: The missing dimension dictated by this plane
is the inferior-superior distance. This table is a summation of that
distance.

195
Table D-10. Apparent Size of Structure/Specimen 5/Transverse
Plane/Right Medial Block
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Inferior
to Superior
Distance
Interarytenoideus Muscle
62-F2-10M
to
62-F3-16M
5
35
microns
4375 microns
or
4.375 mm
Lateral Cricoarytenoid
Muscle
62-F2-18M
to
62-F3-12M
5
35
microns
2275 microns
or
2.275 mm
Posterior Cricoarytenoid
Muscle
62-F2-10M
to
62-F4-10M
5
10
microns
6475 microns
or
6.475 mm
Thyroarytenoid Muscle
62-F3-4M
to
62-F4-10M
5
35
microns
4375 microns
or
4.375 mm
NOTE: Transverse Plane: The missing dimension dictated by this plane
is the inferior-superior distance. This table is a summation of that
distance.

196
Table D-ll. Apparent Size of Structure/Specimen 6/Coronal
Plane/Anterior Block
Structure
SI i de
Range
Number of
Microtome
Passes
Unit of
Measure
Total Anterior
to Posterior
Distance
Cricothyroid Muscle
69-F1-3A
to
69-FI-11A
10
35
microns
3150 microns
or
3.15 mm
Thyroarytenoid Muscle
69-F1-6A
to
69-F2-7A
10
35
microns
7000 microns
or
7.0 mm
Conus Elasticus
69-F1-3A
to
69-F1-9A
10
35
microns
2450 microns
or
2.45 mm
Surface of TVF
69-F1-3A
to
69-F2-7A
10
35
microns
8050 microns
or
8.05 mm
Thyroid Cartilage-
Superior Apexes Present
69-F1-3A
to
69-F2-7A
10
35
microns
8050 microns
or
8.05 mm
Thyroid Cartilage-
Inferior Prominences
Present
69-F1-3A
to
69-F1-14A
10
35
microns
4200 microns
or
4.2 mm
Body of Thyroid Cartilage
69-F1-3A
to
69-F2-10A
10
35
microns
9100 microns
or
9.1 mm
Vibratory Mass-
Cricoid to TVF
69-F1-3A
to
69-F1-14A
10
35
microns
4200 microns
or
4.2 mm
Phonatory Position-
Presence of Glottal
Aperture
69-F1-3A
to
69-FI-11A
10
35
microns
3150 microns
or
3.15 mm
Vibratory Mass-
Thyroarytenoid to
Thyroid Cartilage
69-F1-3A
to
69-F2-7A
10
35
microns
8050 microns
or
8.05 mm

Table D-ll--continued
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Anterior
to Posterior
Distance
Area of Vibratory Mass
69-F1-3A
10
35
8050 microns
to
microns
or
69-F2-7A
8.05 mm
NOTE: Coronal Plane: The missing dimension dictated by this plane is
the anterior-posterior distance. This table is a summation of that
distance.

198
Table D-12. Apparent Size of Structure/Specimen 6/Coronal
Plane/Posterior Block
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Anterior
to Posterior
Distance
Cricothyroid Muscle
69-F1-2P
to
69-F2-18P
10
35
microns
12250 microns
or
12.25 mm
Interarytenoideus Muscle
69-F1-18P
to
69-F2-15P
10
35
microns
5600 microns
or
5.6 mm
Lateral Cricoarytenoid
Muscle
69-F1-2P
to
69-F1-9P
10
35
microns
2800 microns
or
2.8 mm
Posterior Cricoarytenoid
Muscle
69-F1-9P
to
69-F3-3P
10
35
microns
10850 microns
or
10.85 mm
Thyroarytenoid Muscle
69-F1-2P
to
69-F2-6P
10
35
microns
8050 microns
or
8.05 mm
Conus Elasticus
69-F1-2P
to
69-F2-3P
10
35
microns
7000 microns
or
7.0 mm
Thyroid Cartilage
Superior Apexes Present
69-F1-2P
to
69-F2-6P
10
35
microns
8050 microns
or
8.05 mm
Thyroid Cartilage-
Inferior Prominences
Present
69-F1-2P
to
69-F2-10P
10
35
microns
9450 microns
or
9.45 mm
Body of Thyroid Cartilage
69-F1-2P
to
69-F2-10P
10
35
microns
9450 microns
or
9.45 mm
Vibratory Mass-
Thyroarytenoid to
Thyroid Cartilage
69-F1-2P
to
69-F2-3P
10
35
microns
7000 microns
or
7.0 mm

199
Table D-12--continued.
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Anterior
to Posterior
Distance
Area of Vibratory Mass
69-F1-2P
10
35
7000 microns
to
microns
or
69-F2-3P
7.0 mm
NOTE: Coronal Plane: The missing dimension dictated by this plane is
the anterior-posterior distance. This table is a summation of that
distance.

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BIOGRAPHICAL SKETCH
T. L. Hardee was born in Aurora, Illinois, in the not so recent
past. Educational experiences included a brief acquaintance with the
Austrian countryside, a high school graduation from Riverview High
School in Sarasota, Florida, and then on to the University of South
Florida in Tampa, Florida, which culminated in the attainment of the
Master of Science degree in speech pathology. Educational process
continued as an interest in research necessitated the pursuit of the
Ph.D. in speech at the University of Florida, Gainesville. Miss
Hardee is a member of the American Speech-Language Hearing Association
and is both a Hobie sailor and a white-water enthusiast.
205

I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is
fully adequate, in scope and quality, as a dissertation for the degree
of Doctor of Philosophy.
Thomas B.
Professor
Abbott, Chairman
of Speech
I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is
fully adequate, in scope and quality, as a dissertation for the degree
of Doctor of Philosophy.
Distinguished Service Professor
Emeritus of Speech
I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is
fully adequate, in scope and quality, a^a dissertation for the degree
of Doctor of Philosophy.
I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is
fully adequate, in scope and quality, as a dissertation for the degree
of Doctor of Philosophy.
0
jCusisvCU,j J' j /r-
Russell M. Bauer/
&
£lu>q
Associate Professor of Clinical
Psychology

I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is
fully adequate, in scope and quality, as a dissertation for the degree
of Doctor of Philosophy.
This dissertation was submitted to the Graduate Faculty of the
Department of Speech in the College of Liberal Arts and Sciences and
to the Graduate School and was accepted as partial fulfillment of the
requirements for the degree of Doctor of Philosophy.
December, 1985
Dean, Graduate School



152
Table C-5--continued.
Area
Structure Slide tf (Sq.Inch)
Peri- Inferior- Medial-
meter Superior Lateral-
(Inch) (Inch) (Inch)
Thyroid Cartilage
-- Height
(cont.) 46-F3-9A
1.0588L
. 9675R
46-F3-14A
1.0165L
.9474R
46-F4-2A
.9398L
.9642R
46-F4-7A
. 7190L
. 6855 R
45-F4-12A
.7071L
. 707 7 R
Vibratory Mass Measures
-- Height from Cricoid
to TVF 46-F1-4A
. 34 76 L
.4152 R
46-F1-8A
.3535L
.421OR
46-FI-11A
.2961L
- 36 91R
46-F1-14A
.3546L
4081R
46-F2-1A
.4183 L
. 5035R
46-F2-6A
.4220L
.5214R
46-F2-13A
.5190L
.585 7 R
46-F2-18A
.6422L
6880R


199
Table D-12--continued.
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Anterior
to Posterior
Distance
Area of Vibratory Mass
69-F1-2P
10
35
7000 microns
to
microns
or
69-F2-3P
7.0 mm
NOTE: Coronal Plane: The missing dimension dictated by this plane is
the anterior-posterior distance. This table is a summation of that
distance.


142
Table C-3. Apparent Size of Structures/Specimen 2/Transverse
Plane/Superior Block
Peri- Anterior- Lateral-
Structure
SIide H (Sq
Area
. Inch)
meter Posterior
(Inch) (Inch)
Medial
(Inch)
Interarytenoideus Muscle
48-FI-IS
.1064L*
.0760R
1.8258L
1.6346R
.6315L
. 65 6 7 R
.1581L
.1489R
48-FI-11S
.0641
1.5353
.1575
.5488
48-F1-13S
.1213
1.8233
.1381
.7961
48-F1-15S
.0955
1.6081
.1082
.6586
48-F2-1S
.0873
1.6997
.0909
.7681
48-F2-3S
.0597
1.5798
.0721
.6667
48-F2-5S
.0432
1.4788
.0930
.6529
Lateral Cricoarytenoid
Muscle
48-FI-IS
. 0345 R
1.5641R
6469R
.0444R
48-F1-3S
.0330L
. 0402R
1.6164L
1.4805R
.6423L
. 6240R
.06 21L
.0344R
48-F1-5S
.0570L
0480R
1.4869L
1.5244R
.6105L
.6732R
.0855L
. 0499R
48-F1-7S
. 1457L
.0897 R
2.2453L
1.7136R
1.0320L
7249R
.1370L
. 1619R
Posterior Cricoarytenoid
Muscle
48-F1-1S
.03 2 0L
.0197R
1.0162L
.7225R
1025 L
.07 67R
.3930L
.2932R
48-F1-3S
.0255L
.0090R
. 7777L
.40 71R
.0713L
.0544R
.2 946 L
.2177 R
48-F1-5S
.0170L
.0060R
.7776L
.4200R
.0524L
. 035 9 R
.3097L
.1717R
48-F1-7S
.0092L
.0020R
.6432L
2769R
.0189L
0142R
.2546L
. 1242 R
48-F1-9S
.007 5 L
.5468L
.0211L
.2009L


I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is
fully adequate, in scope and quality, as a dissertation for the degree
of Doctor of Philosophy.
Thomas B.
Professor
Abbott, Chairman
of Speech
I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is
fully adequate, in scope and quality, as a dissertation for the degree
of Doctor of Philosophy.
Distinguished Service Professor
Emeritus of Speech
I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is
fully adequate, in scope and quality, a^a dissertation for the degree
of Doctor of Philosophy.
I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is
fully adequate, in scope and quality, as a dissertation for the degree
of Doctor of Philosophy.
0
jCusisvCU,j J' j /r-
Russell M. Bauer/
&
£lu>q
Associate Professor of Clinical
Psychology


36
while one directional parameter was totally void by definition of that
particular plane of dissection. This void in directional parameters
was thought of as the missing dimension. Some advantage did occur as
the result of serial sectioning by plane. Structures were seen in
their appropriate relation to other structures while their
configurations remained intact. The usage of different planes allowed
the same structure(s) to be viewed from different perspectives. The
tabular listings indicated that measures were not made on every
slide. Slides were chosen based on change evidenced in the structures
measured in the preceding slide as compared to how the same structures
appeared in the current slide and for clarity of boundaries.
Essentially Appendix B allows the identification and measurement of
structures on the surface of the remaining block. At any point in the
progression through the larynx, the appearance and/or disappearance of
structures of interest were known. It was as if one was examining the
surface of the remaining block and possessed the ability to proceed or
recede through the dissection.
The second set of tables is given in Appendix C. This set is
organized by the structure of interest. The first table again
addresses the left block of specimen 1, which was dissected in the
sagittal plane. The structure identified initially was that of the
cricothyroid muscle. Two slides are listed, 75-F2-14L and 75-F3-1L,
as containing the cricothyroid muscle in the left block of specimen
1. Measurement values are given for the area, perimeter, inferior-
superior, and anterior-posterior distance of the cricothyroid muscle
as it appeared in those two slides. The next structure of interest


APPENDIX C
APPARENT SIZE OF STRUCTURES
ARRANGED BY STRUCTURE ACROSS SLIDES


195
Table D-10. Apparent Size of Structure/Specimen 5/Transverse
Plane/Right Medial Block
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Inferior
to Superior
Distance
Interarytenoideus Muscle
62-F2-10M
to
62-F3-16M
5
35
microns
4375 microns
or
4.375 mm
Lateral Cricoarytenoid
Muscle
62-F2-18M
to
62-F3-12M
5
35
microns
2275 microns
or
2.275 mm
Posterior Cricoarytenoid
Muscle
62-F2-10M
to
62-F4-10M
5
10
microns
6475 microns
or
6.475 mm
Thyroarytenoid Muscle
62-F3-4M
to
62-F4-10M
5
35
microns
4375 microns
or
4.375 mm
NOTE: Transverse Plane: The missing dimension dictated by this plane
is the inferior-superior distance. This table is a summation of that
distance.


67
closest to Figure 10 (46-F3-12P) were that of slide 46-F3-14P. These
data were taken in conjunction with the data presented in slide
46-F2-16P which was previously chosen as closest to Figure 9
(46-F3-2P) and compared. Examination indicated area values for the
posterior cricoarytenoid and interarytenoideus muscles were increased
in Figure 10 as compared to Figure 9, whereas the values for the
cricothyroid muscle decreased. The lateral cricoarytenoid muscle was
no longer present. Cartilaginous measures indicated the distance
between the superior apexes had decreased as had the height of the
thyroid cartilage. Visual inspection revealed the presence of the
inferior pharyngeal constrictor muscle, fragmented thyroid cartilage
with separate superior cornu, the remnants of the right arytenoid
cartilage and a very prevalent cricoid cartilage.
Figure 11 (48-F2-7S) represents the seventh slide on film two of
the superior block of specimen 2. Specimen 2 was a transverse
dissection specimen. Specific structures of interest included the
thyroarytenoid muscles, arytenoid and thyroid cartilages. Since this
was a transverse dissection specimen it was cut into three blocks
before serial sectioning and the surface of least interest was mounted
face down on the block. This block was dissected from its inferior
surface proceeding in a superior direction. Primary structures of
interest were the thyroarytenoid muscles while the arytenoid and
thyroid cartilage served as landmarks. Measurement data were
generated only on the thyroarytenoid muscles. Visual inspection
revealed a winged cartilaginous appearance.


75
tracing the course of a particular muscle while transition in other
structures was noted. Each muscle was treated singularly, but was
viewed in relation to other musculature. Specific muscles were
selected out but not removed from their natural habitats. Each
identifiable soft tissue structure of interest was identified and
measured. This involved area, perimeter and directional parameters of
inferior to superior, medial to lateral and the anterior to posterior
dimensions. Tabular data incorporated in the appendices reflected the
establishment of this basic normative data base. Subsequently the
same treatment was given to all other soft tissue structures of
interest within a given slide of the remaining block. Muscular course
or range was also noted. Although this study addressed intrinsic
laryngeal musculature, certain non-muscular structures such as
cartilages were utilized primarily as landmarks. The vibratory mass
and various aspects of that mass were described in the text but not
demarcated on the illustrations. All together these serial successive
progressive steps resulted in quantifiable data on adult male
intrinsic laryngeal musculature generated to assess the celloidin
block embedding technique.
The information available in the tables clearly indicated
transition occurred in the size of the various intrinsic
musculature. The illustrations, to some degree, capture the
configurational transition in some of the same structures. Although
these transitions perhaps would have been more evident if it had been
possible to include all'the available Kodak 35mm slides of each
specimen in serial section, and thereby witness the quantitative


92
Table B-4. Apparent Size of Structures/Specimen 2/Transverse
Plane/Medial Block
Slide #
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial-
Lateral
(Inch)
48-FI-2M
Posterior Cricoarytenoid
Muscle
0466L*
.0279R
1.1083L
.8675R
. 1314 L
.0664R
.4178L
.3010R
Lateral Cricoarytenoid
Muscle
.0282L
.0124R
1.1542L
.7009R
.3064 L
.2680R
.0321L
.0485R
Thyroarytenoid Muscle
.0357L
1.1863L
.4688L
.0552L
48-F1-4M
Posterior Cricoarytenoid
Muscle
.0540 L
.0394R
1.3120L
1.1178R
.1415 L
.1263R
.6152 L
4763R
Lateral Cricoarytenoid
Muscle
.0316 L
.0418R
1.1355L
1.1833R
.57 90L
.3971R
.07 07 L
. 2564R
Cricothyroid Muscle
.0951L
.0557R
1.9443L
1.6339R
.7280L
.7107 R
.1401L
. 1087R
48-F1-6M
Posterior Cricoarytenoid
Muscle
.0481L
.0366R
1.1443L
1.0786R
.1418L
.1202R
. 5226L
.4 64 2 R
Lateral Cricoarytenoid
Muscle
.0317 L
.0320R
1.1873L
1.2678R
.5499L
4924R
.1168L
.1328R
Cricothyroid Muscle
.1165L
1.9706L
8813L
.1294L
48-F1-8M
Posterior Cricoarytenoid
Muscle
.02 7 7 L
.02 79R
.8981L
8293R
.0741L
.0580R
.36 91L
.3159R
Lateral Cricoarytenoid
Muscle
. 027 7 L
.0267R
.9813 L
1.1356R
.33 76 L
.4038R
.0784L
.0655R
Cricothyroid Muscle
.0744L
1.9001L
.7335L
.0680L


151
Table C-5--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral -
Structure Slide if (Sq.Inch) (Inch) (Inch) (Inch)
Thyroid Cartilage
-- Distance between
Inferior Prominences
(cont.)
-- Height
46-F3-5A
.4602
46-F3-9A
.3993
46-F3-14A
.3175
46-F4-2A
.1519
46-F4-7A
.2040
46-F4-12A
.1908
46-F1-4A
1.2024L
1.2296R
46-F1-8A
1.1018L
1.0777R
46-FI11A
1.2295L
1.1238R
46-F1-14A
1.2341L
1.0196R
46-F2-1A
1 36 01L
1.1250R
46-F2-6A
1.3680L
1.1036R
46-F2-13A
1.2130L
1.0039R
46-F2-18A
1.2609L
1.0358R
46-F3-5A
1.1228L
.9953R


122
Table B-10--continued.
SI ide ft
Structure (Sq
Area
. Inch)
Peri -
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
62-F3-12M
(cont.)
Interarytenoideus Muscle
.0900
1.2977
.1981
.5041
Thyroarytenoid Muscle
.0666
1.0906
.3607
.1465
62-F3-16M
Posterior Cricoarytenoid
Muscle
.0512
1.1885
.0960
.5795
Interarytenoideus Muscle
.0943
1.3961
.2515
.5366
Thyroarytenoid Muscle
.1198
1.7964
.6236
.2418
62-F4-2M
Posterior Cricoarytenoid
Muscle
.0458
1.1529
.0688
.4735
Thyroarytenoid Muscle
.0557
1.1424
.3796
.1388
62-F4-6M
Posterior Cricoarytenoid
Muscle
.0480
1.5524
.7461
.0453
Thyroarytenoid Muscle
.1440
1.8049
.7477
.1486
62-F4-10M
Posterior Cricoarytenoid
Muscle
.0279
1.0450
.0308
.4792
Thyroarytenoid Muscle
.1483
1.9740
.8886
.1927


26
Measurement to the level of the superior border of the cricoid
cartilage was as stated unless there was an obvious muscle boundary
just lateral and inferior to the apex of the cricoid cartilage. This
concept was considered useful since it was considered that more than
the thyroarytenoid musculature vibrated during sound production.
Hence, these measures were taken in an attempt to quantify the
approximate size of such a mass in healthy adult male specimens. It
was of course impossible to state the exact size of such a mass, as
well as to account for individual variation.
The phonatory position was simply a measure of the glottal width
divided in half. In theory each healthy vocal fold did approximate to
midline. The phonatory position therefore represented the distance
each fold moved medially in order to approximate at midline. In
essence this measure quantified the cadaveric position of the vocal
folds and from that point estimated the distance of medial movement
necessary for sound to be generated. It was also necessary to keep in
mind that this potential displacement was merely an approximate value
since the tissue had been altered due to chemical processing, and
shrinkage.
Measures for all structures were generally secured by moving the
tracing point in a superior to inferior, medial to lateral and/or
anterior to posterior direction. Care was taken to proceed slowly to
allow the Apple He computer to keep pace with the Versawriter
Graphics tablet. Consistency in speed or rate of movement of the
tablet arm as well as consistent sensitivity to pressure were
maintained. Periodic reliability checks were made in an effort to


155
Table C-5--continued.
Structure
SIide §
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral -
(Inch)
Vibratory Mass Measures
-- Area of Vibratory Mass
(cont.)
46-F2-1A
-1402 L
.1553R
1.4667 L
1.7744R
4280L
.6815R
. 3187 L
. 2117 R
46-F2-6A
.1506L
. 1063R
1.7656L
1.3258R
.4801L
.5412 R
.30041
. 2147R
46-F2-18A
.1048L
0768R
1.3948L
1.2301R
.47 OIL
.4454R
.2195 L
. 1356R
45-F3-5A
.0502L
0633R
9391L
.12287R
.3079L
.3050R
.1294L
. 1161R
46-F3-9A
.0458L
.0383R
.9668L
. 9337 R
.2947L
.3000R
. 1682L
. 1577 R
* L = left, R = right; no letter = neither L nor R is indicated


Figure 3. Slide 46-F2-4A/Specimen 3/Coronal Plane/Anterior Block
en
CO


193
Table D-8. Apparent Size
Block
of Structure/Specimen
4/Sagittal
Plane/Right
Structure
SI i de
Range
Number of
Microtome
Passes
Unit of
Measure
Total Medial
to Lateral
Distance
Cricothyroid Muscle
68-F7-4R
to
68-F8-13R
10
35
microns
9800 microns
or
9.8 mm
Interarytenoideus Muscle
68-F8-1R
to
68-F8-4R
10
35
microns
1400 microns
or
1.4 mm
Lateral Cricoarytenoid
Muscle
68-F8-1R
to
68-F8-4R
10
35
microns
1400 microns
or
1.4 mm
Posterior Cricoarytenoid
Muscle
68-F6-1R
to
68-F8-4R
10
35
microns
14000 microns
or
14 mm
Thyroarytenoid Muscle
68-F6-1R
to
68-F8-1R
10
35
microns
12950 microns
or
12.95 mm
Height of TVF
68-F6-1R
to
68-F7-4R
10
35
microns
7700 microns
or
7.7 mm
Thyroid Cartilage
63-F6-1R
to
68-F8-7R
10
35
microns
15050 microns
or
15.05 mm
NOTE: Sagittal Plane: The missing dimension dictated by this plane is
the medial-lateral distance. This table is a summation of that
distance.


CHAPTER III
RESULTS
The current study assessed the utility of the intact celloidin
embedded specimen block as a photographed medium for generating
representative measures of the intrinsic laryngeal musculature.
Serial sectioning of the intact block was conducted in three planes of
dissection, coronal, sagittal, and transverse.
Some Aspects of Measurement
Structures were consistently measured throughout the progression
into or out of the larynx as long as clear boundaries were
identifiable. Absence of a measurement indicated the boundaries were
either obscure or that the structure of interest ceased to exist in a
given specimen. Utilization of the celloidin embedding, serial
sectioning and topical block staining techniques did indeed make it
possible to view and measure the structures of interest in relation to
one another as well as in relation to cartilage. The course of a
given intrinsic laryngeal muscle as well as transition in its size and
shape distribution were revealed via serial sectioning. Changes in
size were corroborated by the area, perimeter, anterior to posterior,
medial to lateral and inferior to superior measures generated. These
values were listed in the attached appendices. For further
demonstration of structural change illustrations were included
24


188
Table D-5. Apparent Size
Block
of Structure/Specimen
3/Coronal
PIane/Anterior
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Anterior
to Posterior
Distance
Cricothyroid Muscle
46-F1-4A
to
46-F3-9A
5
35
microns
7350 microns
or
7.35 mm
Lateral Cricoarytenoid
Muscle
46-F2-1A
to
46-F2-13A
5
35
microns
2275 microns
or
2.275 mm
Thyroarytenoid Muscle
46-F1-4A
to
46-F3-9A
5
35
microns
7350 microns
or
7.35 mm
Thyromuscularis Bundle
of Thyroarytenoid
46-F3-5A
5
35
microns
175 microns
or
.175 mm
Thyrovocalis Bundle
of Thyroarytenoid
46-F3-5A
5
35
microns
175 microns
or
.175 mm
Conus Elasticus
46-F1-4A
to
46-F2-18A
5
35
microns
5775 microns
or
5.775 mm
Surface of TYF
46-F1-4A
to
46-F3-9A
5
35
microns
7350 mcirons
or
7.35 mm
Thyroid Cartilage--
Superior Apexes Present
46-F1-4A
to
46-F4-12A
5
35
microns
11025 microns
or
11.025 mm
Thyroid Cartilage-
Inferior Prominences
Present
46-F1-4A
to
46-F4-12A
5
35
microns
11025 microns
or
11.025 mm
Body of Thyroid Cartilage
46-F1-4A
to
45-F4-12A
5
35
microns
11025 microns
or
11.025 mm


96
Table B-5--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
46-F1-8A
) Conus Elasticus
.47 64 L
. 5 311R
Surface Width of TVF
. 1908L
. 1868R
Thyroid Cartilage
-- Distance between
Superior Apexes
1.0641
-- Distance between
Inferior Prominences
1.2651
-- Height
1.1018L
1.0777R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
.3 5 35 L
.421OR
-- Phonatory Position
(glottal width/2)
.0667
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
. 3201L
.2064R
-- Area of Vibratory Mass
. 16 51L
. 1384 R
1.5717L
1.4454R
.3560L
4099R
.3683 L
.2742R
11A Cricothyroid Muscle
.0328L
1.2800L
5131L
. 1669L
Thyroarytenoid Muscle
. 07 76 L
.0690R
1.1051L
1.0829R
. 3325L
.3823R
. 2914L
.1982R
Conus Elasticus
. 4 716 L
.55 91R
Surface Width of TVF .1489L
.1563R


139
Table C-2. Apparent Size of Structures/Specimen 1/Sagittal Plane/Right
Block
Peri- Inferior- Anterior-
Area meter Superior Posterior
Structure Slide# (Sq.Inch) (Inch) (Inch) (Inch)
Cricothyroid Muscle 75-F2-9R
75-F2-13R
75-F2-18R
75-F3-6R
75-F3-13R
75-F3-17R
Interarytenoideus Muscle 75-F2-18R
75-F3-6R
75-F3-9R
75-F3-13R
75-F3-17R
Lateral Cricoarytenoid
Muscle 75-F1-14R
75-F1-18R
75-F2-3R
75-F1-10R
75-F1-14R
75-F1-18R
75-F2-3R
75-F2-9R
75-F2-13R
75-F2-18R
0511
1.2982
.5173
.0828
0745
1.2826
.4429
.1122
0531
1.0358
.3938
.1174
0671
1.0945
.3199
.1495
0605
1.2089
.4766
.1551
0978
1.5023
.6228
.1260
0346
1.0269
.4031
.0629
0324
.9207
.3433
.0300
0258
1.1329
.4390
.0446
0725
1.2628
.4163
.1019
0214
.6236
.1524
.0650
0381
.8314
.2240
.0606
0037
.4817
.0866
.0932
0368
1.0733
.2972
.2483
0468
.8388
.2694
.1151
0528
.9230
.2926
.1077
0395
.8420
.2545
.1254
0439
.8940
.3089
.1116
0489
.9773
.2760
.1361
0211
.6673
.1951
.0819
0859
1.8817
.7122
.1023
Posterior Cricoarytenoid
Muscle


39
size from slide to slide for the same and different structures were
also noted. Due to the nature of the consistency of the core a
continuity of pattern was predictable. There was an anticipation of
the appearance of structures thought of as comprising the core of
intrinsic musculature via the sagittal plane.
Specimen 2 (Table B-3) had a slightly different core than did
specimen 1. The consistency of this core depended on how far up or
down into the block dissection had occurred.
Specimen 3 (Table B-5) generated the most data. These measures
are perhaps due to nearly simultaneous bilateral representation. The
core of the initial slide in both the anterior and posterior blocks
was the same. This representation of muscles was expected since the
first slide in each block represents the two medial surfaces that were
in contact prior to embedding. And although the agreement in muscular
representation was anticipated, it was not exactly true for specimen 6
(Table B-ll) which was the second coronally dissected specimen. The
vibratory mass and its associated measurements existed nearly
throughout the entire specimen, that is in both blocks. A coronally
dissected specimen was perhaps the easiest in which to view the
structures of interest in continuity. Due to the bilateral
representation there was generally a symmetrical comparison.
Specimen 4 (Table B-7), although a sagittal dissection specimen,
presented somewhat differently than did specimen 1. A likely reason
for this difference was the number of microtome passes between
photographic slides was twice the number in specimen 4 than those
occurring in specimen 1. This difference was a factor in all the same


123
Table B-ll. Apparent Size of Structures/Specimen 6/Coronal
Piane/Anterior Block
SIide #
Structure (Sq
Area
. Inch)
Peri- Inferior-
meter Superior
(Inch) (Inch)
Medial -
Lateral
(Inch)
69-F1-3A
Cricothyroid Muscle
.0423L
.0257R'
1.0559L
. 7850R
. 4241L
. 2821R
.1644L
.17 88 R
Conus Elasticus
4850L
.4 95 0 R
Surface Width of TVF
.0886L
.1360R
Thyroid Cartilage
-- Distance between
Superior Apexes
.8727
-- Distance between
Inferior Prominences
.9503
-- Height
1.0979L
1.0200R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
.45 31L
.3224R
-- Phonatory Position
(glottal width/2)
.0491
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
. 2636L
.2 7 22 R
-- Area of Vibratory Mass
. 1505L
. 1349R
1.6719L
1.7276R
.5861L
. 5781R
.2778L
. 27 57 R
69-F1-6A
Cricothyroid Muscle
.0361L
0375R
.8898L
8846R
.3675L
3619R
.1518L
. 17 7 3 R
Thyroarytenoid Muscle
.0970L
. 0616R
1.4748L
1.2871R
.6581L
.5517 R
. 2606L
.2035 R
Conus Elasticus
4298L
.4656R


27
monitor speed and sensitivity. Calibration of the Versawriter tablet
with the measurement grid incorporated in each slide occurred at the
beginning of each session. If any movement of the projector occurred,
the program was restarted and recalibrated. In certain planes, due to
the nature of dissection in that plane, certain structures were not
observed. They were, however, identified and measured in a different
plane. This was especially true in the case of ligaments. In all
specimens cartilage was easily distinguished from soft tissue
musculature and ligaments. In most cases fiber tracts were followed
via Kodak 35 mm slide projection without much difficulty. The same
slides, made into prints, showed far less differentiation. Each slide
carried with it the photographic 1/2-inch grid equivalent to 12.7 mm
as well as a slide number. Once again, the slide number was composed
of the age of the specimen, the number of the roll of film thus far
used on that specimen block, and the number of slices which had been
cut into that block.
The data generated by this study established the normative data
base of intrinsic laryngeal musculature in adult male disease-free
specimens. This was a small sample and meant to serve as a data base
with that limitation in mind. These data yield the area, perimeter,
and essentially height, width, and depth values of intrinsic laryngeal
musculature in six adult male specimens.
Shrinkage Study
A specimen from a 45 year old, disease-free, adult male was taken
fresh from autopsy and subjected to each of the chemical processing


43
dissected in serial section. It was determined that the medial block,
bilaterally, contained the structures pertinent to the purposes of
this study. The most transition in size distribution in the left
block implicated two muscles, the posterior cricoarytenoid and the
thyroarytenoid muscles. The least change was indicated in the lateral
cricoarytenoid muscle. Further the thyroarytenoid muscle represented
the most change in the right medial block, while the lateral
cricoarytenoid muscle demonstrated the least change.
The last specimen addressed in the terms of structural transition
was the sixth specimen (Table C-ll). This was the second coronally
dissected specimen presenting with both an anterior and a posterior
block. The greatest size transition, in soft tissue of the anterior
block, occurred in the area of the vibratory mass. However, the
single soft tissue structure which demonstrated the most transition
was the conus elasticus. The least transition was revealed, in the
cricothyroid muscle. Measurement values in the posterior block
demonstrated, assessment of one aspect of the vibratory mass, the
thyroarytenoid muscle to thyroid cartilage, manifested the most
transition. The single structure demonstrating the most change was
the thyroarytenoid muscle. And lastly, the lateral cricoarytenoid
muscle displayed the least transition in a given soft tissue
structure.
Summation: The Missing Dimension Due to Dissection Plane
The last set of tables (Appendix D) is most appropriate for
quantification of the extent of the missing dimension. This


161
Table C-6--continued.
Structure
Slide # l
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial-
Lateral-
(Inch)
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
46-F1-3P
.5178R
.3509R
46-F1-9P
. 4674L
3478R
46-FI-14 P
.4193 L
.3631R
46-F2-1P
.1055L
.2970R
46-F2-6P
.3660R
46-F2-11P
. 3582 R
46-F2-16P
.3331R
-- Area of Vibratory Mass
46-F1-3P
. 1409R
1.6238R
3616R
.3195 R
46-F1-9P
.1868R
1.6161R
.4423R
.3801R
46-FI-14 P
. 1337R
1.4625R
.33 99 R
.3958 R
46-F2-1P
.1728R
1.6224R
.4211R
.3592R
46-F2-6P
. 20 76 R
1.9591R
. 4165 R
.4196R
46-F2-11P
.1850R
1.8736R
.3316R
.3887R
46-F2-16P
.1292R
1.7040R
.3720R
. 34 HR
* L = 1 eft, R = right; no
letter =
neither L
nor R is
; indicated



116
Table B-8. Apparent Size of Structures/Specimen 4/Sagittal Plane/Right
Block
Slide If
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
68-F6-1R
Posterior Cricoarytenoid
Muscle
.0285
.7277
.2650
.0831
Thyroarytenoid Muscle
.1149
1.4336
.1771
.5012
Height of TVF
.4631
Thyroid Cartilage
.8610
68-F6-3R
Thyroarytenoid Muscle
.1291
1.6192
.2558
.6081
Height of TVF
.3803
)
68-F7-1R
Thyroid Cartilage
.9480
Thyroarytenoid Muscle
.0942
1.4417
.1571
.5287
Height of TVF
-
.5032
Thyroid Cartilage
1.0284
68-F7-4R
Cricothyroid Muscle
.0289
.8556
.3545
.0675
Thyroarytenoid Muscle
.0374
1.5047
.2434
.4779
Height of TVF
.4478
Thyroid Cartilage
.8895
68-F7-7R
Posterior Cricoarytenoid
Muscle
.0277
.6718
.2507
.0696
Cricothyroid Muscle
.0698
1.6629
.8011
.1493
Thyroarytenoid Muscle
.0487
.8649
.2137
.2536
Thyroid Cartilage
.9436
68-F8-1R
Posterior Cricoarytenoid
Muscle
.0642
1.2864
.4503
.0932
Lateral Cricoarytenoid
Muscle
.0940
1.1921
.3628
.2443


109
Table B-6--contiruied.
Slide #
Structure
Area
(Sq. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial-
Lateral
(Inch)
46-F2-11P
Posterior Cricoarytenoid
Muscle
.02 7 6 L
.9311L
.4446L
.0999L
Lateral Cricoarytenoid
Muscle
.02 32 R
.73 93 R
.2003R
. 1538R
Cricothyroid Muscle
.057 3R
1.1898R
.5385R
.2024R
Thyroarytenoid Muscle
. 0581R
1.46 5 7 R
2459R
. 3140R
Conus Elasticus
.1763R
Thyroid Cartilage
Distance between
Superior Apexes
1.5598
-- Distance between
Inferior Prominences
1.2531
-- Height
1.2664L
1.0713R
Vibratory Mass Measures
-- Phonatory Position
(glottal width/2)
.0652
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
. 3582 R
-- Area of Vibratory Mass
.1850R
1.8736R
.3316R
.3887 R
46-F2-16P
Posterior Cricoarytenoid
Muscle
. 0465 L
1.1882L
. 5848L
.0968L
Lateral Cricoarytenoid
Muscle
0208R
.5632R
. 1742R
.1839R
Interarytenoideus Muscle
.0776
1.7639
.3120
.2592
Cricothyroid Muscle
.06 3 7 R
1.3206R
.6024R
.2009R
Thyroarytenoid Muscle
.0414R
.8371R
.2948R
.2300R


144
Table C-4. Apparent Size of Structures/Specimen 2/Transverse
Plane/Medial Block
Peri- Anterior- Lateral -
Area meter Posterior Medial
Structure Slide # (Sq.Inch) (Inch) (Inch) (Inch)
Cricothyroid Muscle
Lateral Cricoarytenoid
Muscle
48-F1-4M
.0951L*
.055 7 R
1.9443L
1.6339R
.7280L
.7107 R
.1401L
. 1087 R
48-F1-6M
.1165L
1.9706L
.8813L
.1294L
48-F1-8M
. 07 44 L
1.9001L
. 7335L
.0680L
48-F1-10M
.0945L
.0341R
2.3980L
1.8636R
8588L
.97 08 R
.0808L
. 0417 R
48-FI-12M
.0758L
.04 99 R
2.2403L
2.0943R
.9797L
. 9150R
.0558L
0364R
48-F1-14M
0876L
.0216R
2.3492L
1.2152R
1.1252L
.42 92 R
.0515 L
.0174R
48-F1-16M
.0599L
.0181R
2.1333L
1.1947R
.8408L
.54 32 R
.0388L
.0512R
48-F1-18M
.0534L
.0382R
1.7257L
1.6771R
.6689L
0993R
.0505L
. 7622R
48-F2-2M
.0442L
.03 68 R
1.6849L
1.8994R
. 6191L
8610R
.0633L
.0744R
48-F2-4M
.0504L
.0654 R
1.5878L
2.1769R
.5061L
3238R
.0423L
.0685R
48-F1-2M
.0282L
.0124R
1.1542L
.7009R
3064L
. 2680R
.03 21L
.0485R
48-F1-4M
.0316L
.0418R
1.1355L
1.1833R
.5790L
. 3971R
.07 07 L
. 2564R
48-F1-6M
.0317L
.0320R
1.1373L
1.2678R
5499L
. 4924R
.1168L
.13 28 R
48-F1-8M
.0277L
.0267R
.9313L
1.1356R
.3376L
.4038R
0784L
. 0655 R


179
Table C-12--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral-
Structure
SIide # (Sq
. Inch)
(Inch)
(Inch)
(Inch)
Thyroarytenoid Muscle
(cont.)
69-F1-13P
. 1440L
. 09 HR
1.6525L
1.3250R
.4368L
.2666R
. 3540L
. 2842R
69-F1-18P
.0440L
.9372L
.2278L
.21971
69-F2-3P
.0340L
.0257R
.8465L
.7607R
2457 L
.1025R
.23361
. 2301R
69-F2-6P
.0267R
.7566R
.2215R
.2202R
Conus Elasticus
69-F1-2P
.5098R
69-F1-4P
.4962L
.4057R
69-F1-7P
.5012L
.3709R
69-F1-9P
.3667L
.2841R
69-F1-13P
.3120L
. 1821R
69-F1-18P
.37 22 L
. 167 OR
69-F2-3P
.2258L
.1003R
Thyroid Cartilage
Distance between
Superior Apexes
69-F1-2P
1.1672
69-F1-4P
1.0519
69-F1-7P
1.1302
69-F1-9P
.9925


65
the thyroarytenoid muscle to the thyroid cartilage. The phonatory
position had also increased. Structures which decreased in size were
the right lateral cricoarytenoid, right cricothyroid, and right
thyroarytenoid muscles as well as the right vibratory mass. The
fragmented interarytenoideus muscle was a new entity in the tabular
data at this level. Cartilaginous framework demonstrated an increase
in the distance between the superior apexes of the thyroid cartilage,
as well as an increase in the distance between the inferior
prominences. Height of the thyroid cartilage increased on the right
and decreased on the left. Visual examination of Figure 9 (46-F3-2P)
reveals the archway effect of the epiglottis to have vanished. The
left arytenoid cartilage was replaced by the seemingly ever expanding
cricoid cartilage. The right lateral cricoarytenoid muscle had
assumed a more lateral position than it had in Figure 8. The conus
elasticus and the right thyroartyenoid muscle had ceased to exist.
The left posterior cricoarytenoid muscle had aligned itself with the
cricoid cartilage. Two final observations which indicated this
particular slide for selection were the presence of the articular
facet of the cricothyroid joint and the fragmented appearance of the
interarytenoideus muscle.
Figure 10 (46-F3-12P) represents the 12th slide on film three of
the posterior block. Specific structures identified included the
interarytenoideus muscle, right cricothyroid muscle, posterior
cricoarytenoid muscles, superior cornu of the thyroid cartilages,
arytenoid, cricoid and thyroid cartilages as well as the inferior
pharyngeal constrictor muscle. The tabular slide data chosen as


146
Table C-4--continued.
Structure
SI i de #
Area
(Sq.Inch)
Peri- i
meter
(Inch)
Anterior-
Posterior
(Inch)
Lateral -
Medial
(Inch)
Posterior Cricoarytenoid
Muscle (cont.)
48-FI-18M
. 0252 L
.0195R
. 987 5 L
1.0592R
.0418L
.0238R
. 3616L
.3796R
48-F2-2M
.0241L
- 0121R
1.0599L
- 9365 R
.0628L
.0161R
.3658L
.3215 R
48-F2-4M
. 0198L
0116R
.9567L
.7490R
.40761
.307 3 R
.0616L
0140R
Thyroarytenoid Muscle
48-F1-2M
.0357L
1.1863L
.4688L
.0552L
* L = left, R = right; no
letter =
neither L
nor R is
indicated



31
celloidin rather than paraffin. Celloidin had demonstrated clearer
visualization of tissue in the slice than did paraffin. That is to
say for histologic preparation of microscopic slides celloidin was
preferred over paraffin. When left in block, the specimen was viewed
through the block and in that way the structures soon to be
encountered in the dissection were seen well before they were at the
surface of the block. The intensity of the Van Gieson stain in some
instances tended to obscure the visibility of the individual fiber
tracts. It was believed that this obscurity was in part due to the
nature of the thickness of the block rather than due to the medium
being celloidin. It is likely that some irregularities in staining
were the result of the specimen being stained in block rather than by
the slice. The traditional means of preparation involves a slice,
perhaps 10-15 microns thick, stained via hematoxylin and eosin and
then mounted on a microscopic slide. Hematoxylin and eosin are better
stains for histologic observation. Although the current study was not
a histologic study, the stain choice was more for macroscopic
purposes. Microtome slices for the current study were 35 microns
thick and the remaining stained block was much thicker. Still it is
likely that some of the staining irregularities were due to the block
itself. Each time slices were removed and the block surface stained
and cleared, the surface of the block was changed. In some instances
penetration deep into the block via the clearing medium can result in
staining irregularities. This was not the problem in this case since
the clearing agent was not allowed to remain on the block surface
sufficiently long enough to penetrate deep into the medium and cause


118
Table B-9. Apparent Size of Structures/Specimen 5/Transverse Plane/Left
Medial Block
Slide #
Structure (Sq
Area
. Inch)
Peri
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
62-F2-1M
Posterior Cricoarytenoid
Muscle
.0058
.4541
.0141
.1405
62-F2-3M
Posterior Cricoarytenoid
Muscle
.0096
.5274
.0276
.2162
62-F2-5M
Posterior Cricoarytenoid
Hus cle
.0160
.6688
.0451
.2666
Lateral Cricoarytenoid
Muscle
.0143
.6651
.1827
.0320
62-F2-7M
>
Posterior Cricoarytenoid
Muscle
.0225
.7393
.0493
.2608
Lateral Cricoarytenoid
Muscle
.0084
.5535
.1622
.0226
62-F2-9M
Posterior Cricoarytenoid
Muscle
.0227
.7190
.0748
.2652
Lateral Cricoarytenoid
Muscle
.0062
.4439
.1112
.0155
62-F2-11M
Posterior Cricoarytenoid
Muscle
.0397
.9535
.0956
.3781
Lateral Cricoarytenoid
Muscle
.0136
.6975
.1886
.0133
62-F2-13M
Posterior Cricoarytenoid
Muscle
.0420
.9842
.0686
.3898
Lateral Cricoarytenoid
Muscle
.0144
1.1044
.4619
.0290
62-F2-15M
Posterior Cricoarytenoid
Muscle
.0341
.8048
.0717
.2475
Lateral Cricoarytenoid
Muscle
.0150
.9551
.3989
.0137


79
during dissection. Secondly, a generated normative data base was
established regarding laryngeal intrinsic musculature in adult
disease-free male specimens. This was a small sample size and data
were to be viewed with an awareness of that limitation. Lastly, an
empirically derived shrinkage estimate was established in an attempt
to assess laryngeal tissue shrinkage as a result of chemical
processing. Thereby, a closer approximation of actual in vivo values
was possible. Essentially, the celloidin embedding method made
possible the preparation of specimens in order that said data were
extracted. This in turn was combined with the shrinkage factor which
in turn facilitated an approach to elucidate structural dimensions in
the living.


112
Table B-6--continued.
SI ide #
Area
Structure (Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
46-F4-6P
(cont.)
Interarytenoideus Muscle .0719
1.7179
.1880
.7449
Thyroid Cartilage
-- Height
1.2995R
46-F4-IIP
Thyroid Cartilage
-- Height
1.1614R
* L = left, R = right; no letter = neither L nor R is indicated.


34
photographic and/or illustrative means. It was possible to
reconstruct the specimen through either means. This study generated a
total of 792 slides, only some of which were selected for measurement
and illustration. There was sufficient material available for
reconstruction via photographic slides. The illustrations were drawn
from the slides, tracings of those slides, and when available
photographic prints. The illustrations were chosen due to the clarity
of their reproduction.
Tabular Data
The first set of tables is found in Appendix B. Data presented
there are organized according to slide. In other words, slides are
presented in the order in which they were photographed during the
serial sectioning. All intrinsic laryngeal musculature of interest
and cartilage, largely identified as landmarks, appearing in each
consecutive slide were identified and measured. Specimen 1 was
dissected via the sagittal plane and presented with both left and
right sides. These sides were each infiltrated with celloidin and
became celloidin blocks. Sectioning began with the most medial aspect
of each block. The first slide appearing in this set of tables is
75-F1-5L. This was the fifth photographic slide on the first roll of
film. There were five microtome passes at 35 microns each between
each photographic slide. We were, therefore, 25 passes into the left
sagittal block of specimen 1 when this photographic slide was taken.
The only structure of interest appearing in this slide and, therefore,
at the surface of the block was the interarytenoideus muscle. This


28
stages the other specimens had been subjected to prior to serial
sectioning. The rationale was to determine the amount of shrinkage
introduced via chemical processing. This was of significant interest
since no such data could be found concerning the larynx and none
particularly concerning the intrinsic musculature of the larynx.
The initial weight of the specimen was 107.7 grams. The specimen
was then cut sagittally, rendering the right half to be used, weighing
57.4 grams. Polypropylene sutures were sewn in two places,
constructing a backwards "L" configuration. A triangular shape could
actually be discerned. A set of Riefler calipers were used to measure
the sides of the triangle. Volume displacement conducted in a 70%
ethyl alcohol solution yielded 43 ml; while the values of the distance
between sutures were 1.0 mm inferior suture, .7 mm lateral suture, and
1.4 mm hypotenuse.
The specimen was then placed in a formalin solution for 48 hours
and then measured. Weight was 62 grams; the inferior suture was .9
mm; the lateral suture was .6 mm; the hypotenuse was 1.3 mm; volume
displacement was 41 ml. The specimen was then decalcified and
x-rayed. The specimen remained in the decalcification solution with
appropriate changes to fresh solution for 11 days. Weight was then
52.4 grams; inferior suture was .9 mm; lateral suture was .6 mm; the
hypotenuse 1.3 mm; volume displacement was 37 ml.
The specimen was placed in running tap water for 1 day to remove
any acid from the decalcification solution. Weight was 50.5 grams;
inferior suture was .9 mm; lateral suture was .6 mm; the hypotenuse
was 1.3 mm; volume displacement was 41 ml.


2
has specific biological functions, the larynx is the primary organ of
speech and deserves a less circumscribed and more comprehensive
treatment. It is regrettable so few texts in comparison to the number
of texts available provide the reader a firm foundation in laryngeal
anatomy and physiology.
The purpose of this study was to examine the intrinsic laryngeal
musculature revealed by multipianar serial sectioning of the celloidin
block. The end product would be a better understanding than is
currently available of laryngeal structure as revealed by the
techniques utilized in this study.
Review of the Literature
The Advent of Laryngeal Awareness
The larynx has been a subject of inquiry for centuries. The
literature demonstrates an early keen interest in the larynx. There
exists various citations crediting dissimilar sources with discovery
of diverse aspects of the larynx (Andrews & Badger, 1979; Canal is,
1980; Cooper, 1985; Fink, 1975; Whicker & Devine, 1972). These
sources run the gamut from identification of the larynx as an entity
in the body to labeling of cartilaginous and soft tissue structures.
There has also been speculation regarding function, and actual
physiology is a separate issue. As a consequence of the scientific
question under consideration, the historical perspective reflected
differs. Some sources cite Hippocrates (Whicker & Devine, 1972) as
the initial laryngeal investigator. Hippocrates was purportedly
interested in function (Andrews & Badger, 1979; Whicker & Devine,


Figure 7
Slide 46-Fl-3P/Specimen 3/Coronal Plane/Posterior Block
CT
O


85
Table B-2. Apparent Size of Structures/Specimen 1/Sagittal Plane/Right
Block
SIide #
Structure (Sq
Area
.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
75-F1-7R
Thyroarytenoid Muscle
.1318
2.0219
.2949
.6773
75-F1-10R
Posterior Cricoarytenoid
Muscle
.0468
.8388
.2694
.1151
Thyroarytenoid Muscle
.2292
2.4642
.3717
.9157
Thyroid Cartilage
1.0628
75-F1-14R
Posterior Cricoarytenoid
Muscle
.0528
.9230
.2926
.1077
Lateral Cricoarytenoid
Muscle
.0381
.8314
.2240
.0606
Thyroarytenoid Muscle
.2855
2.5105
.4953
.7123
Thyroid Cartilage
1.1093
75-F1-18R
Posterior Cricoarytenoid
Muscle
.0395
.8420
.2545
.1254
Lateral Cricoarytenoid
Muscle
.0087
.4817
.0866
.0932
Thyroarytenoid Muscle
.2517
2.5753
.3719
.7938
Anterior Cricoarytenoid
Ligament
.5944
Thyroid Cartilage
1.0378
75-F2-3R
Posterior Cricoarytenoid
Muscle
.0439
.8940
.3089
.1116
Lateral Cricoarytenoid
Muscle
.0368
1.0733
.2972
.2483
Thyroarytenoid Muscle
.2595
2.5892
.3084
.6724
Anterior Cricoarytenoid
Ligament
.6189


30
tissue intrinsic structure. Although it was possible to observe and
trace intrinsic fiber tracts in most cases, it was not possible to
infer unique locations and behavior beyond the course and functions
already attributed to individual muscles by recognized anatomists
(Bailey & Biller, 1985; Gray, 1985; Hollinshead, 1974; McMinn et al.,
1981; Paff, 1973; Pernkopf, 1963-64; Sobotta & Uhlenhuth, 1957 ;
Zemlin, 1981).
The second hypothesis addressed differentiation of tissue
utilizing the block embedding and staining techniques. Particular
attention was given to the delineation of soft tissue from cartilage
and soft tissue from other soft tissue as a result of staining. The
Van Gieson stain did easily differentiate soft tissue or intrinsic
musculature from cartilage. However, although the Van Gieson stain
was the stain of choice following many trial stains and clearing
procedures, it failed to easily differentiate muscle tissue fiber
tracts in all cases. Fiber tracts were generally discernible, but not
always. Overstaining obscured the course of various tracts. And
although it was not reasonable to expect a stain to selectively and
differentially stain the same type of tissue, in this case the
composition of muscle tissue, still the ability to follow certain
fiber tracts was anticipated. Some color change was evident across
and within specimens. The Van Gieson stain was expected to turn
muscle tissue yellow and collagen tissue hues of red and pink. These
color parameters probably would have been consistent and blatantly
obvious had the medium been paraffin. Some deviation from this color
pattern was anticipated since the clarity of the medium of choice was


100
Table B-5continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide $ Structure (Sq.Inch) (Inch) (Inch) (Inch)
46-F2-6A
(cont.) Thyroid Cartilage
-- Distance between
Inferior Prominences
-- Height
Vibratory Mass Measures
-- Height from Cricoid
to TVF
-- Phonatory Position
(glottal width/2)
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
-- Area of Vibratory Mass
46-F2-13A Lateral Cricoarytenoid
Muscle
Cricothyroid Muscle
Thyroarytenoid Muscle
Conus Elasticus
Thyroid Cartilage
-- Distance between
Superior Apexes
-- Distance between
Inferior Prominences
-- Height
1.1598
1.3680L
1.1036R
.4 220 L
.5214R
.0710
.2666L
.1685R
1506L
1063R
1.7656L
1.3258R
.4801L
.5412 R
. 3004L
. 2147R
0170L
.5369L
. 1573L
-1123L
0295L
.8304L
.3870L
.0931L
0462L
0343R
.9206 L
.7473R
. 3387 L
. 28 HR
.27 32 L
.1597R
.4976R
.7440
.8972
1.2130L
1.0039R


37
listed was the interarytenoideus muscle. Five different slides are
listed as containing the interarytenoideus muscle and appropriate
measurement values are given for each. This procedure is followed
with each of the structures of interest all the way through the left
block of specimen 1. Table C-2 presents the same information, that
is, identification and measurement of the structures of interest
organized by structure for the entire right block of specimen 1.
Table C-3 lists information organized by the structure of
interest on the superior block of specimen 2. Specimen 2 was a
transverse specimen and by virtue of definition of this plane of
dissection slightly different information is given. Measurement
values were generated for area, perimeter, anterior-posterior, and
1ateral-medial distance.
Table C-5 addresses the anterior block of the coronally dissected
specimen 3. Measurement parameters include area, perimeter, inferior-
superior distance, and medial-1ateral distance. Again, since this is
the C set of tables, information is organized by the structures of
interest.
Finally, Appendix D or the D set of tables is organized in a
slightly different fashion. As was indicated earlier, by definition
of a particular plane, a specific parameter of directional information
was absent. Specimens 1 and 4 were sagittal dissection specimens. By
virtue of the sagittal dissection plane no information was given on
the medial-lateral appearance of structures of interest. For
transverse dissection specimens, specimens 2 and 5, no information was
given on the inferior-superior distance of appearance of structures of


Figure 13. Slide 75-Fl-16R/Specimen 1/Sagittal Plane/Right Block


86
Table B-2--continued.
SIide #
Structure (Sq
Area
. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
75-F2-3R
(cont.)
Thyroid Cartilage
.9614
75-F2-9R
Posterior Cricoarytenoid
Muscle
.0489
.9773
.2760
.1361
Cricothyroid Muscle
.0511
1.2982
.5173
.0828
Thyroarytenoid Muscle
.2747
1.999
.4168
.5179
Anterior Cricoarytenoid
Ligament
.3941
Thyroid Cartilage
.9306
75-F2-13R
Posterior Cricoarytenoid
Muscle
.0211
.6673
.1951
.0819
Cricothyroid Muscle
.0745
1.2826
.4429
.1122
Thyroarytenoid Muscle
.3309
2.2542
.6543
.4656
Thyroid Cartilage
1.0544
75-F2-18R
Interarytenoideus Muscle
.0346
1.0269
.4081
.0629
Posterior Cricoarytenoid
Muscle
.0859
1.8817
.7122
.1023
Cricothyroid Muscle
.0531
1.0358
.3938
.1174
Thyroarytenoid Muscle
.0741
1.4425
.1536
.4873
Anterior Cricoarytenoid
Ligament
.7455
Thyroid Cartilage
.7618
75-F3-6R
Posterior Cricoarytenoid
Muscle
.0749
1.4190
.6045
.1129
Interarytenoideus Muscle
.0324
.9207
.3433
.0300


Figure 11. Slide 48-F2-7S/Specimen 2/Transverse Plane/Superior Block
Or
CO


156
Table C-6. Apparent Size of Structures/Specimen 3/Coronal
Plane/Posterior Block
Structure
Slide # i
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral -
(Inch)
Cricothyroid Muscle
46-F1-3P
.0458L*
. 04 91R
.9319L
1.0776R
.3385L
.3490R
.0982L
. 1036R
46-F1-9P
.0379L
. 0545 R
.8679L
1.2233R
.3592L
.5716R
. 1145L
. 1491R
46-F1-14P
.0493L
.0874R
1.2822L
1.4708R
.4014L
.69 06 R
.2366L
. 2346R
46-F2-1P
.0645R
1.3436R
.5986R
. 1585R
46-F2-6P
.0600R
1.3137R
. 5853 R
.2284 R
46-F2-IIP
.0573R
1.1898R
.5385R
.2024R
45-F2-16P
.0637R
1.3206R
.6024 R
.2009R
46-F3-4P
.0527R
1.2340R
.5602R
.1599R
46-F3-9P
. 027 4 R
1.0486R
.37 74 R
.1290R
46-F3-14P
0226R
1.1492R
.1737R
.1301R
Interarytenoideus Muscle
46-F2-16P
.0776
1.7639
.3120
.2592
46-F3-4P
.1340
1.7089
.3489
.6986
46-F3-9P
.1096
1.6641
.2559
.6781
46-F3-14P
.1031
1.4920
.3221
.5809
46-F4-6P
.0719
1.7179
.1880
.7449
Lateral Cricoarytenoid
Muscle
46-F1-14P
.0230L
.0420R
.7091L
.8419R
3240L
.2482R
.175 7 L
.2527R
46-F2-1P
.0597R
1.0220R
.2618R
.3296R
46-F2-6P
.0211R
. 715 OR
.1880R
1836R


165
Table C-8. Apparent Size
Block
of Structures/Specimen 4/Sagittal Plane/Right
Structure
SI ide ff
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
Cricothyroid Muscle
68-F7-4R
.0289
. 8556
.3545
.0675
68-F7-7R
.0698
1.6629
.8011
.1493
68-F8-1R
.0779
1.5064
.6775
.3314
68-F8-4R
.1831
1.8536
.3061
.5543
68-F8-7R
.1221
1.3845
.4053
.2317
68-F8-10R
.1241
1.3515
.4710
.2860
V
68-F8-13R
.1901
1.8359
.5042
.4823
Interarytenoideus Muscle
68-F8-1R
.0426
1.1795
.5188
.0984
68-F8-4R
.0624
1.4129
.7587
.0870
Lateral Cricoarytenoid
Musclfe
68-F8-1R
.0940
1.1921
.3628
.2443
68-F8-4R
.0295
.8147
.1923
.1437
Posterior Cricoarytenoid
Muscle
68-F6-1R
.0285
.7277
.2650
.0831
68-F7-7R
68-F8-1R
68-F8-4R
.0277
.0642
.0717
.6718
1.2864
1.2321
.2507
.4503
.4847
.0696
.0932
.1335
68-F6-1R
.1149
1.4336
.1771
68-F6-3R
.1291
1.6192
.2558
68-F7-1R
.0942
1.4417
.1571
68-F7-4R
.0874
1.5047
.2434
.5012
.6081
.5287
.4779
Thyroarytenoid Muscle


Ill
Table B-6--continued.
Slide #
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
46-F3-9P
Posterior Cricoarytenoid
Muscle
.0805 L
.0190R
1.9273L
.5728R
. 915 7 L
. 2407R
.1144 L
.1043R
Interarytenoideus Muscle
.1096
1.6641
.2559
.6781
Cricothyroid Muscle
.02 74 R
1.0486R
. 37 74 R
. 1290R
Thyroid Cartilage
-- Distance between
Superior Apexes
1.8120
-- Distance between
Inferior Prominences
1.3809
-- Height
.6944L
1.1018R
Vibratory Mass Measures
-- Phonatory Position
(glottal width/2)
.0814
46-F3-14P
Posterior Cricoarytenoid
Muscle
. 0754L
.0069R
1.8037L
.5042R
. 8635 L
.2408R
.1321L
.0452R
Interarytenoideus Muscle
.1031
1.4920
.3221
.5809
Cricothyroid Muscle
.02 2 6 R
1.1492R
. 17 3 7 R
. 1301R
Thyroid Cartilage
-- Distance between
Superior Apexes
1.7285
-- Height
1.1483R
46-F4-6P
Posterior Cricoarytenoid
Muscle
.0431L
.0300R
1.4604L
1.0539R
.65 23 L
. 4636R
. 0993 L
.0656R


10
separate measures were taken. These measures were primarily linear
although one measure was angular and six concerned weight. Structures
of particular interest were the vocal folds, hyoid bone and laryngeal
cartilages. Hicks (1981a, b) concluded specimens derived from female
subjects were in all cases smaller than that of their male
counterparts. The superior angle of the thyroid cartilage was found
to be under 90 in males and over 90 in females. This finding held
true with all age groups. Lastly, Hicks (1981a, b) concluded changes
in the human voice over the span of decades are not attributable to
changes in the hyoid bone or cartilage.
Mafee, Schild, Valvassori, and Capek (1983) verified the presence
and general extent of carcinoma by using celloidin embedded specimens
to complement the results of computed tomography. Seven specimens,
cut only in the transverse plane, were cut down to the level
appropriate for the computed tomography scan. Results indicated
sectioning did indeed confirm the computed tomography findings. Mafee
et al. (1983) concluded computed tomography scanning to be the best
means of laryngeal integrity assessment available.
Silverman and Korobkin (1983) utilized computed tomography on
normal larynges. The purpose was to scan the larynges in transaxial,
coronal and sagittal planes to demonstrate disease-free laryngeal
anatomy. These data were to serve as a basis of comparison for
obscure anatomical anomalies induced by disease states.
Kahane and Kahn (1984) examined the intrinsic laryngeal
musculature of infants. Particular emphasis was placed on weight,
differences due to gender, and intermuscular interactions. Nine


Table C-12--continued
Structure
SI ide if
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral -
(Inch)
Vibratory Mass Measures
-- Area of Vibratory Mass
(cont.)
69-F1-7P
. 1630L
.1287R
1.8518L
1.4590R
. 5286 L
.3384R
.5006L
.3960R
69-F1-9P
.1527L
.1989R
1.7791L
2.0116R
.5105L
.4738R
.3318L
3112R
69-F1-13P
.1847L
.1865R
2.2236L
2.0105R
.4752L
.4171R
4684L
. 3842 R
69-F1-18P
.0769L
1.3278L
.2761L
.2284L
69-F2-3P
.07 68L
1.2560L
.2480L
. 3079L
* L = left, R = right; no letter = neither L nor R is indicated


196
Table D-ll. Apparent Size of Structure/Specimen 6/Coronal
Plane/Anterior Block
Structure
SI i de
Range
Number of
Microtome
Passes
Unit of
Measure
Total Anterior
to Posterior
Distance
Cricothyroid Muscle
69-F1-3A
to
69-FI-11A
10
35
microns
3150 microns
or
3.15 mm
Thyroarytenoid Muscle
69-F1-6A
to
69-F2-7A
10
35
microns
7000 microns
or
7.0 mm
Conus Elasticus
69-F1-3A
to
69-F1-9A
10
35
microns
2450 microns
or
2.45 mm
Surface of TVF
69-F1-3A
to
69-F2-7A
10
35
microns
8050 microns
or
8.05 mm
Thyroid Cartilage-
Superior Apexes Present
69-F1-3A
to
69-F2-7A
10
35
microns
8050 microns
or
8.05 mm
Thyroid Cartilage-
Inferior Prominences
Present
69-F1-3A
to
69-F1-14A
10
35
microns
4200 microns
or
4.2 mm
Body of Thyroid Cartilage
69-F1-3A
to
69-F2-10A
10
35
microns
9100 microns
or
9.1 mm
Vibratory Mass-
Cricoid to TVF
69-F1-3A
to
69-F1-14A
10
35
microns
4200 microns
or
4.2 mm
Phonatory Position-
Presence of Glottal
Aperture
69-F1-3A
to
69-FI-11A
10
35
microns
3150 microns
or
3.15 mm
Vibratory Mass-
Thyroarytenoid to
Thyroid Cartilage
69-F1-3A
to
69-F2-7A
10
35
microns
8050 microns
or
8.05 mm


11
infant larynges were collected. Seven of these subjects died as a
result of sudden infant death syndrome. Five subjects were male and
four were female. Muscles were dissected off, blotted, and weighed on
a Mettler balance. Kahane and Kahn (1984) compared their data to that
of adult data generated by Bowden and Scheure (1960). Kahane and Kahn
(1984) concluded the weights of respective intrinsic muscles
established in infancy, maintained their proportional relationships in
adulthood as well. A consistent finding in both infant and adult
larynges indicated the cricothyroid muscle to have the largest mean
weight. Bowden and Scheure (1960) did not address differences due to
gender in the weight of the adult intrinsic laryngeal musculatures.
However Kahane and Kahn (1984) found no differences due to gender in
their infant intrinsic laryngeal musculature. They further concluded
intermuscular interactions or functions aimed at delineating vocal and
nonvocal laryngeal behaviors would require additional research.
Statement of Purpose
A review of the literature indicates there is little serial
sectioning information available on disease-free larynges. The
purpose of this study was to examine disease-free human larynges in
block following serial dissection. The major thrust of the proposed
study was to delineate specific soft tissue structures and how those
structures appear different depending on the plane of dissection.
Horizontal, coronal, and sagittal serial section planes were employed
as a means to facilitate examination. Six adult male human larynges
were dissected. Comparative measures were made primarily regarding


23
information on the structures of interest would be altered from what
their actual values were in life. These values were expected to be
altered as a result of shrinkage due to the chemical processing. In
order to have an idea of what that change was, another specimen
separate from the six adult male specimens previously mentioned was
taken fresh from autopsy prior to any fixation in formalin. This
specimen was then processed as each of the other specimens and
measured and weighed (when appropriate) through each phase of the
chemical processing procedure.


185
Table D-2. Apparent Size
Block
of Structure/Specimen
1/Sagittal
PI ane/Right
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Medial
to Lateral
Distance
Cricothyroid Muscle
75-F2-9R
to
75-F3-17R
5
35
microns
4725 microns
or
4.725 mm
Interarytenoideus Muscle
75-F2-18R
to
75-F3-17R
5
35
microns
3150 microns
or
3.15 mm
Lateral Cricoarytenoid
Muscle
75-F1-14R
to
75-F2-3R
5
35
microns
1400 microns
or
1.4 mm
Posterior Cricoarytenoid
Muscle
75-F1-10R
to
75-F3-17R
5
35
microns
7700 microns
or
7.7 mm
Thyroarytenoid Muscle
75-F1-7R
to
75-F3-17R
5
35
microns
8225 microns
or
8.225 mm
Anterior Cricoarytenoid
Li gament
75-F1-18R
to
75-F3-13R
5
35
microns
5600 microns
or
5.6 mm
Posterior Cricoarytenoid
Li gament
75-F3-13R
5
35
microns
175 microns
or
.175 mm
Thyroid Cartilage
75-F1-10R
to
75-F4-6R
5
35
microns
8925 microns
or
8.925 mm
NOTE: Sagittal Plane: The missing dimension dictated by this plane is
the medial-1ateral distance. This table is a summation of that
distance.


121
Table B-10. Apparent Size of Structures/Specimen 5/Transverse
Plane/Right Medial Block
Slide #
Structure (Sq
Area
. Inch)
Peri
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
62-F2-10M
Posterior Cricoarytenoid
Muscle
.0145
.7847
.0591
.3591
Interarytenoideus Muscle
.0585
1.0400
.2115
.3359
62-F2-14M
Posterior Cricoarytenoid
Muscle
.0397
1.2562
.0749
.5051
Interarytenoideus Muscle
.0827
1.2952
.1416
.4848
62-F2-18M
Posterior Cricoarytenoid
Muscle
.0399
1.1909
.0813
.5852
Lateral Cricoarytenoid
Muscle
.0246
.7528
.3042
.0648
Interarytenoideus Muscle
.0816
1.3716
.5896
.2332
62-F3-4M
Posterior Cricoarytenoid
Muscle
.0537
1.2480
.0673
.5628
Lateral Cricoarytenoid
Muscle
.0321
1.0137
.4225
.0598
Interarytenoideus Muscle
.0854
1.3716
.2248
.5448
Thyroarytenoid Muscle
.0618
1.0381
.4014
.1302
62-F3-8M
Posterior Cricoarytenoid
Muscle
.0512
1.2649
.0724
.6040
Lateral Cricoarytenoid
Muscle
.0316
1.0164
.4298
.0643
Interarytenoideus Muscle
.0952
1.3919
.2488
.5082
Thyroarytenoid Muscle
.0904
1.2385
.3856
.2549
62-F3-12M
Posterior Cricoarytenoid
Muscle
.0519
1.2667
.0540
.6394
Lateral Cricoarytenoid
Muscle
.0092
.5452
.2434
.0343


CHAPTER I
BACKGROUND AND PURPOSE
Introduction
A perusal of a number of anatomical texts indicates the larynx
often receives a rather cursory presentation. The superficial
descriptions many times result in both extrinsic and intrinsic
laryngeal musculature being addressed in a few paragraphs (Anderson,
1984; Anthony & Thibodeau, 1979, 1980; Basmajian, 1980, 1982).
Frequently the information available on the larynx requires the reader
to seek additional sources (Burke, 1980; Crouch & McClintic, 1971;
Gardner et al., 1963). This type of discourse demonstrates the need
for detailed treatment. The anatomy texts are likely to be the major
source of enlightenment and initial contact for many students and
unfortunately the superficial treatment of the larynx prejudices
students about the importance of this vital organ. These texts
properly concentrate their limited presentations on the structure of
the larynx, and although that information is often incomplete, the
question of function or physiology may be totally omitted (Ellis,
1976; Ellis & Feldman, 1977; Evans, 1976; Francis & Martin, 1975). A
few texts provide a limited improvement of laryngeal information
(Christensen & Telford, 1972; Dienhart, 1979). However the general
dearth of illuminating information perhaps suggests that the larynx
has not been regarded as a particularly important organ. Although it
1


63
vibratory mass and the phonatory position. Whereas the presence of
other structures declined. Structures which decreased in size were
the conus elasticus, all thyroid cartilage measures and the medial
aspect of the thyroarytenoid muscle to the thyroid cartilage. Visual
inspection of Figure 8 as compared to Figure 7 demonstrates the folds
of the left pyriform sinus disappeared and were replaced by a
perforation. The left arytenoid cartilage was nearly entirely
exposed. The right side of the specimen revealed the transitional
stage of the peeling away of the thyroarytenoid muscle and the
discovery of the arytenoid cartilage underneath. The larynx itself
had taken on an archway configuration.
Figure 9 (46-F3-2P) represents the second slide on film three of
the posterior block. Specific structures identified included the
right lateral cricoarytenoid, left posterior cricoarytenoid, fragments
of the interarytenoideus muscle, right cricothyroid muscle, articular
facet of the cricothyroid joint and the arytenoid, cricoid and thyroid
cartilages. Slide 46-F2-16P was selected for comparison purposes.
Examination of the tabular data indicates that the right
thyroarytenoid muscle, although present in slide 46-F2-16P, had ceased
to exist in Figure 9. This same muscle was in the process of being
dissected off in Figure 8, and by Figure 9, it had been completely cut
away. Measurement values of the slide closest to Figure 8 (46-F1-17P)
and the slide closest to Figure 9 were selected for comparison. Those
slides were 46-F2-1P and 46-F2-16P respectively. Examination of
tabular data reveals soft tissue structures which had increased in
area were the posterior cricoarytenoid muscle and the medial aspect of


125
Table B-ll--contiruied.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
69-F1-9A
(cont.) Thyroid Cartilage
-- Distance between
Superior Apexes
-- Distance between
Inferior Prominences
-- Height
Vibratory Mass Measures
-- Height from Cricoid
to TVF
-- Phonatory Position
(glottal width/2)
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
-- Area of Vibratory Mass
69-FI-11A Cricothyroid Muscle
Thyroarytenoid Muscle
Surface Width of TVF
Thyroid Cartilage
-- Distance between
Superior Apexes
-- Distance between
Inferior Prominences
.8642
.6616
.9866L
1.0183 R
. 5661L
.4 996 R
.0496
. 1752L
. 1858R
1068L
1.4632L
.5427L
.2 247 L
1304R
1.5296R
. 5089R
.2268 R
0413L
.862 9L
.277 9L
.1984L
0386R
. 9445 R
.365 3 R
0920R
0529L
1.2082L
.4700L
.1618L
0567R
1.1407R
4605R
1532R
. 1224L
. 1294R
.7961
.4373


186
Table D-3. Apparent Size of Structure/Specimen 2/Transverse
Piane/Superior Block
Structure
SI i de
Range
Number of
Microtome
Passes
Unit of
Measure
Total Inferior
to Superior
Distance
Interarytenoideus Muscle
48-F1-1S
to
48-F2-5S
10
35
microns
8050 microns
or
8.05 mm
Lateral Cricoarytenoid
Muscle
48-FI-IS
to
48-F1-7S
10
35
microns
2450 microns
or
2.45 mm
Posterior Cricoarytenoid
Muscle
48-FI-IS
to
48-F1-9S
10
35
microns
3150 microns
or
3.15 mm
Thyroarytenoid Muscle
48-F1-3S
to
48-F2-11S
10
35
microns
9450 microns
or
9.45 mm
Posterior Cricoarytenoid
Ligament
48-F1-11S
10
35
microns
350 microns
or
.35 mm
NOTE: Transverse Plane: The missing dimension dictated by this plane
is the inferior-superior distance. This table is a summation of that
distance.


158
Table C-6--continued.
Structure
Area
SI ide # (Sq. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral -
(Inch)
Thyroarytenoid Muscle
(cont.)
46-F2-11P 0581R
1.4657R
. 245 9 R
. 3140R
46-F2-16P .0414R
- 8371R
.2948R
.2300R
Conus Elasticus
46-F1-3P
4653L
.3877 R
46-F1-9P
.3438R
46-F1-14P
.3137R
46-F2-1P
.2040R
46-F2-6P
.2064R
46-F2-11P
.1763R
Surface Width of TVF
46-F1-3P
0890R
Thyroid Cartilage
-- Distance between
Superior Apexes
46-F1-3P
1.6395
46-F1-9P
1.7539
46-F1-14P
1.7439
46-F2-1P
1.5532
46-F2-6P
1.5327
46-F2-11P
1.5598
46-F2-16P
1.7542
46-F3-4P
1.8488
46-F3-9P
1.8120
46-F3-14P
1.7285


181
Table C-12--continued.
Peri- Inferior- Medial -
Area meter Superior Lateral -
Structure Slide ft (Sq.Inch) (Inch) (Inch) (Inch)
Thyroid Cartilage
-- Height
69-F1-13P
.85 51L
.7860R
69-F1-18P
.8246L
1.0152R
69-F2-3P
.7179L
1.0053R
69-F2-6P
1.2155R
69-F2-10P
.3500R
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
69-F1-2P
. 37 66R
69-F1-4P
. 3246L
.3558R
69-F1-7P
.3545L
3877R
69-F1-9P
. 2 6 54 L
. 2974 R
69-F1-13P
.3703L
.3425R
69-F1-18P
.2259L
69-F2-3P
2497 L
.1874R
-- Area of Vibratory Mass
69-F1-2P
.1725R
2.0100R
.5812R
.4071R
59-F1-4P
. 1393L
.1650R
1.7387L
1.7960R
- 5517 L
.4415R
.3498L
.3558R


20
musculature revealed in serial section. The stain ultimately selected
was Van Gieson stain, and the clearing solution selected was 70
ethanol alcohol.
Van Gieson Stain
A saturated aqueous solution of picric acid consisted of 100 ml
of distilled water and 2 grams of picric acid. While a 1% aqueous
solution of acid fuchsin required 1 gram of acid fuchsin and 100 ml of
distilled water. In order to yield Van Gieson stain, 5 ml of 1%
aqueous solution of acid fuchsin was combined with 100 ml of picric
acid. The Van Gieson stain was chosen because of the multitude of
stains tested it best delineated the structures of interest. Muscle
was expected to take on a yellow hue, while collagen was expected to
be in the red/pink distribution (Humason, 1979; Luna, 1968).
Measurement
Photographic Apparatus
A commercially available copy stand equipped with twin tungsten
lights was mounted with an Olympus (0M2) 35 mm camera and a 90 mm
Vivitar lens. The copy stand was stationed across from the sliding
microtome. The preferred F stop was between 5.6 and 8, while the
preferred shutter speed was 1/30 second. The film selected was
Kodachrome 25 which produced faithful color representation and
contained fine grain emulsion. To facilitate accurate measurement a
1/10 inch grid was present in each photographic slide, adjacent to the
identification number assigned each particular slide. The slide
identification number incorporated the age of the specimen, the roll


120
Table B-9--continued.
SI ide #
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
62-F3-15M
(cont.)
Thyroarytenoid
Muscle
.0557
1.0647
.2301
.1138
62-F3-18M
Cricothyroid Muscle
.0110
.7686
.3361
.0233
Thyroarytenoid
Muscle
.0922
1.7482
.6422
.2916
62-F4-3M
Thyroarytenoid
Muscle
.0827
1.4783
.6461
.2065


192
Table D-7. Apparent Size
Block
of Structure/Specimen
4/Sagittal
Plane/Left
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Medial
to Lateral
Di stance
Cricothyroid Muscle
68-F5-1L
to
68-F5-9L
10
35
microns
31500 microns
or
31.5 mm
Interarytenoideus Muscle
68-F1-7L
to
68-F4-8L
10
35
microns
19600 microns
or
19.6 mm
Lateral Cricoarytenoid
Muscle
68-F5-1L
to
68-F5-2L
10
35
microns
700 microns
or
.7 mm
Posterior Cricoarytenoid
Muscle
68-F3-2L
to
68-F5-2L
10
35
microns
12950 microns
or
12.95 mm
Thyroarytenoid Muscle
68-F3-2L
to
68-F5-2L
10
35
microns
12950 microns
or
12.95 mm
Anterior Cricothyroid
Ligament
68-F2-7L
10
35
microns
350 microns
or
.35 mm
Posterior Cricothyroid
Ligament
68-F3-4L
to
68-F3-9L
10
35
microns
2100 microns
or
2.1 mm
Thyroid Cartilage
68-F3-2L
to
68-F5-9L
10
35
microns
15400 microns
or
15.4 mm
NOTE: Sagittal Plane: The missing dimension dictated by this plane is
the medial-lateral distance. This table is a summation of that
distance.


40
plane dissection comparisons. Also another possible factor in this
particular case was the initial size of the specimen itself. The
outward appearance of a specimen may be deceiving, perhaps due to the
presence of extensive extrinsic laryngeal musculature.
Specimen 5 (Table B-9), another transverse specimen, was set up
into six different celloidin blocks. Due to the number of blocks in
specimen 2, it was possible to examine for bilateral representation of
musculature. Specimen 5 lacked bilateral representation as a result
of a center cut and each side cut into thirds. Sectioning revealed
the structures of interest were located in the medial blocks. There
was certainly some structural asymmetry present as was clear in the
case of the lateral cricoarytenoid muscle. This structure appeared at
different levels slices apart on the two sides. In part this
difference was due to asymmetry. However it is quite likely that the
structure was present earlier on the right side but with dubious
boundaries. A center cut for transverse specimens is not recommended
for future dissections.
Specimen 6 (Table B-11), a coronal dissection, closely resembled
the anterior block of specimen 3 in terms of appearance of structures
of interest. However the posterior block was somewhat atypical. It
was not possible to measure the distance from the cricoid cartilage to
the true vocal fold. It was equally impossible to assess any glottal
aperture or phonatory position. Again, the number of microtome passes
differed on these two coronal specimens. However, it is unlikely that
this factor alone could account for the absence of the glottal
aperture and true vocal folds in the posterior block. Perhaps the


101
Table B-5--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
46-F2-13A
(cont.) Vibratory Mass Measures
-- Height from Cricoid
to TVF .5190L
.5857R
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.2372 L
.1584R
46-F2-18A Thyroarytenoid Muscle
.0567L
.0304R
.9853L .2903L
. 8816 R 354 5 R
.14761
.1389R
Conus Elasticus
.6277L
. 6235 R
Surface Width of TVF
.1885L
. 1923R
Thyroid Cartilage
-- Distance between
Superior Apexes
.5776
-- Distance between
Inferior Prominences
.6686
-- Height
1.2609L
1.0358R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
.6422L
.6880R
-- Phonatory Position
(glottal width/2)
.0127
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
. 1608L
.0670R


6
conducted. The technique at issue for this study is celloidin
embedding followed by serial sectioning when applied to laryngeal
material. The assumed position is such that a slice by slice
progression through the larynx yields an appreciation of the component
parts.
Laryngeal Investigation: Anomaly and Disease
There is very little available research which has concerned
itself with sectioning of the larynx via a specific plane. A thesis
project conducted by Jean Robert-Leroux (1936) was probably the first
study to incorporate serial sectioning in cancerous specimens. This
study followed the patient's preoperative course with direct and
indirect 1aryngoscopy, x-ray evaluation, surgical procedure, and
postoperatively with serial sectioning and histological examination of
the laryngeal specimens. The major emphasis of that study was the
location and extent of the tumor. The availability of such
information was and still is a useful learning tool.
As early as 1943 a study conducted by Broyles examined the
anterior commissure tendon. Broyles (1943) concentrated on the
anterior commissure tendon because he believed an area with weak" or
"deficient" cartilaginous protection was susceptible to disease.
Particular attention was given to squamous cell carcinoma. Cross
sections were made of the anterior commissure and surrounding tissue
and thyroid cartilage in two carcinoma specimens, a young adult and a
62 year old male. Broyles (1943) concluded that carcinoma occurring
in the anterior larynx and reoccurring should be examined closely. In
the event that a "midline incision of the thyroid cartilage" was the


22
at a time onto the surface of the tablet for measurement. A standard
screen was cut and secured onto the tablet surface. The photographic
images were projected from a Kodak Ektagraphic slide projector model
AF-2 fitted with a Kodak Ektanar lens.
Structures to Be Measured
Soft tissue measurements were of three basic types: anterior to
posterior, medial to lateral, and superior to inferior. These
measurements were made when appropriate for a particular plane and
applied to specific soft tissue structures. For instance coronal
slices allowed for medial to lateral and superior to inferior measures
(Tucker, 1971), whereas sagittal slices allowed for anterior to
posterior and superior to inferior measures. And transverse slices
allowed for anterior to posterior and medial to lateral measures. The
structures of interest were measured as closely as could be determined
by the delineated boundaries. These values represented apparent
height, width, and depth as opposed to actual height, width, and
depth. Each structure was followed as closely as possible. In the
event that a structure curved, if it was necessary to follow the curve
in order to get a more representative measure, the curve was
followed. Some cartilaginous measures were included (Hicks, 1981b;
Mane, 1971). Obviously not all structures appeared in all planes in
all specimens.
Shrinkage Study
In addition to the processing of the specimens as mentioned
above, it was clear that the numerical values determined from the


113
Table B-7. Apparent Size of Structures/Specimen 4/Sagittal Plane/Left
Block
SIide #
Structure
Area
(Sq. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
68-F1-7L
Interarytenoideus Muscle
.0495
.8900
.2848
.1033
68-F2-1L
Interarytenoideus Muscle
.0428
.8404
.2947
.8329
68-F2-3L
Interarytenoideus Muscle
.0459
.9125
.3169
.1038
68-F2-6L
Interarytenoideus Muscle
.0581
.9788
.2992
.1193
68-F2-7L
Interarytenoideus Muscle
.1773
1.7639
.5951
.2457
Anterior Cricothyroid
Ligament
.7165
68-F3-2L
Posterior Cricoarytenoid
Muscle
.4321
4.353
1.9810
.2372
Interarytenoideus Muscle
.1630
1.7196
.6144
.2793
Thyroarytenoid Muscle
.2357
2.0103
.2410
.7152
Thyroid Cartilage
1.8108
68-F3-4L
Posterior Cricoarytenoid
Muscle
.1318
2.9374
1.4187
.0866
Interarytenoideus Muscle
.1793
1.9606
.5772
.2059
Thyroarytenoid Muscle
.6754
4.5848
.3556
1.3031
Posterior Cricoarytenoid
Ligament
.4594
Thyroid Cartilage
2.3446
68-F3-7L
Posterior Cricoarytenoid
Muscle
.0578
1.7806
.7988
.0780
Interarytenoideus Muscle
.0517
1.0700
.3136
.1055
Thyroarytenoid Muscle
.1712
2.4115
.1829
.6706
Posterior Cricoarytenoid
Ligament
.3945


Apparent Size of Structures Arranged by Slide 38
Apparent Size of Structures Arranged by Structure
Across Slides 41
Summation: The Hissing Dimension Due to Dissection
Plane 43
IV DISCUSSION AND CONCLUSIONS 48
Interpretation of Results with Graphic II1ustrations....48
Concl usions 74
Implications for Future Research 77
APPENDIX
A STRUCTURES OF INTEREST 80
B APPARENT SIZE OF STRUCTURES ARRANGED BY SLIDE 83
C APPARENT SIZE OF STRUCTURES ARRANGED BY STRUCTURE
ACROSS SLIDES 137
D SUMMATION: THE MISSING DIMENSION DUE TO DISSECTION
PLANE 184
BIBLIOGRAPHY 200
BIOGRAPHICAL SKETCH 205
v


133
Table B-12--continued.
Peri- Inferior- Medial -
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
69-F1-18P
(cont.) Thyroid Cartilage
-- Distance between
Superior Apexes
-- Distance between
Inferior Prominences
-- Height
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
-- Area of Vibratory Mass
69-F2-3P Posterior Cricoarytenoid
Muscle
Interarytenoideus Muscle
Cricothyroid Muscle
Thyroarytenoid Muscle
Conus Elasticus
1.1156
.9310
8246L
1.0152R
.2259L
0769L
1.3278L
.2761L
. 2284L
0116R
. 67 76 R
.2680R
.0492R
0812
1.4533
.1294
.5563
0395L
0368R
1.2494L
1.2353R
. 5163 L
.4214R
. 1039L
.0647R
0340L
0257R
.8465L
. 7607R
.2457L
. 1025R
. 2336L
. 2301R
. 2258L
.1003 R
Thyroid Cartilage
-- Distance between
Superior Apexes 1.0556
Distance between
Inferior Prominences 1.0116
-- Height
.7179L
1.0053R


To D.V.H., K.F.H., and D.K.H
Copyright by
Terry L. Hardee
1985


5
the arytenoid cartilages and blowing air into the larynx that sound
could be produced (Whicker & Devine, 1972). Hence, in Magendie's
lifetime, late 1780s to late 1880s, the issue of laryngeal function
was again addressed. Studies following Magendie began to look more
closely, even explicitly, at function. The first successful indirect
laryngoscopy was self performed by Manuel Garcia in 1855 with the use
of mirrors and sunlight. Laryngoscopy and the means by which to
achieve it generated a widespread interest. For the first time man
had a means of viewing the interior of the larynx and movements of the
vocal folds and arytenoid cartilage movement. Garcia (1855) and then
Czermak (1861), who used lighting sources other than sunlight,
conducted laryngeal inspections which led to detailed descriptions of
intrinsic laryngeal activity. Czermak (1861) illustrated the
differing types of glottal activity such as closure during certain
biological functions which he observed.
Early studies of the larynx were consistent with the level of
scientific knowledge and instrumentation available. As the base of
scientific information has been augmented, the refinement of skills
and investigative methods have reflected scientific and technological
advancements. Further, the types of questions which can be addressed
today are appreciably different from earlier times. Perhaps the
questions are not intrinsically more difficult, but certainly they are
more technical. The scientific method employed dictates, limits, or
influences the types of results derived as well as their
interpretation. A review of the 20th century literature elucidates
the relationship between the state of the art and the type of research


APPENDIX A
STRUCTURES OF INTEREST
1. Posterior Cricoarytenoid Muscle
2. Lateral Cricoarytenoid Muscle
3. Interarytenoids
a. Transverse Arytenoid Muscle
b. Oblique Arytenoid Muscle
4. Cricothyroid Muscle
a. Pars Oblique
b. Pars Recta
5. Thyroarytenoid Muscle
a. Thyromuscularis
b. Thyrovocalis
6. Conus Elasticus
a. Cricothyroid Ligament
b. Cricothyroid Membrane
7. Quadrangular Membrane
8. Cricoarytenoid Ligaments
a. Anterior Cricoarytenoid Ligament
b. Posterior Cricoarytenoid Ligament
*9. Surface width of TVF
* In the sagittal plane of dissection, this structure is referred to as
"height of the TVF."
80


Figure 5. Slide 46-F3-2A/Specimen 3/Coronal Plane/Anterior Block.


124
Table B-ll--continued.
SI ide #
Structure (Sq
Area
.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial-
Lateral
(Inch)
69-F1-6A
(cont.)
Surface Width of TVF
.0856L
.1039R
Thyroid Cartilage
-- Distance between
Superior Apexes
.9350
Distance between
Inferior Prominences
.7585
-- Height
.9975L
1.0020R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
.4000L
. 321OR
Phonatory Position
(glottal width/2)
.0435
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.24 05 L
.2411R
-- Area of Vibratory Mass
.1467L
.1280R
1.7024L
1.6996R
.7069L
6406R
.2443L
.2622 R
69-F1-9A
Cricothyroid Muscle
.0407L
.0188R
.9085L
.5578R
.3779L
.2314R
.1390L
.104 6 R
Thyroarytenoid Muscle
.0884L
.05 78 R
1.3891L
1.0025R
-6411L
.35 95 R
.2156L
. 1749R
Conus Elasticus
.5050R
Surface Width of TVF
. 1027L
.1045R


177
Table C-12. Apparent Size of Structures/Specimen 6/Coronal
Plane/Posterior Block
Structure
SI ide § (Sq
Area
.Inch)
Peri
meter !
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
Cricothyroid Muscle
69-F1-2P
.0472R
1.0663R
.4063R
. 1974R
69-F1-4P
.0428R
.97 25 R
. 3665 R
. 1464R
69-F1-7P
.0546L
.0717 R
1.7088L
1.4901R
.7649L
- 7 311R
. 1398L
. 1264R
69-F1-9P
.0544L
.0407R
1.4229L
1.1372R
.6149L
.50 7 3 R
.1108L
.0981R
69-F1-13P
.0493L
.0697 R
1.3687L
1.4686R
.6040L
.6230R
.0844L
.1000R
69-F1-18P
.0385L
0194R
1.1740L
.6718R
.5107L
. 1797R
.0829L
.0704R
69-F2-3P
.0395L
.0368R
1.2494L
1.2353R
.5163L
. 4214R
.1039L
0647R
69-F2-6P
.0226L
.0320R
.9795L
.9225R
4768L
. 35 52 R
.1005L
0933R
69-F2-10P
.0253L
.0949R
.9155 L
2.0353R
.3621L
.6819R
.0865L
. 1945 R
69-F2-15P
.0371L
1.0632L
.3877L
.0754L
69-F2-18P
.0266L
.8715 L
. 2922 L
.065 7 L
Interarytenoideus Muscle
69-F1-18P
.0824
1.5325
.6664
.1463
69-F2-3P
.0812
1.4533
.1294
.5563
69-F2-6P
.0665
1.4223
.1470
.6689
69-F2-15P
.0117
1.3473
.0565
.5235
Lateral Cricoarytenoid
Muscle
69-F1-2P
0185R
. 6965 R
. 1577 R
. 22 76 R


Figure 4. Slide 46-F2-12A/Specimen 3/Coronal Plane/Anterior Block.
en
en


21
and number of the exposure on the film, as well as plane markers. The
presence of L or R signals the sagittal plane and either the left or
right side respectively. The presence of A or P signals the coronal
plane and either the anterior or posterior aspect respectively,
whereas the presence of I, M, S or IL, ML, SL signals the transverse
plane and either inferior, medial, superior, or inferior left, medial
left, or superior left aspect respectively.
Instrumentation
Serial sectioning was conducted through the use of a sliding
microtome model number 1400 Leitz. The means of measurement was a
graphics tablet referred to as the Versawriter Tablet, marketed by
Versa Computing, Inc., of Newbury Park, CA. The versawriter was
interfaced with an Apple lie computer. A numerical value appears on
the screen and was accurate to greater than 30/1000 inch. A line
drawing of the structure of interest was displayed on the screen along
with a numerical value. This value was directly proportional to the
value identified utilizing the 1/10 inch grid for calibration. Area
and perimeter values were also determined. In securing measures, the
same procedure or manner in which the measure(s) were made, were
consistently followed, except when not possible due to the limits of
the size of the graphics tablet (8 inches x 12.5 inches). In some
instances the orientation of the tablet had to be changed, as in
measuring the height of the thyroid cartilage. Similarly, this
reorientation was also necessary at times when measuring the distance
between the apexes and prominences of the thyroid cartilages.
Photographic images of the slides in serial section were projected one


94
Table B-4--continued.
SI ide #
Structure
Area
(Sq.Inch)
Peri -
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
48-F1-18M
(cont.)
Lateral Cricoarytenoid
Muscle
. 025 9 L
.7413 L
.1990L
. 1191L
Cricothyroid Muscle
.0534L
0382R
1.7257L
1.6771R
.6689L
.0993R
.0505L
.762 2 R
48-F2-2M
Posterior Cricoarytenoid
Muscle
.0241L
. 0121R
1.0599L
.9365R
0628L
.0161R
.3658 L
.3215R
Lateral Cricoarytenoid
Muscle
.0134 L
. 707 7 L
. 1642L
.0712 L
Cricothyroid Muscle
.0442L
.0368R
1.6849L
1.8994R
. 6191L
. 861 OR
.0633L
0744R
48-F2-4M
Posterior Cricoarytenoid
Muscle
.0198L
.0116R
.95 6 7 L
.7490R
.4076L
.3073R
.0616L
.0140R
Lateral Cricoarytenoid
Muscle
.0320L
1.0130L
.3191L
0938L
Cricothyroid Muscle
.0504L
.0654R
1.5878L
2.1769R
.5061L
.3238R
.0423L
.0685R
* L = left, R = right; no letter = neither L nor R is indicated


74
Cone!usions
The purpose of this study was to examine disease-free adult male
larynges in block following serial dissection. Amultiplanar approach
to serial sectioning allowed measurement of soft tissue structures of
interest in the remaining specimen block. This study combined three
different empirical phases. All three phases of this study together
indicated significant information. It was determined that the block
technique of laryngeal assessment was a viable method for experimental
studies designed to address the intrinsic laryngeal musculature. It
was also indicated that change in the critical structures of interest
as well as a means for quantifying that change was possible. And
lastly, an empirically derived chemically induced percent shrinkage
estimate was established. This variable was never before quantified
on laryngeal material. The generated basic data base was intended as
incomplete in vivo values. However these values, augmented with the
empirically determined shrinkage values of 10% for measurements taken
along the course of a muscle and 14% for measurements perpendicular to
that course, represent as nearly as possible in vivo values.
Concisely, the triad reflected a proven method with quantifiable
normative data base combined with a now known chemical shrinkage
factor. A series of successive progressive measures contributed to
the resolution of the triad. One step along the continuum allowed by
the method chosen was that structures were viewed in relation to one
another. Specimen blocks were examined for change in soft tissue size
and configuration as indicated by the presence of the illustrations
and tabular data. Further, this method allowed the possibility of


56
Figure 5 (46-F3-2A) represents the second photographic slide on
film three in the anterior block. Specific structures were
identified. The thyroartyenoid muscle became meshed together near
midline. Slides preceding 46-F3-2A presented the thyroarytenoid
muscle as two separate bilaterally distributed muscles. The first
slide listed in the tabular data which followed (46-F3-2A) was
46-F3-5A. Fiber tract discernment in this case allowed the
identification of discrete bundles of the thyroarytenoid muscle.
However when the bundle fiber tracts were not easily discerned the
major muscle label, thyroarytenoid, was again used. Another
bilaterally identified structure was the cricothyroid muscle. However
the conus elasticus at this point had ceased to exist. Measurement
from slides 46-F2-13A, the slide closest to Figure 4, and 46-F3-5A
were examined in order to address transition in Figure 5. The lateral
cricoarytenoid muscle ceased to exist, whereas the right cricothyroid
muscle became clearly measurable. Both bundles of the thyroarytenoid
muscle, thyromuscularis and thyrovocalis, were demarcated in
46-F3-5A. Clarity of the discrete muscular bundle fiber tracts or the
thyroarytenoid muscle only occurred once throughout dissection and
that was at this interval. The boundary of the thyroarytenoid muscle
and the mucosal layer which surrounds it superiorly and medially was
once again obvious. This in turn made possible the resumed
measurement of the surface of the true vocal fold, phonatory position
and the area of the vibratory mass. Since these were resumed
measures, they were not present in 46-F2-13A. However values taken
from slide 46-F2-6A and compared to 46-F3-5A indicated a decrement on


160
Table C-6--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral -
Structure Slide # (Sq.Inch) (Inch) (Inch) (Inch)
Thyroid Cartilage
(cont.)
Height 46-F3-4P
46-F3-9P
46-F3-14P
46-F4-6P
46-F4-IIP
.8954L
1.0996R
.6 944 L
1.1018R
1.1483R
1.2995R
1.1614R
Vibratory Mass Measures
-- Height from Cricoid
to TVF 46-F1-3P .3419R
46-F1-9P .27 97 R
- Phonatory Position
(glottal width/2) 46-F1-3P .0609
46-F1-9P .0713
46-F1-14P .0837
46-F2-1P .0794
46-F2-6P .0853
46-F2-IIP .0652
46-F2-16P .0977
46-F3-4P .0900
46-F3-9P
.0814


176
Table C-ll--continued.
Peri-
Inferior-
Medial-
Area
meter
Superior
Lateral -
Structure
SIide #
(Sq.Inch)
(Inch)
(Inch)
(Inch)
Vibratory Mass Measures
-- Area of Vibratory Mass
(cont.)
69-F2-7A
- 0218L
.6277L
. 1611L
.1621L
.0168R
.5663R
.1620R
.1489R
* L = left, R = right; no
letter =
neither L
nor R is
indicated


69
Figure 12 (48-F1-3M) represents the third slide on film one of
the medial block of specimen 2, or an inferior level of the same
specimen depicted in Figure 11. In this instance the medial block was
at issue and dissection proceeded from a superior to an inferior
direction. Tabular data indicates some difference existed between the
surrounding slides (48-F1-2M) and 48-F1-4M). Specific structures of
interest included bilateral distribution of the thyroarytenoid,
lateral cricoarytenoid, and the posterior cricoarytenoid muscles and
the cricoid cartilage. The thyroarytenoid muscle ceased to exist as
dissection proceeded in an inferior direction. As this muscle dropped
out another, the cricothyroid muscle, appeared. Figure 12 (48-F1-3M)
reflects the transition in progress as the lateral cricoarytenoid,
posterior cricoarytenoid, and the thyroartyenoid muscles were depicted
bilaterally with increased area in all lateral and posterior
cricoarytenoid muscles. The cartilaginous framework consisted
primarily of the cricoid cartilage. Visual examination of Figure 12
reveals a ring shaped structure sparingly draped with musculature.
Figure 13 (75-F1-16R) represents the 16th slide on film one of
the right block of specimen 1. Specimen 1 was a sagittal dissection
specimen. Specific structures identified included the thyroarytenoid,
lateral cricoarytenoid, posterior cricoarytenoid muscles, arytenoid,
cricoid, epiglottis and thyroid cartilages. Tabular data indicates
the surrounding slides were (75-F1-14R and 75-F1-18R). Both slides
concurred with Figure 13 as to the presence of the posterior
cricoarytenoid, lateral cricoarytenoid, and thyroarytenoid muscles as
soft tissue structures of interest. Area values for all three


157
Table C-6--continued.
Structure
SI ide ff
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial-
Lateral -
(Inch)
Lateral Cricoarytenoid
Muscle (cont.)
46-F2-11P
.0232R
.7393R
.2003 R
. 1538R
46-F2-16P
0208R
. 5632R
.1742R
.1839R
Posterior Cricoarytenoid
Muscle
46-FI-14 P
.02 06 L
. 6157 L
. 187 7 L
. 1700L
46-F2-1P
.0224L
.66471
.277 6L
.1189L
45-F2-6P
.0114 L
.4692L
. 1849L
. 07 81L
46-F2-11P
.0276L
. 9 311L
4446L
.0999L
46-F2-16P
.0465 L
1.1882L
.5848L
. 0968 L
46-F3-4P
.0627L
.0208R
1.5894L
.6511R
.8020L
. 2971R
.1249L
.0980R
46-F3-9P
.0805L
.0190R
1.9273L
5728R
.9157L
.2407R
. 1144L
. 1043R
46-F3-14P
.0754L
.0069 R
1.8037L
. 5042R
8635L
.2408R
.1321L
.0452R
46-F4-6P
.0431L
.0300R
1.4604L
1.0539R
.6523L
.4636R
.0993L
. 0656 R
Thyroarytenoid Muscle
46-F1-3P
.1157L
. 1004 R
1.3751L
1.3007R
.3095L
. 4257 R
.3482L
. 2123R
46-F1-9P
.0614
.0854R
1.1498
1.2700R
.2413
. 251 OR
.2704
.287 2 R
46-FI-14 P
.0800L
.14 2 5 R
1.3600L
1.6227R
. 2111L
.4342R
.3331L
.3659R
46-F2-1P
.2169R
1.8345R
.5997R
.5212R
46-F2-6P
0610R
1.1619R
.2 981R
.2892 R


141
Table C-2continued.
Peri- Inferior- Anterior-
Area meter Superior Posterior
Structure Slide ft (Sq.Inch) (Inch) (Inch) (Inch)
Anterior Cricoarytenoid
Ligament (cont.)
Posterior Cricoarytenoid
Ligament
Thyroid Cartilage
75-F3-6R .5145
75-F3-13R .0733
75-F3-13R .0640
75-FI-1 OR
1.0628
75-F1-14R
1.1093
75-F1-18R
1.0378
75-F2-3R
.9614
75-F2-9R
.9306
75-F2-13R
1.0544
75-F2-18R
.7618
75-F3-5R
.9296
75-F3-9R
.9534
75-F3-13R
.8256
75-F3-17R
.8343
75-F4-3R
.9030
75-F4-6R
1.1037


58
all three. Measurements of the left cricothyroid muscle on 46-F3-5A
indicated a reduction in area. Thyroid cartilage measures indicated a
decrement in the distance between the superior apexes as well as the
inferior apexes, while height increased. Vibratory mass measures
indicated an increase in the height from the cricoid cartilage to the
true vocal fold and a decrease in the medial aspect of the
thyroarytenoid muscle to the thyroid cartilage. The overall
configuration of the remaining block had become narrowed and the fused
tracheal rings clearly present.
Figure 6 (46-F3-18A) represents the 18th photographic slide on
film three of the anterior block. This slide was so far forward in
the anterior block that all the soft tissue structures of interest
ceased to exist. The "U" shaped thyroid cartilage was the only
identifiable landmark.
Figure 7 (46-F1-3P) represents the third photographic slide on
film one of the posterior block. Identifiable structures included the
cricothyroid and thyroarytenoid muscles bilaterally, conus elasticus,
arytenoid, cricoid and thyroid cartilages and the pyriform sinus were
also identified. This particular slide is listed in the tabular
data. Numerical values of this figure are easily compared to the
values associated with Figure 1, which was the first anterior block
illustration. These figures represent the most medially depicted
aspects of the anterior and posterior blocks respectively.
Measurement indicated the area of the left cricothyroid muscle, conus
elasticus, and the surface width of the right true vocal fold smaller
in Figure 7 than in Figure 1. Also the area of the vibratory mass


97
Table B-5--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
46-FI-11A
(cont.) Thyroid Cartilage
-- Distance between
Superior Apexes
-- Distance between
Inferior Prominences
-- Height
Vibratory Mass Measures
-- Height from Cricoid
to TVF
-- Phonatory Position
(glottal width/2)
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
-- Area of Vibratory Mass
46-F1-14A Cricothyroid Muscle
Thyroarytenoid Muscle
Conus Elasticus
Surface Width of TVF
Thyroid Cartilage
-- Distance between
Superior Apexes
1.1126
1.2332
1.2295L
1.1238R
.2 961L
. 3691R
.0886
. 3009L
. 2470R
1185L
1.2637L
.3550L
.3378L
1360R
1.4678R
.3487 R
.264 9 R
0829L
1.4870L
.5604L
.1924L
0831L
1.2322L
.3168L
.2833 L
0537R
1.0832R
.3600R
.1873R
.4869L
.54 97 R
.1997L
.1908R
1.1497


115
Table B-7--continued.
Slide ff
Structure
Area
(Sq. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
68-F5-1L
Posterior Cricoarytenoid
Muscle
.0468
1.0279
.4040
.1050
Lateral Cricoarytenoid
Muscle
.0123
.5366
.0906
.1869
Cricothyroid Muscle
.0690
1.3063
.3597
.0953
Thyroarytenoid Muscle
.0846
1.3717
.1658
.4468
Thyroid Cartilage
.8860
68-F5-2L
Posterior Cricoarytenoid
Muscle
.0212
.6847
.2662
.0521
*
Lateral Cricoarytenoid
Muscle
.0087
.4292
.0394
.1271
Cricothyroid Muscle
.0370
1.5676
.6593
.1272
Thyroarytenoid Muscle
.0436
.8598
.1377
.3597
Thyroid Cartilage
.9072
58-F5-5L
Cricothyroid Muscle
.1881
1.6636
.4965
.5172
Thyroid Cartilage
.7418
68-F5-7L
Cricothyroid Muscle
.1656
1.5977
.3919
.3931
Thyroid Cartilage
1.1713
68-F5-9L
Cricothyroid Muscle
.1779
1.7146
.3168
.5183
Thyroid Cartilage
1.1249


159
Table C-6--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral -
Structure Slide ff (Sq.Inch) (Inch) (Inch) (Inch)
Thyroid Cartilage
(cont.)
-- Distance between
Inferior Prominences
-- Height
46-F1-3P
1.5893
46-F1-9P
1.6197
46-FI-14 P
1.5995
46-F2-1P
1.2922
46-F2-6P
1.2827
46-F2-IIP
1.2531
46-F2-16P
1.2983
45-F3-4P
1.2735
46-F3-9P
1.3809
46-F1-3P
1.5106L
1.3498R
46-F1-9P
.7042L
1.5368R
46-F1-14P
1.2618L
1.5103 R
46-F2-1P
1.3136L
.87 3 9 R
46-F2-6P
1.3113L
1.0926R
46-F2-11P
1.2664L
1.0713R
46-F2-15P
1.3072L
1.1530R


138
Table C-l--continued.
Structure
SI ide # (Sq
Area
.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
Thyroartenoid Muscle
(cont.)
75-F3-1L
.0723
1.2612
.2320
.4319
75-F3-5L
.2114
2.0595
.3273
.7110
75-F3-10L
.1304
1.9755
.1641
.6557
75-F3-14L
.2928
2.6509
.4667
.7022
Conus Elasticus --
Cricothyroid Ligament
75-F2-14L
.3567
Posterior Cricoarytenoid
Ligament
75-F1-13L
.2190
75-F1-18L
.2091
75-F2-5L
.0629
75-F2-9L
.1099


87
Table B-2--continued.
SI ide #
Structure (Sq
Area
. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
75-F3-6R
(cont.)
Cricothyroid Muscle
.0671
1.0945
.3199
.1495
Thyroarytenoid Muscle
.1499
1.7387
.1725
.6242
Anterior Cricoarytenoid
Ligament
.5145
Thyroid Cartilage
.9296
75-F3-9R
Posterior Cricoarytenoid
Muscle
.0972
1.6961
.6931
.1149
Interarytenoideus Muscle
.0258
1.1329
.4390
.0446
Thyroarytenoid Muscle
.0902
1.3978
.4474
.1639
Thyroid Cartilage
.9534
75-F3-13R
Posterior Cricoarytenoid
Muscle
.0672
1.2091
.4379
.1514
Interarytenoideus Muscle
.0725
1.2628
.4163
.1019
Cricothyroid Muscle
.0605
1.2089
.4756
.1551
Thyroarytenoid Muscle
.0747
1.1475
.2457
.3353
Anterior Cricoarytenoid
Ligament
.0733
Posterior Cricoarytenoid
Ligament
.0640
Thyroid Cartilage
.8256
75-F3-17R
Posterior Cricoarytenoid
Muscle
.0784
1.4652
.5421
.0909
Interarytenoideus Muscle
.0214
.6236
.1524
.0650
Cricothyroid Muscle
.0978
1.5023
.6228
.1260


9
Michaels and Gregor (1980) conducted a study which compared their
own method of laryngeal preparation and dissection to the more
traditional time proven methods. Their method consisted of fixation
in a 10% buffered formol saline for a minimum of 2 days after which
the specimen was sectioned serially on a meat slicer. Michaels and
Gregor (1980) judged their method superior by virtue of less chemical
intervention as well as the option of leaving the specimen whole prior
to dissection. This technique was used with both normal and diseased
specimens.
Gregor et al. (1980) addressed the efficacy of using computed
tomography (CT) as a noninvasive means of studying the larynx. This
group took various laryngeal sections and compared the pathological
findings via conventional tomography with those obtained by CT scan.
Their results indicated that particular areas were better evaluated
through the use of the CT scan, ". .an accurate assessment of
laryngeal anatomy and involvement by tumor, particularly of the pre-
epiglottic space, paracordal area, anterior commissure, and
cricoarytenoid area [and] . the presence of anterior or posterior
commissure involvement is of paramount importance in precluding the
possibility of conservative laryngeal surgery" (p. 291).
Hicks (1981a, b) made various measurements of 31 laryngeal
specimens to establish normative data documenting changes in the
larynx over the decades of life. His particular hypothesis also
addressed the possibility that these changes occurred as a result of
the aging process. Specimens were derived from both male and female
subjects ranging in age from 47 to 90 years of age. A total of 54


204
Tucker, G. F., Jr. (1961). A histological method for the study of the
spread of carcinoma within the larynx. Annals of Otology,
Rhinology and Laryngology, 70, 910-921.
Tucker, G. F., Jr. (1971). Human larynx: Coronal section atlas.
Washington, DC: Armed Forces Institute of Pathology.
Whicker, J. H., & Devine, K. D. (1972). The commemoration of great
men in laryngology. Archives of Otolaryngology, 95, 522-525.
Winslow, J. B. (1756). Exposition anatomique de la structure du corps
humain (4th ed.) (G. Douglas, Trans.). Paris, France: R. Ware.
Zemlin, W. R. (1981). Speech and hearing science: Anatomy and
physiology (2nd ed.")^ Englewood Cliffs, NJ: Prentice-Hal 1.


Table B-l. Apparent Size of Structures/Specimen 1/Sagittal Plane/Left
Block
SI ide #
Structure
Area
(Sq. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior'
Posterio
(Inch)
75-F1-5L
Interarytenoideus Muscle
.0707
1.1431
.3068
.2682
75-F1-9L
Posterior Cricoarytenoid
Muscle
.0332
1.0662
.3837
.0565
Interarytenoideus Muscle
.0684
1.2454
.2647
.2664
75-F1-13L
Posterior Cricoarytenoid
Muscle
.0718
1.2962
.4913
.0689
Interarytenoideus Muscle
.0645
1.1818
.3184
.1771
Thyroarytenoid Muscle
.0461
.8798
.3342
.1285
Posterior Cricoarytenoid
Li gainent
.2190
75-F1-18L
Posterior Cricoarytenoid
Muscle
.0711
1.5063
.6244
.1040
Interarytenoideus Muscle
.0560
1.1498
.4497
.0619
Thyroarytenoid Muscle
.1093
1.2671
.2326
.4155
Posterior Cricoarytenoid
Ligament
.2091
75-F2-5L
Posterior Cricoarytenoid
Muscle
.0710
1.3485
.5375
.1034
Interarytenoideus Muscle
.0127
.5903
.1846
.0216
Thyroarytenoid Muscle
.3625
2.6739
.2630
1.0387
Posterior Cricoarytenoid
Ligament
.0629
75-F2-9L
Posterior Cricoarytenoid
Muscle
.0753
1.4958
.6256
.1011
Thyroarytenoid Muscle
.5553
2.9600
.5425
1.1944
83


153
Table C-5continued.
Peri- Inferior- Medial -
Area meter Superior Lateral-
Structure Slide # (Sq.Inch) (Inch) (Inch) (Inch)
Vibratory Mass Measures
-- Height from Cricoid
to TVF
(cont.)
46-F3-5A
. 6247 L
.7314R
46-F3-9A
.6906L
.7 041R
46-F3-14A
. 1656L
.1488R
-- Phonatory Position
(glottal width/2)
46-F1-4A
.0878
46-F1-8A
.0667
46-FI-11A
.0886
46-F1-14A
.0926
46-F2-1A
.0893
46-F2-6A
.0710
46-F2-18A
.0127
46-F3-5A
.0140
46-F3-9A
.0006
46-F3-14A
.0060
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
46-F1-4A
. 3186 L
. 2229R
46-F1-8A
.3201L
.2064 R


166
Table C-8--continued.
Peri-
Inferior-
Anterior-
Area
meter
Superior
Posterior
Structure
SI ide #
(Sq. Inch)
(Inch)
(Inch)
(Inch)
Thyroarytenoid Muscle
(cont.)
68-F7-7R
.0487
.8649
.2137
.2536
68-F8-1R
.0460
.8098
.1858
.1665
Height of TVF
68-F6-1R
.4631
68-F6-3R
.3803
68-F7-1R
.5032
68-F7-4R
.4478
Thyroid Cartilage
68-F6-1R
.8610
68-F6-3R
.9480
68-F7-1R
1.0234
68-F7-4R
.8895
68-F7-7R
.9436
68-F8-1R
.9631
68-F8-4R
.9244
68-F8-7R
.9961


13
(3) There are no significant demonstrations of accurate real life
measurements of soft tissue structures of interest as a
result of the combined block embedding technique and
photography.
The question generated by this hypothesis reflects a
comparison of techniques. Will the block technique including
photography of the cut block surface demonstrate the
capability of measurements of soft tissue structures?
(4) There are no significant changes in the structures of
interest seen during progressive serial sectioning in one
plane of one specimen in its entirety.
The question is as follows: is it possible to measure
the dimensions of critical structures following the removal
of each slice, by means of scaled photography of the
remaining block, and to demonstrate change in those
dimensions?
(5) There is no significant effect as a result of photographic
and/or illustrative reconstruction of the identified soft
tissue structures in a given specimen.
Is it possible to reconstruct a specimen by photographic
and/or illustrative means?


46
muscle and the lateral cricoarytenoid muscle. The right block of the
same specimen (Table D-8) evidenced the greatest distance by the
thyroarytenoid muscle and the least distance shared equally between
the lateral cricoarytenoid and the interarytenoideus muscles.
The second and last transverse specimen was specimen 5. It was
dissected in six blocks, two of which contained relevant information
for the current soft tissue study. The intangible dimension in a
transverse specimen again was the inferior to superior dimension. The
left medial block (Table D-9) demonstrated the most and least range in
the posterior cricoarytenoid and the interarytenoideus muscles
respectively. The right medial block of the same specimen (Table
D-10) indicated the most extensive range involved the posterior
cricoarytenoid muscle and the least extensive, the lateral
cricoarytenoid muscle.
The sixth and final specimen was comprised of two blocks,
anterior and posterior dissected in the coronal plane (Table D-ll).
The missing dimension of a coronal dissection once again was the
anterior to posterior distance. This distance was conspicuously
occupied by the thyroarytenoid muscle. However both the area of the
vibratory mass and the distance between the thyroarytenoid muscle and
the thyroid cartilage demonstrated greater values as did the surface
of the true vocal folds. All of these were equivalent measures. The
single intrinsic muscle which demonstrated the least presence was the
cricothyroid muscle. However another soft tissue structure, the conus
elasticus, was even less apparent. The last block of specimen 6
(Table D-12) was the posterior block. The structure of greatest range


Ventricle of Morgagni
Thyroid cartilage
Thyroarytenoid m
Cricothyroid m.
Cricoid cartilage
Thyroid cartilage
Thyroarytenoid m.
Cricoid cartilage
Figure 2. Slide 46-Fl-17A/Specimen 3/Coronal Plane/Anterior Block,


202
Gregor, R. T., Lloyd, G. A., & Michaels, L. (1980). Computed
tomography of the larynx: A clinical and pathologic study. Head
and Neck Surgery, _3, 284-296.
Hicks, D. M. (1981a). A morphometric study of the aged human
larynx. Unpublished doctoral dissertation, Vanderbilt University,
Nashville, TN.
Hicks, D. M. (1981b). A morphometric study of the aging human
larynx. In V. L. Lawrence (Ed.), Transcripts of the Tenth
Symposium Care of the Professional Voice Part I: Instrumentation
in Voice Research (pp. 115-120). New York: The Voice Foundation.
Hirano, M. (1974). Morphological structure of the vocal cord as a
vibrator and its variations. Folia Phoniatrica, 26 89-94.
Hirano, M. (1977). Structure and vibratory behavior of the vocal
folds. In M. Sawashima & F. Cooper (Eds.), Dynamic aspects of
speech production (pp. 13-30). Tokyo, Japan: University of Tokyo
Press.
Hirano, M. (1981). The structure of the vocal folds. In K. Stevens,
& M. Hirano (Eds.), Vocal fold physiology (Chapter 4). Tokyo,
Japan: University of Tokyo Press.
Hirano, M., Koichi, M., Kakita, Y., Kawasaki, H., & Kurita, S.
(1983). In I. Titze & R. Scherer (Eds.)', Vocal fold
physiology: Biomechanics, acoustics and phonatory control (pp.
26-40). Denver, C: The Denver Center for the Performing Arts,
Inc.
Hollinshead, W. H. (1974). Textbook of anatomy (3rd ed.). Baltimore,
MD: Harper and Row.
Humason, G. L. (1979). Animal tissue techniques (4th ed.). San
Francisco, CA: W. H. Freeman & Co.
Kahane, J. C., & Kahn, A. R. (1984). Weight measurements of infant
and adult intrinsic laryngeal muscles. Folia Phoniatrica, 36,
129-133.
Kelemen, G. (1953). Congenital laryngeal stridor. Archives of
Otolaryngology, 58, 245-268.
Kernan, J. D. (1951). The pathology of carcinoma of the larynx
studies in serial section. Transactions of the American Academy
of Ophthalmology and Otolaryngology, 55, 10-21.
Lillie, R. D., & Fullmer, H. M. (1976). Histopathologic technic and
practical histochemistry (4th ed.). New York: McGraw-Hill.


150
Table C-5--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral -
Structure Slide ff (Sq.Inch) (Inch) (Inch) (Inch)
Thyroid Cartilage
-- Distance between
Superior Apexes
(cont.) 46-F1-14A
46-F2-1A
46-F2-6A
46-F2-13A
46-F2-18A
46-F3-5A
46-F3-9A
46-F3-14A
46-F4-2A
46-F4-7A
46-F4-12A
1.1497
1.0305
.9390
.7440
.5776
.4799
.4235
.4123
.3962
.3595
.3856
- Distance between
Inferior Prominences 46-F1-4A
46-F1-8A
46-F1-11A
46-FI-14A
46-F2-1A
46-F2-6A
46-F2-13A
1.2552
1.2651
1.2332
1.3148
1.1919
1.1598
.8972
46-F2-18A
.6636


LIST OF TABLES
Table Page
B-l Apparent Size of Structures/Specimen 1/Sagittal Plane/
Left Block 83
B-2 Apparent Size of Structures/Specimen 1/Sagittal Plane/
Right Block 85
B-3 Apparent Size of Structures/Specimen 2/Transverse Plane/
Superior Block 89
B-4 Apparent Size of Structures/Specimen 2/Transverse Plane/
Medial Block 92
B-5 Apparent Size of Structures/Specimen 3/Coronal Plane/
Anterior Block 95
B-6 Apparent Size of Structures/Specimen 3/Coronal Plane/
Posterior Block 105
B-7 Apparent Size of Structures/Specimen 4/Sagittal Plane/
Left Block 113
B-8 Apparent Size of Structures/Specimen 4/Sagittal Plane/
Right Block 116
B-9 Apparent Size of Structures/Specimen 5/Transverse Plane/
Left Medial Block 118
B-10 Apparent Size of Structures/Specimen 5/Transverse Plane/
Right Medial Block 121
B-11 Apparent Size of Structures/Specimen 6/Coronal Plane/
Anterior Block 123
B-12 Apparent Size of Structures/Specimen 6/Coronal Plane/
Posterior Block 129
C-l Apparent Size of Structures/Specimen 1/Sagittal Plane/
Left Block 137
C-2 Apparent Size of Structures/Specimen 1/Sagittal Plane/
Right Block 139
vi


163
Table C-7--continued.
Structure
Slide #
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
Posterior Cricoarytenoid
Muscle
68-F3-2L
.4321
4.353
1.9810
.2372
68-F3-4L
.1318
2.9374
1.4187
.0866
68-F3-7L
.0578
1.7806
.7988
.0780
68-F3-9L
.0657
1.7648
.8414
.0916
63-F4-3L
.0932
1.6160
.6677
.1424
68-F4-5L
.0959
1.6117
.7362
.1255
68-F4-8L
.0880
1.8637
.7293
.1305
68-F5-1L
.0468
1.0279
.4040
.1050
68-F5-2L
.0212
.6847
.2662
.0521
Thyroarytenoid Muscle
68-F3-2L
.2357
2.0103
.2410
.7152
68-F3-4L
.6754
4.5848
.3556
1.3031
68-F3-7L
.1712
2.4115
.1829
.6706
68-F3-9L
.1721
2.0446
.6399
.2792
63-F4-3L
.0359
.9992
.0810
.4415
68-F4-5L
.0558
1.4561
.6860
.0907
68-F4-8L
.0514
1.1416
.1184
.4433
68-F5-1L
.0846
1.3717
.1658
.4468
68-F5-2L
.0436
.8598
.1377
.3597


Fragments of
Figure 9. Slide 46-F3-2P/Specimen 3/Coronal Plane/Posterior Block
CT>
4^


BIBLIOGRAPHY
Albrecht von Haller (1708-1777). (1973). In Early American medical
imprints [microfilm no. 858, reel 47]. New Haven, CT: Research
Publication Inc. (Original work published 1803)
Anderson, P. D. (1984). Basic human anatomy and physiology.
Monterey, CA: Wadsworth Health Sciences Division.
Andrews, J. L., & Badger, T. (1979). Lung sounds through the ages
from Hippocrates to Laennec to Osier. Journal of American Medical
Association 241 2625-2630.
Anthony, C. P., & Thibodeau, G.A. (1979). Textbook of anatomy and
physiology (10 ed.). St. Louis, MO: Mosby.
Anthony, C. P., & Thibodeau, G.A. (1980). Structure and function of
the body (6th ed.). St. Louis, M0: Mosby.
Bailey, B., & Biller, H. (1985). Surgery of the larynx.
Philadelphia, PA: W. B. Saunders Co.
Basmajian, J. V. (1980). Grant's method of anatomy (10th ed.).
Baltimore, MD: Williams and Wilkins Co.
Basmajian, J. V. (1982). Primary anatomy (8th ed.). Baltimore, MD:
Williams and Wilkins Co.
Bowden, R., & Scheure, J. (1960). Weights of abductor and adductor
muscles of the human larynx. Journal of Laryngology and
Otolaryngology, 74, 971-980.
Broyles, E. (1943). The anterior commissure tendon. Annals of
Otology, Rhinology and Laryngology, 52, 342-345.
Burke, S. (1980). Human anatomy and physiology for the health
sciences New York: Wi1ey.
Camper, P. (1779). Account of the organs of speech of the
orangoutan. Philosophical Transactions, Royal Society of London,
69, 139-159.
200


12
soft tissue. The proposed measurements required the soft tissue
structures be revealed at different sequential levels for the purpose
of viewing and comparing those structures in relation to one another
as well as in relation to hard tissue. Further, this technique allows
the course of particular soft tissue structure(s) to be illustrated.
Serial sectioning best demonstrated the internal configuration of
these structures. The relevance of this study's contribution to the
field of speech pathology is such that these measurements are used to
facilitate a greater understanding of laryngeal anatomy.
This study has been designed to address several questions. In
order to answer these questions the following null hypotheses were
tested:
(1) There are no significant inferences relative to laryngeal
behavior or function which can be postulated based on the
course of muscle fibers demonstrated by this technique.
This hypothesis leads to the question, is it possible to
infer cartilaginous and soft tissue behavior based on the
combined information of the chosen measurements and
illustration?
(2) There is no significant differentiation of tissue in block
when topically stained.
This hypothesis generates a two part question. To what
extent is it possible to differentiate via a stain (a) soft
tissue from cartilage and (b) soft tissue from other soft
tissue?


CHAPTER II
METHODS
The purpose of this study was to determine the viability of
obtaining measurement values of the intrinsic laryngeal musculature
from a photographic slide of the remaining celloidin embedded block at
given intervals following serial sectioning.
Procedures
Specimens
Adult male disease-free specimens were collected from autopsy in
a 10% formalin solution. All specimens were Caucasian and male. The
age of the specimens ranged from 45 to 75 years of age, specifically
46, 48, 62, 68, 69, and 75, respectively. All organ donors expired
due to causes other than that of any form of laryngeal pathology or
compromise.
Chemical Processing
Specimens were allowed to remain fixed in the formalin solution
for 48 to 72 hours after which decalcification procedures were
followed. The formalin solution was poured off and the specimen was
rinsed three times in tap water before being placed in the
decalcification solution.
14


119
Table B-9--continued.
SI ide ff
Structure (Sq
Area
. Inch)
Peri -
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
62-F2-17M
Posterior Cricoarytenoid
Muscle
.0433
.9551
.0745
.3749
Lateral Cricoarytenoid
Muscle
.0244
.8588
.3100
.0411
62-F3-2M
Interarytenoideus Muscle
.0932
1.2657
.2003
.4230
Lateral Cricoarytenoid
Muscle
.0150
.8103
.3901
.0380
Posterior Cricoarytenoid
Muscle
.0446
1.0855
.0854
.3811
Thyroarytenoid Muscle
.0157
.5862
.0790
.1386
62-F3-5M
Interarytenoideus Muscle
.0607
1.1562
.0820
.4177
Lateral Cricoarytenoid
Muscle
.0163
.8377
.2537
.0269
Thyroarytenoid Muscle
.0160
.5640
.1166
.1348
62-F3-8M
Posterior Cricoarytenoid
Muscle
.0760
1.2209
.2011
.3641
Interarytenoideus Muscle
.0305
.8941
.0605
.3622
Cricothyroid Muscle
.0760
1.2209
.2076
.5351
Thyroarytenoid Muscle
.0478
.8976
.2535
.2468
62-F3-11M
Posterior Cricoarytenoid
Muscle
.1009
1.2970
.2449
.4290
Cricothyroid Muscle
.0361
1.1687
.4584
.0980
Thyroarytenoid Muscle
.0489
.8583
.2020
.2186
62-F3-15M
Posterior Cricoarytenoid
Muscle
.0894
1.2260
.1889
.4069
Cricothyroid Muscle
.0308
1.0243
.3922
.0287


D-8 Apparent Size of Structures/Specimen 4/Sagittal Plane/
Right Block 193
D-9 Apparent Size of Structures/Specimen 5/Transverse Plane/
Left Medial Block 194
D-10 Apparent Size of Structures/Specimen 5/Transverse Plane/
Right Medial Block 195
D-11 Apparent Size of Structures/Specimen 6/Coronal Plane/
Anterior Block 196
D-12 Apparent Size of Structures/Specimen 6/Coronal Plane/
Posterior Block 198
vi i i


Inf. Pharyngeal
'constrictor m.
Thyroid cartilage<
Arytenoid cartilage
Post.Cricoarytenoid m.
Post.Cricoarytenoid m.
Cricothyroid m.
Figure 10. Slide 46-F3-12P/Specimen 3/Coronal Plane/Posterior Block.
cn


I certify that I have read this study and that in my opinion it
conforms to acceptable standards of scholarly presentation and is
fully adequate, in scope and quality, as a dissertation for the degree
of Doctor of Philosophy.
This dissertation was submitted to the Graduate Faculty of the
Department of Speech in the College of Liberal Arts and Sciences and
to the Graduate School and was accepted as partial fulfillment of the
requirements for the degree of Doctor of Philosophy.
December, 1985
Dean, Graduate School


Table C-4--continued
Peri- Anterior- Lateral-
Structure
SI ide If (Sq
Area
.Inch)
meter Posterior
(Inch) (Inch)
Medial
(Inch)
Lateral Cricoarytenoid
Muscle (cont.)
48-FI-1OM
.02 21L
.9665 L
.33 92 L
.06 7 3 L
48-FI-12M
.0405L
1.1063L
.3854L
. 1163L
48-F1-14M
. 03 7 2 L
.9768L
. 3903L
. 1454L
48-F1-16M
.0290L
8346L
.3131L
. 1355L
48-F1-18M
. 02 5 9 L
.7413 L
.1990L
. 1191L
48-F2-2M
. 0184L
.7077L
.1642L
.0712L
48-F2-4M
. 03 2 0 L
1.0130L
. 3191L
. 0938L
Posterior Cricoarytenoid
Muscle
48-F1-2M
. 04 66 L*
.0279R
1.1083L
.8675R
.1314L
.0664R
.4178L
.301OR
48-F1-4M
.0540L
.0394 R
1.3120L
1.1178R
.1415L
1263R
.6152 L
4763R
48-F1-6M
.0481L
.03 66 R
1.1443L
1.0786R
.1418L
1202R
.5226L
.4642R
48-F1-8M
.0277L
.0279R
.8 981L
8293R
.0741L
.0580R
. 3691L
. 3159R
48-F1-10M
.0319L
.02 04 R
. 9922L
.72 5 6 R
.0616L
.0954R
.3884L
. 2921R
48-FI-12M
.0386L
.0309R
1.1756L
1.1624R
.1067L
. 03 61R
.4907 L
. 54 7 OR
48-F1-14M
.0292L
- 02 97 R
1.0321L
1.2766R
.1147L
.0285R
.4699L
. 585 6 R
48-FI-16M
.0224L
.0191R
.9535L
1.1222R
.0817L
0274R
.3226L
.5717 R


194
Table D-9. Apparent Size of Structure/Specimen 5/Transverse Plane/Left
Medial Block
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Inferior
to Superior
Distance
Cricothyroid Muscle
62-F3-8M
to
62-F3-18M
5
35
microns
1925 microns
or
1.925 mm
Interarytenoideus Muscle
62-F3-2M
to
62-F3-8M
5
35
microns
1225 microns
or
1.225 mm
Lateral Cricoarytenoid
Muscle
62-F2-5M
to
62-F3-5M
5
35
microns
3325 microns
or
3.325 mm
Posterior Cricoarytenoid
Muscle
62-F2-1M
to
62-F3-15M
5
35
microns
5775 microns
or
5.775 mm
Thyroarytenoid Muscle
62-F3-2M
to
62-F4-3M
5
35
microns
3500 microns
or
3.5 mm
NOTE: Transverse Plane: The missing dimension dictated by this plane
is the inferior-superior distance. This table is a summation of that
distance.


respectively. Area, perimeter, height and width measurements were
made of the soft tissue structures of interest when clearly present.
Structures void of discernible boundaries were not measured in a
particular slide and this accounts for the disappearance and
reappearance of a structure in the tabular data found in the
appendices. Shrinkage data were generated in an attempt to determine
the approximate amount that muscular tissue shrinks as a result of the
chemical processes of fixation, decalcification and dehydration.
These measurement values taken together with the shrinkage data yield
a normative data base closely representative of in vivo conditions.
Tabular data are presented in three forms. First, tabular data
are presented in a progressive slide by slide sequence in which all
structures of interest shown in the sectional plane are delineated by
name and measure. Secondly, individual intrinsic laryngeal muscles
are identified and measured as they are presented throughout a given
specimen. This information is combined with the serial laryngeal
illustrations. Finally, as a result of the chosen plane of
dissection, one dimension is not measurable. The last set of tables
presents a summation of range of structures of interest in the missing
dimension. It is entirely likely subsequent studies may expand the
quantity and type of measurements generated.
xi


147
Table C-5. Apparent Size of Structures/Specimen 3/Coronal
Plane/Anterior Block
Structure
SI ide ft
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral -
(Inch)
Cricothyroid Muscle
46-F1-4A
.0908L*
1.5171L
.6043L
.2764L
46-F1-8A
0794L
1.4152L
.5114L
.1684 L
46-FI-11A
.0828L
1.2800L
.5131L
.1669L
46-FI-14A
0829L
1.4870L
. 5604 L
.1924 L
46-F2-1A
.0412L
.9792L
. 3256L
. 1243L
46-F2-6A
.0219L
.8010L
. 307 2 L
.0976 L
46-F2-13A
.0295L
8304L
.3870L
.0931L
46-F3-5A
0288L
.0154R
6632L
.5228R
.1771L
.1491R
. 1231L
.0742R
46-F3-9A
.0248L
.0104 R
.5790L
.45 95 R
.1228L
1169R
.1313L
.0663R
Lateral Cricoarytenoid
Muscle
46-F2-1A
.0057 L
.3071L
0846L
.07 3 6 L
46-F2-6A
.0137L
.4907L
.1605L
.1544L
46-F2-13A
.0170 L
.5369L
1573L
. 1123 L
Thyroarytenoid Muscle
46-F1-4A
.0646L
.017 2 R
1.2746L
6164R
.4120L
2143R
.5223L
. 1261R
46-F1-8A
.0984L
.0608R
1.2688L
1.1227R
.3064L
. 3632R
. 2287L
. 1768R
46-FI-11A
.0776L
0690R
1.1051L
1.0829R
.3325L
.38 23 R
. 2914 L
. 1982 R


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FILES


A MULTIDIMENSIONAL STUDY
OF THE INTRINSIC LARYNGEAL MUSCULATURE
BY
TERRY L. HARDEE
A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
1935


140
Table C-2--continued.
Peri- Inferior- Anterior-
Area meter Superior Posterior
Structure Slide # (Sq.Inch) (Inch) (Inch) (Inch)
Posterior Cricoarytenoid
Muscle (cont.) 75-F3-6R
75-F3-9R
75-F3-13R
75-F3-17R
Thyroarytenoid Muscle 75-F1-7R
75-F1-10R
75-F1-14R
75-F1-18R
75-F2-3R
75-F2-9R
75-F2-13R
75-F2-18R
75-F3-6R
75-F3-9R
75-F3-13R
75-F3-17R
75-F1-18R
75-F2-3R
75-F2-9R
75-F2-18R
0749
1.4190
.6045
.1129
0972
1.6961
.6931
.1149
0672
1.2091
.4379
.1514
0784
1.4652
.5421
.0909
1318
2.0219
.2949
.6773
2292
2.4642
.3717
.9157
2855
2.5105
.4953
.7123
2517
2.5753
.3719
.7938
2595
2.5892
.3084
.6724
2747
1.999
.4168
.5179
3309
2.2542
.6543
.4656
0741
1.4425
.1536
.4873
,1499
1.7387
.1725
.6242
0902
1.3978
.4474
.1639
,0747
1.1475
.2457
.3353
,0626
.9493
.1428
.2108
5944
6189
3941
7455
Anterior Cricoarytenoid
Li gament


117
Table B-8--continued.
SIide #
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
68-F8-1R
(cont.)
Interarytenoideus Muscle
.0425
1.1795
.5188
.0984
Cricothyroid Muscle
.0779
1.5064
.6775
.3314
Thyroarytenoid Muscle
.0460
.8098
.1858
.1665
Thyroid Cartilage
.9631
68-F8-4R
Posterior Cricoarytenoid
Muscle
.0717
1.2321
.4847
.1335
1
Lateral Cricoarytenoid
Muscle
.0295
.8147
.1923
.1437
Interarytenoideus Muscle
.0624
1.4129
.7587
.0870
Cricothyroid Muscle
.1831
1.8536
.3061
.5543
Thyroid Cartilage
.9244
68-F8-7R
Cricothyroid Muscle
.1221
1.3845
.4053
.2317
Thyroid Cartilage
.9961
68-F8-10R
Cricothyroid Muscle
.1241
1.3515
.4710
.2860
68-F8-13R
Cricothyroid Muscle
.1901
1.8359
.5042
.4823


132
Table B-12--continued.
SI ide a
Structure (Sq
Area
.Inch)
Peri- Inferior-
meter Superior
(Inch) (Inch)
Medial -
Lateral
(Inch)
69-FI-13P
(cont.)
Cricothyroid Muscle
.0493L
.0697R
1.3687L
1.4686R
.6040L
.6230R
.0844L
.1000R
Thyroarytenoid Muscle
.1440L
. 0911R
1.6525L
1.3250R
.43681
. 2666 R
. 3540L
. 2842 R
Conus Elasticus
.3120L
. 1821R
Thyroid Cartilage
-- Distance between
Superior Apexes
.9274
Distance between
Inferior Prominences
.8687
-- Height
.85 51L
.7860R
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.37 03 L
.3425R
-- Area of Vibratory Mass
.1847L
. 1865 R
2.2236L
2.0105R
.47 5 2L
.4171R
.4684 L
. 3842 R
69-F1-18P
Posterior Cricoarytenoid
Muscle
.0019R
.1735R
.06 32 R
.0361R
Interarytenoideus Muscle
.0824
1.5325
.6664
.1463
Cricothyroid Muscle
.0385L
.0194R
1.1740L
.6718R
.5107 L
.1797R
.08291
.0704R
Thyroarytenoid Muscle
.0440L
.9372L
.2278L
. 2197L
Conus Elasticus
.37 2 2 L
. 1670R


173
Table C-ll--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral-
Structure Slide# (Sq.Inch) (Inch) (Inch) (Inch)
Thyroid Cartilage
Distance between
Inferior Prominences
(cont.)
-- Height
69-F1-3A
.9503
69-F1-6A
.7585
69-F1-9A
.6616
69-FI-11A
.4373
69-F1-14A
.2930
69-F1-3A
1.0979L
1.0200R
69-F1-6A
.9975L
1.0020R
69-F1-9A
.9866L
1.0183R
69-FI-11A
1.0981L
1.0571R
69-F1-14A
1.1902L
1.1634R
69-F1-18A
1.1302L
1.1622R
69-F2-3A
1.0327L
.9248R
69-F2-3A
. 1013L
.0703R
69-F2-7A
1.0652L
1.1009R


C-3 Apparent Size of Structures/Specimen 2/Transverse Plane/
Superior Block 142
C-4 Apparent Size of Structures/Specimen 2/Transverse Plane/
Medial Block 144
C-5 Apparent Size of Structures/Specimen 3/Coronal Plane/
Anterior Block 147
C-6 Apparent Size of Structures/Specimen 3/Coronal Plane/
Posterior Block 156
C-7 Apparent Size of Structures/Specimen 4/Sagittal Plane/
Left Block 162
C-8 Apparent Size of Structures/Specimen 4/Sagittal Plane/
Right Block 165
C-9 Apparent Size of Structures/Specimen 5/Transverse Plane/
Left Medial Block 167
C-10 Apparent Size of Structures/Specimen 5/Transverse Plane/
Right Medial Block 169
C-ll Apparent Size of Structures/Specimen 6/Coronal Plane/
Anterior Block 171
C-12 Apparent Size of Structures/Specimen 6/Coronal Plane/
Posterior Block 177
D-l Apparent Size of Structures/Specimen 1/Sagittal Plane/
Left Block 184
D-2 Apparent Size of Structures/Specimen 1/Sagittal Plane/
Right Block 185
D-3 Apparent Size of Structures/Specimen 2/Transverse Plane/
Superior Block 186
D-4 Apparent Size of Structures/Specimen 2/Transverse Plane/
Medial Block 187
D-5 Apparent Size of Structures/Specimen 3/Coronal Plane/
Anterior Block 183
D-6 Apparent Size of Structures/Specimen 3/Coronal Plane/
Posterior Block 190
D-7 Apparent Size of Structures/Specimen 4/Sagittal Plane/
Left Block 192
vi i


stains. Kelemen (1953) concluded that anatomical anomalies were
present and accounted for the stridor.
Further Refined Investigative Techniques
8
G.F. Tucker, Jr. (1961) utilized histologic methods to determine
a more precise classification system delineating the limits of
carcinoma. He believed a better system was necessary as some systems
omitted the submucosal structures. Hence, a more universal system
would be desirable. The clinical means of determining the extent of
the lesion depends on the absence of fold mobility. Tucker (1961)
pointed out a classification system based on dissection is far more
specific. For this reason Tucker (1961) conducted a coronal serial
section laryngeal dissection of celloidin embedded specimens.
Specimens were cut on a Spencer microtome following a modified
decalcification, dehydration and embedding procedure. A variety of
different stains was used. Tucker (1961) concluded that coronel
serial sectioning allowed the inspection of a tumor in relation to the
remaining healthy structures. It also permitted speculation as to the
initial disease locale prior to the spread of the disease.
Livingston et al. (1976) developed a rather innovative means of
studying structure. Although concerned with the brain, horizontal
slices were studied via filmed computer graphics. This technique was
applied to various brain structures throughout the horizontal
slices. The advantage of using computer graphics is that it enables
the entire brain to be represented in a three-dimensional fashion as
well as allowing the viewer the flexibility of visualizing the brain
externally or to travel through the inner structures.


18
after it was successfully hardened. If the celloidin had remained
clear, then a celloidin strip would have been cut out of the dish.
This strip would have existed at the lateral margins of the dish,
virtually all the way around the dish. The specimen would have been
covered in chloroform once again, the lid replaced, and left for one
hour. The most significant step was to be sure to place the correct
side face down in the dish. The correct side was the side or surface
intended to be cut first. This side was the top of the block.
Once the specimen was hardened into the block, it was mounted on
the microtome sledge plate. This was achieved as a result of several
steps. The chloroform was poured off. The specimen was placed in a
separate dish and covered with ether alcohol where it remained for 5
minutes. The sledge plate and 20% celloidin were ready for immediate
use. A small amount of ether alcohol, was followed quickly by a small
amount of 20% celloidin poured onto the sledge plate. ¡These solutions
established a mounting base for the specimen. The specimen block was
immediately placed on the solution base and oriented in such a fashion
that it was at an angle to the blade. The purpose was to ease the
blade into the specimen block, thereby reducing the shock to the
specimen. It was also important to note the composition of the
structure encountered first by the blade to avoid bone where
possible. Once the specimen was oriented on the solution base, the
specimen was covered in 20% celloidin to seal the block onto the
sledge. The specimen, sledge and all, was placed in chloroform for
one hour. The specimen should not remain in the chloroform over one
hour, as changes result in the block. The block was mounted on the


167
Table C-9. Apparent Size of Structures/Specimen 5/Transverse Plane/Left
Medial Block
Structure
Slide if (Sq
Area
Inch)
Peri -
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
Cricothyroid Muscle
62-F3-8M
.0760
1.2209
.2076
.5351
62-F3-11M
.0361
1.1687
.4584
.0980
62-F3-15M
.0308
1.0243
.3922
.0287
62-F3-18M
.0110
.7686
.3361
.0233
Interarytenoideus Muscle
62-F3-2M
.0932
1.2657
.2003
.4230
62-F3-5M
.0607
1.1562
.0820
.4177
62-F3-8M
.0305
.8941
.0605
.3622
Lateral Cricoarytenoid
Muscle
62-F2-5M
.0143
.6651
.1827
.0320
62-F2-7M
.0084
.5535
.1622
.0226
62-F2-9M
.0062
.4439
.1112
.0155
62-F2-11M
.0136
.6975
.1886
.0133
62-F2-13M
.0144
1.1044
.4619
.0290
62-F2-15M
.0150
.9551
.3989
.0137
62-F2-17M
.0244
.8588
.3100
.0411
62-F3-2M
.0150
.8103
.3901
.0380
62-F3-5M
.0163
.8377
.2537
.0269
Posterior Cricoarytenoid
Muscle
62-F2-1M
.0058
.4541
.0141
.1405
62-F2-3M
.0096
.5274
.0276
.2162
62-F2-5M
.0160
.6688
.0451
.2666


38
interest. Specimens subject to the coronal plane of dissection
included specimens 3 and 6. This plane of dissection did not display
anterior-posterior distance on structures of interest. Appendix D
presents a summation of the missing dimension for each plane of
dissection for each specimen. This information was the result of
tabulation of the number of slides in which the structures of interest
appeared in, multiplied by the number of microtome passes occurring
between photographic slides, and multiplied again by the unit of slice
thickness of 35 microns. This value was then converted from microns
to millimeters. The number of microtome passes between slides varied
with the specimen.
Apparent Size of Structures Arranged by Slide
Examination of the available data was that the course of each
particular muscle was visible. Some structures were easily
identifiable in all planes and in all blocks, while others were barely
discernible.
Specimen 1 (Table B-l) demonstrated a definite core of consistent
intrinsic musculature. It also manifested the infrequent appearance
of ligaments, such as the posterior cricoarytenoid ligament and the
anterior cricoarytenoid ligament, as well as the singular entry of the
conus elasticus. Slide by slide, a sequential progression, medial to
lateral, existed through each block of this specimen. Measurement
values were given for the structures of interest. These values
allowed the comparison of structures of interest within a given level
of the remaining block. Size differences were noted and alteration in


A Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy
A MULTIDIMENSIONAL STUDY
OF THE INTRINSIC LARYNGEAL MUSCULATURE
BY
TERRY L. HARDEE
December, 1985
Chairman: Thomas B. Abbott, Ph.D.
Major Department: Speech
The study of laryngeal anatomy has a long history. It has
examined cartilaginous framework and later muscular composition.
Laryngeal replicas were modeled out of wax to depict structure.
Laryngeal material was also embedded in various mediums and sectioning
ensued. Recognizing early examination of the larynx has been fairly
extensive, the crucial question becomes what new information may be
gathered as a result of the current study? The current study attempts
to assess the feasibility of generating intrinsic laryngeal
musculature measurements from photographic slides of the remaining
celloidin embedded block in adult male disease-free specimens cut in
multiplanar serial section. It also is an attempt to follow size,
configurational and relational changes in the intrinsic laryngeal
musculature. A total of six celloidin embedded topically stained
specimens were dissected via coronal, sagittal, and transverse planes,
x


99
Table B-5--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
46-F2-1A
(cont.) Thyroid Cartilage
-- Distance between
Inferior Prominences
-- Height
Vibratory Mass Measures
-- Height from Cricoid
to TVF
-- Phonatory Position
(glottal width/2)
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
-- Area of Vibratory Mass
46-F2-6A Lateral Cricoarytenoid
Muscle
Cricothyroid Muscle
Thyroarytenoid Muscle
Conus Elasticus
Surface Width of TVF
Thyroid Cartilage
-- Distance between
Superior Apexes
1.1919
1.3601L
1.1250R
.4183L
.5035 R
.0893
.2722 L
.1851R
1402L
1553R
1.4657L
1.7744R
4280L
.6815 R
.3187L
. 2117R
0137L
. 4907 L
. 1605L
- 1544L
0219L
8010L
.3072L
.0976L
0633L
0449R
.9813L
1.2506R
.2964L
1.5469R
. 2549L
.1903R
.5855L
.5341R
.2057L
.2380R
.9390


TABLE OF CONTENTS
Page
ACKNOWLEDGMENTS iii
LIST OF TABLES vi
LIST OF FIGURES ix
ABSTRACT x
CHAPTERS
IBACKGROUND AND PURPOSE 1
Introduction 1
Review of the Literature 2
The Advent of Laryngeal Awareness 2
Laryngeal Investigation: Anomaly and Disease 6
Further Refined Investigative Techniques 8
Statement of Purpose 11
IIMETHODS 14
Procedures 14
Specimens 14
Chemical Processing 14
Decalcification 15
Dehydration 15
Block Preparation and Celloidin Embedding 16
Di ssection 19
Van Gieson Stain 20
Measurement 20
Photographic Apparatus 20
Instrumentation 21
Structures to Be Measured 22
Shrinkage Study 22
IIIRESULTS 24
Some Aspects of Measurement 24
Shrinkage Study 27
Hypotheses: Empirical Reply 29
Tabular Data 34
IV


169
Table C-10. Apparent Size of Structures/Specimen 5/Transverse
Plane/Right Medial Block
Structure
Slide ^ (Sq
Area
. Inch)
Peri -
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
Interarytenoideus Muscle
62-F2-10M
.0585
1.0400
.2115
.3359
62-F2-14M
.0827
1.2952
.1416
.4848
62-F2-18M
.0816
1.3716
.5896
.2332
62-F3-4M
.0854
1.3716
.2248
.5448
62-F3-8M
.0952
1.3919
.2488
.5082
62-F3-12M
.0900
1.2977
.1981
.5041
62-F3-16M
.0943
1.3961
.2515
.5366
Lateral Cricoarytenoid
Muscle
62-F2-18M
.0246
.7528
.3042
.0648
62-F3-4M
.0321
1.0137
.4225
.0598
62-F3-8M
.0316
1.0164
.4298
.0643
62-F3-12M
.0092
.5452
.2434
.0348
Posterior Cricoarytenoid
Muscle
62-F2-10M
.0145
.7847
.0591
.3591
62-F2-14M
.0397
1.2562
.0749
.5051
62-F2-18M
.0399
1.1909
.0813
.5852
62-F3-4M
.0537
1.2480
.0673
.5628
62-F3-8M
.0512
1.2649
.0724
.6040
62-F3-12M
.0519
1.2667
.0540
.6394
62-F3-16M
.0512
1.1885
.0960
.5795
62-F4-2M
.0458
1.1529
.0688
.4735
62-F4-6M
.0480
1.5524
.7461
.0453


91
Table B-3--continued.
Slide #
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
48-F2-9S
Thyroarytenoid
Muscle
.0950L
.0719R
2.0835L
1.5469R
.7782L
. 6469R
.1755L
- 0931R
48-F2-11S
Thyroarytenoid
Muscle
.0518L
0812R
1.1320L
1.3308R
.4329L
.4815R
.1263L
.1596R
* L = left
, R = right; no
i letter =
neither L
nor R is
indicated


44
previously unavailable directional parameter was assessed by summation
across the number of slides in which a structure was identified. The
information herein presented differs from the soft tissue measures
evidencing the most and least transition within a block as presented
in Appendix C. The current data set was not numerically derived from
a most to least site transition in a structure. Rather, Appendix D
addresses the continued presence, range, or extension of a
structure. The summation, or Appendix D set of tables, of the
previously intangible dimension indicated in specimen 1 (Table D-l)
was the medial to lateral dimension. The most extensive soft tissue
structure in specimen 1 was the thyroarytenoid muscle. The least
extensive range involved two structures, the lateral cricoarytenoid
muscle and the conus elasticus. The right block of specimen 1 (Table
D-2) demonstrated the soft tissue structure of greatest range was the
thyroarytenoid muscle. The structure with the least range was the
posterior cricoarytenoid ligament.
The superior block of transverse specimen 2 (Table D-3) indicated
the thyroarytenoid and the posterior cricoarytenoid ligament as
structures with the greatest and least musculature range
respectively. This was determined by a summation of inferior to
superior dimension. The medial block in this transverse specimen
(Table D-4) indicated two soft tissue structures of equivalent
range. They were the lateral cricoarytenoid muscle and the posterior
cricoarytenoid muscle. The structure of the least range proved to be
the thyroarytenoid muscle.


72
diminished as dissection proceeded laterally. Visual inspection
revealed the inferior pharyngeal constrictor muscle and what appeared
to be the fragmented beginning of the interarytenoideus muscle while a
nearly midline position was assumed by the arytenoid cartilage.
Figure 14 (75-F2-17R) represents the 17th slide on film two of
the right block of specimen 1. Specific structures identified
included the thyroarytenoid muscle, cricothyroid muscle, posterior
cricoarytenoid muscle, interarytenoideus muscle, arytenoid, cricoid
and thyroid cartilages. Tabular data indicate the closest surrounding
slide of Figure 14 (75-F2-17R) was 75-F2-18R. This slide listed the
interarytenoideus, posterior cricoarytenoid, and cricothyroid muscles
as present. The anterior cricoarytenoid ligament was also
indicated. Comparison of Figures 13 and 14 as a result of compared
tabular data on the slides indicated as closest to the appropriate
figures, 75-F1-18R for Figure 13 and 75-F2-18R for Figure 14
respectively, were as listed. Area measurement indicated the
posterior cricoarytenoid muscle increased, while the cricothyroid and
interarytenoideus muscles were both new additions at the level of
dissection for Figure 14. The area of the thyroarytenoid muscle was
demonstrated as decreased. Figure 14 did not evidence an anterior
cricoarytenoid ligament. Visual examination revealed the most
extensive features were a definite interarytenoideus muscle, and the
unmistakable characteristic shapes of both the arytenoid and cricoid
carti1 age.


81
10. Thyroid Cartilage
a. Distance between superior apexes
b. Distance between inferior prominences
c. Height
11. Vibratory Mass Measures
a. Height from Cricoid cartilage to TVF
b. Phonatory position (glottal width/2)
c. Medial aspect of Thyroarytenoid muscle to Thyroid cartilage
d. Area


Table D-ll--continued
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Anterior
to Posterior
Distance
Area of Vibratory Mass
69-F1-3A
10
35
8050 microns
to
microns
or
69-F2-7A
8.05 mm
NOTE: Coronal Plane: The missing dimension dictated by this plane is
the anterior-posterior distance. This table is a summation of that
distance.


17
grams of nitrocellulose dissolved in 3000 ml of ether alcohol.
Specimens were then placed in a 10% celloidin solution and remained
there for 2 weeks. Ten percent celloidin solution consists of 300
grams of nitrocellulose dissolved in 3000 ml of ether alcohol.
Finally, specimens were placed in a 20% celloidin solution and
remained there for 2 weeks. Twenty percent celloidin solution
consists of 600 grams of nitrocellulose dissolved in 3000 ml of ether
alcohol.
After the six weeks of celloidin processing the specimen was
prepared for cutting or set up into a block. Essentially this was
achieved by several steps. The side or surface of interest of the
specimen was placed face down in the dish. A quantity sufficient to
cover the specimen with 20% celloidin was poured into the dish. A
piece of paper with the autopsy identification number was placed on
the top surface of the specimen. In effect this top surface became
adjacent to the microtome mount and, therefore, in reality was at the
bottom of the mounted specimen block. The identification number was
recorded in pencil, as inks wash out or run. Next, the lid was
loosened and the specimen allowed to dry until it was the consistency
of gelatin. Chloroform was poured over the specimen, sufficient to
cover it, and left overnight. The dish was sealed tightly with
tape. The next day the excess celloidin was cut off around the edges
of the specimen. The specimen was put back in the dish, and fresh
chloroform poured over it. The specimen remained like this for one
hour. This step allowed the portion of the specimen, face down in the
dish, to harden as a part of the block. The block appeared hazy,


105
Table B-6. Apparent Size of Structures/Specimen 3/Coronal
Plane/Posterior Block
Slide §
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
46-F1-3P
Cricothyroid Muscle
.0458L*
. 04 91R
.9319L
1.0776R
.3385L
.3490R
.0982L
. 1036R
Thyroarytenoid Muscle
-1157L
. 1004R
1.3751L
1.3007R
.3095L
.42 5 7 R
. 3482 L
.2123 R
Conus Elasticus
. 4653L
. 3877 R
Surface Width of TVF
.0890R
Thyroid Cartilage
-- Distance between
Superior Apexes
1.6395
-- Distance between
Inferior Prominences
1.5893
-- Height
1.5106L
1.3498R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
.3419R
-- Phonatory Position
(glottal width/2)
.0609
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
. 5178L
.3509R
-- Area of Vibratory Mass
.1409R
1.6238R
.3616R
. 3195R
46-FI-9 P
Cricothyroid Muscle
.03 7 9 L
.0545R
.8679L
1.2233R
. 35 92L
.5716R
-1145 L
.1491R
Thyroarytenoid Muscle
.0614
0854R
1.1498
1.2700R
.2413
.251 OR
.2704
2872R
Conus Elasticus
.3438R


114
Table B-7continued.
SI ide ft
Structure
Area
(Sq. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
68-F3-7L
(cont.)
Thyroid Cartilage
1.0239
68-F3-9L
Posterior Cricoarytenoid
Muscle
.0657
1.7648
.8414
.0916
Interarytenoideus Muscle
.0610
1.2134
.4784
.1085
Thyroarytenoid Muscle
.1721
2.0446
.6399
.2792
Posterior Cricoarytenoid
Ligament
.3785
Thyroid Cartilage
1.2068
68-F4-3L
Posterior Cricoarytenoid
Muscle
.0932
1.6160
.6677
.1424
Interarytenoideus Muscle
.0166
.7302
.3086
.0420
Thyroarytenoid Muscle
.0359
.9992
.0810
.4415
Thyroid Cartilage
.9510
68-F4-5L
Posterior Cricoarytenoid
Muscle
.0959
1.6117
.7362
.1255
Interarytenoideus Muscle
.0221
.7896
.3417
.0462
Thyroarytenoid Muscle
.0558
1.4561
.6850
.0907
Thyroid Cartilage
.9909
68-F4-8L
Posterior Cricoarytenoid
Muscle
.0880
1.8637
.7293
.1305
Interarytenoideus Muscle
.0102
.6754
.0152
.2687
Thyroarytenoid Muscle
.0514
1.1416
.1184
.4433
Thyroid Cartilage
.9218


Thyroid cartilage
Arytenoid cartilage
Thyroarytenoid m.
Lateral cricoarytenoid
Cricothyroid m.
Cricoid cartilage
Pyriform sinus
Thyroid cartilage
Arytenoid cartilage
Lateral cricoarytenoid m.
Posterior cricoarytenoid m.
Cricothyroid m.
Cricoid cartilage
Figure 8. Slide 46-Fl-17P/Specimen 3/Coronal Plane/Posterior Block
CT
r>o


187
Table D-4. Apparent Size of Structure/Specimen 2/Transverse
Plane/Medial Block
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Inferior
to Superior
Distance
Cricothyroid Muscle
48-F1-4M
to
48-F2-4M
10
35
microns
6650 microns
or
6.65 mm
Lateral Cricoarytenoid
Muscle
48-F1-2M
to
48-F2-4M
10
35
microns
7350 microns
or
7.35 mm
Posterior Cricoarytenoid
48-F1-2M
to
48-F2-4M
10
35
microns
7350 microns
or
7.35 mm
Thyroarytenoid Muscle
48-F1-2M
10
35
microns
350 microns
or
.35 mm
NOTE: Transverse Plane: The missing dimension dictated by this plane
is the inferior-superior distance. This table is a summation of that
distance.


104
Table B-5--continued.
SIide #
Area
Structure (Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial-
Lateral
(Inch)
46-F3-14A
(cont.)
Thyroid Cartilage
-- Height
1.0165L
.9474R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
-- Phonatory Position
(glottal width/2)
. 1656L
. 1488R
.0060
46-F4-2A
Thyroid Cartilage
-- Distance between
Superior Apexes
.3962
-- Distance between
Inferior Prominences
.1519
-- Height
.9398L
. 9642R
46-F4-7A
Thyroid Cartilage
-- Distance between
Superior Apexes
.3595
-- Distance between
Inferior Prominences
.2040
-- Height
.7190L
- 6855 R
46-F4-12A Thyroid Cartilage
-- Distance between
Superior Apexes
.3856
-- Distance between
Inferior Prominences
.1908
-- Height
.7071L
. 7077R
* L = left, R = right; no letter = neither L nor R is indicated.


76
change, per specific muscle. It was, however, not possible to include
the bulk of the Kodak 35mm slides as a part of this text. It was
anticipated that the combination of the illustrations in addition to
the measures of each muscle would jointly convey these transitions
effectively. In reviewing the various available anatomy texts, it was
clear that in many the larynx was given light cursory treatment.
Descriptions of laryngeal musculature as previously mentioned were
generally relegated to a few paragraphs. One had to ponder why the
larynx apparently was such an unimportant organ. Perhaps, the
significance of such an organ grew due to increased instrumentation
capabilities which in turn allowed a means of putting to task various
questions. This was most evident via the engineering and radiological
literature (Damste et al., 1968; Hirano, 1977 ; Hirano et al ., 1981;
Run and Chung, 1983). Although the engineers' proclivity for the true
vocal folds was an exhaustive pursuit to capture and mathematically
catalog the very essence of the true folds, other investigators'
quests have addressed the true folds as well as other intrinsic
musculature (Hirano et al., 1983). Other means of describing and
cataloguing were sometimes preferred as mathematical formulas did not
always facilitate resolution (Cooper, 1985; Mueller & Sweeney,
1985). Surely the true vocal folds do not accomplish phonation alone,
without assistance from other structures (Hirano, 1974, 1977; Hirano
et al., 1981, 1983). Although the true vocal folds can be considered
critical for phonation, the surrounding musculature likely contributed
to the overall structure and function, including phonation, of the
larynx. Since the present study was not geared to elucidate


16
half absolute ethyl alcohol, referred to as ether alcohol, which was
also changed twice during a 24 hour period.
Following dehydration, the celloidin processing was begun.
Block Preparation and Celloidin Embedding
The specimens selected for sagittal plane sectioning were split
mid-sagittally and dissection proceeded in a medial to lateral
progression, first on one side and then the other. Coronal specimens
were cut in half along the anterior to posterior continuum and then
set up into two separate blocks, an anterior and a posterior block.
Each block was dissected from the central coronal plane of cut on out
anteriorly and posteriorly, respectively. Finally, the two transverse
specimens were cut into superior, medial and inferior blocks. One
specimen had a center sagittal cut, the other did not. In one case
rendering three blocks, superior, medial and inferior, that contained
both right and left structures. In the other case, where the right
and left halves were separated at the median sagittal plane, six
blocks, superior, medial and inferior existed. In one case soft
tissue measures resulted in bilateral representation within the same
block. The other case or second transverse specimen resulted in
unilateral representation of soft tissue structures. In the case of
the six block transverse specimen, the medial blocks contained the
designated structures of interest. The inferior and superior blocks
consisted largely of cartilage and some fat. In all cases the large
block cuts were made with the use of a brain knife or a band-saw.
Specimens were placed in a 5% celloidin solution and remained
there for 2 weeks. Five percent celloidin solution consists of 150


168
Table C-9--continued.
Structure
Slide ft 1
Area
(Sq.Inch)
Peri -
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial-
Lateral -
(Inch)
Posterior Cricoarytenoid
Muscle (cont.)
62-F2-7M
.0225
.7393
.0493
.2608
62-F2-9M
.0227
.7190
.0748
.2652
62-F2-11M
.0397
.9585
.0956
.3781
62-F2-13M
.0420
.9842
.0686
.3893
62-F2-15M
.0341
.8048
.0717
.2475
62-F2-17M
.0433
.9551
.0745
.3749
62-F3-2M
.0446
1.0855
.0854
.3811
62-F3-8M
.0760
1.2209
.2011
.3641
62-F3-11M
.1009
1.2970
.2449
.4290
62-F3-15M
.0894
1.2260
.1889
.4069
Thyroarytenoid Muscle
62-F3-2M
.0157
.5862
.0790
.1386
62-F3-5M
.0160
.5640
.1166
.1348
62-F3-8M
.0478
.8976
.2535
.2468
62-F3-11M
.0489
.8583
.2020
.2186
62-F3-15M
.0557
1.0647
.2301
.1138
62-F3-18M
.0922
1.7482
.6422
.2916
62-F4-3M
.0827
1.4783
.6461
.2065


189
Table D-5continued.
Structure
SI i de
Range
Number of
Microtome
Passes
Unit of
Measure
Total Anterior
to Posterior
Distance
Vibratory Mass-
Cricoid to TVF
46-F1-4A
to
46-F3-14A
5
35
microns
8225 microns
or
8.225 mm
Phonatory Position-
Presence of Glottal
Aperture
46-F1-4A
to
46-F3-14A
5
35
microns
8225 microns
or
8.225 mm
Vibratory Mass-
Thyroarytenoid to
Thyroid Cartilage
46-F1-4A
to
46-F3-9A
5
35
microns
7350 microns
or
7.35 mm
Area of Vibratory Mass
46-F1-4A
to
46-F3-9A
5
35
microns
7350 microns
or
7.35 mm
NOTE: Coronal Plane: The missing dimension dictated by this plane is
the anterior-posterior distance. This table is a summation of that
distance.


180
Table C-12--continued.
Area
Structure Slide ft (Sq.Inch)
Peri- Inferior- Medial-
meter Superior Lateral -
(Inch) (Inch) (Inch)
Thyroid Cartilage
-- Distance between
Superior Apexes
(cont.) 69-F1-13P
.9274
69-F1-18P
1.1156
69-F2-3P
1.0556
69-F2-6P
1.1492
-- Distance between
Inferior Prominences 69-F1-2P
1.0454
69-F1-4P
.9038
69-F1-7P
.9197
69-F1-9P
.8742
69-FI-13 P
.8687
69-F1-18P
.9310
69-F2-3P
1.0116
69-F2-6P
1.0263
69-F2-10P
1.0663
Height 69-F1-2P
1.1427L
9682R
69-F1-4P
.9076L
. 847 7 R
69-F1-7P
.9845L
.7946 R
69-F1-9P
.8591L
.7325R


201
Canal is, R. F. (1980). Laryngeal ventricle historical features.
Annals of Otology, 89, 184-187.
Christensen, J., & Telford, I. (1972). Synopsis of gross anatomy (2nd
ed.). New York: Harper and Row.
Cooper, D. S. (1985). Research in laryngeal physiology with excised
1arynges. Unpublished manuscript.
Crouch, J., & McClintic, J. R. (1971). Human anatomy and
physiology. New York: Wiley.
Czermak, J. N. (1861). On the laryngoscope and its employment in
physiology and medicine. London: New Sydenham Society.
Damste, P. H., Hollien, H., Moore, P., & Murry, Th. (1968). An X-ray
study of vocal fold length. Folia Phoniatrica, 20, 349-359.
Dienhart, C. (1979). Basic human anatomy and physiology (3rd ed.).
Philadelphia, PA: W. B. Saunders Co.
Dodart, D. (1719). Sur les causes de la voix de l'homme, et de ses
differens tons. Memoires Academy of Royal Science (Paris), 244-
273.
Ellis, H. (1976). Clinical anatomy (6th ed.). Philadelphia, PA:
Lippincott.
Ellis, H., & Feldman, S. (1977). Anatomy for anaesthetists (3rd
ed.). Philadelphia, PA: Lippincott.
Evans, W. F. (1976). Anatomy and physiology (2nd ed.). Englewood
Cliffs, NJ: Prentice-Hall.
Fink, R. B. (1975). The human larynx: A functional study. New
York: Raven Press.
Francis, C., & Martin, A. (1975). Introduction to human anatomy (7th
ed.). St. Louis, MO: Mosby.
Galen. (1968). On the usefulness of the parts of the body (M. T. May,
Trans.). Ithaca, NY: Cornell University Press.
Garcia, M. (1855). Observations on the human voice. Proceedings of
Royal Society (London), _7> 399-420.
Gardner, E., Gray, D., & O'Rahilly, R. (1963). Anatomy: A regional
study of human structure (2nd ed.). Philadelphia, PA: W. B.
Saunders Co.
Gray, H. (1985). Gray's anatomy (13th ed.). Philadelphia, PA: Lea
and Febiger.


Table C-l. Apparent Size of Structures/Specimen 1/Sagittal Plane/Left
Block
Structure
Slide ff (Sq
Area
. Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior
Posterio
(Inch)
Cricothyroid Muscle
75-F2-14L
.3260
2.6021
.3953
1.0607
75-F3-1L
.2912
2.4133
.6381
.4925
Interarytenoideus Muscle
75-F1-5L
.0707
1.1431
.3068
.2682
75-F1-9L
.0684
1.2454
.2647
.2664
75-F1-13L
.0645
1.1818
.3184
.1771
75-F1-18L
.0560
1.1498
.4497
.0619
75-F2-5L
.0127
.5903
.1846
.0216
Lateral Cricoarytenoid
Muscle
75-F2-14L
.0497
1.1466
.2128
.3146
Posterior Cricoarytenoid
Muscle
75-F1-9L
.0332
1.0662
.3837
.0565
75-F1-13L
.0718
1.2962
.4913
.0689
75-F1-18L
.0711
1.5063
.6244
.1040
75-F2-5L
.0710
1.3485
.5375
.1034
75-F2-9L
.0753
1.4958
.6256
.1011
75-F2-14L
.0626
1.5335
.5680
.1079
75-F3-1L
.0464
.9284
.3931
.1044
Thyroarytenoid Muscle
75-F1-13L
.0461
.8798
.3342
.1285
75-F1-18L
.1093
1.2671
.2326
.4155
75-F2-5L
.3525
2.6789
.2630
1.0387
75-F2-9L
.5553
2.9600
.5425
1.1944
75-F2-14L
.3379
2.3723
.7633
.4423
137


127
Table B-ll--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
69-F1-14A
(cont.) Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage -151SL
.1030R
-- Area of Vibratory Mass
.0860L
. 1257R
1.7673L
1.9662R
.6670L
7596R
.1542L
. 1804R
69-FI-18A
Thyroarytenoid Muscle
.0248L
.0262R
.7825L
.8543 R
.3381L
.321 OR
. 1272L
. 0722 R
Surface Width of TVF
-1143L
. 1203R
Thyroid Cartilage
-- Distance between
Superior Apexes
.6770
-- Height
1.1302L
1.1622R
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.132 3 L
.1322R
-- Area of Vibratory Mass
.0481L
.0444R
.9124L
.87 2 7 R
.3049L
3020R
.1341L
. 13 71R
69-F2-3A
Thyroarytenoid Muscle
.0117L
. 0071R
.49 23L
4632R
.2081L
1566R
.0608L
.0402R
Surface Width of TVF .0791L
.0454R
Thyroid Cartilage
-- Distance between
Superior Apexes .5754


7
surgical technique employed, a return of carcinoma should not be
viewed as a recurrence, but rather as a continuation. The growth
would be suspect of having been in the tendon itself or its "insertion
into the thyroid cartilage" (p. 344).
Kernan (1951) studied laryngeal carcinoma via horizontal
celloidin embedded serial sections. The specimens were derived from
patients whom he had followed throughout the course of their
treatment. Kernan (1951) was most concerned with illustrating the
insidious nature of subglottic carcinoma and the failures of too
conservative surgery or inappropriate use of radiation therapy as
forms of treatment. Serial sectioning and histologic techniques were
used on the resulting specimens. Kernan (1951) concluded that
treatment failures need to be studied in depth.
Kelemen (1953) investigated congenital laryngeal stridor in four
newborns. He also had a control group consisting of laryngeal
specimens from four normal newborns. Dissections were parallel for
each group. Three larynges were sectioned in the horizontal plane and
the fourth was dissected in the "frontal plane" (p. 246). Specimens
were infiltrated with celloidin before cutting. The horizontal
sectioning resulted in 640, 800, and 900 sections respectively.
Sectioning for the frontal plane required a midsagittal split, with
the right side of the larynx further divided into 340 slices. A
hematoxylin and an eosin stain were used on every tenth horizontal
slice. Staining for the frontal plane employed Van Gieson and Gomori
stains in addition to the previously mentioned hematoxylin and eosin


89
Table B-3. Apparent Size of Structures/Specimen 2/Transverse
Piane/Superior Block
SI ide ft
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial -
Lateral
(Inch)
48-FI-IS
Posterior Cricoarytenoid
Muscle
.0320L*
.0197R
1.0162L
.7225R
.102 5 L
0767R
.3930L
.2932R
Lateral Cricoarytenoid
Muscle
.0345R
1.5641R
6469R
.0444R
Interarytenoideus Muscle
.1064L
.0760R
1.8258L
1.6346R
.6315L
.65 67 R
. 1581L
. 1489R
48-F1-3S
Posterior Cricoarytenoid
Muscle
.0255 L
.0090R
.77 7 7 L
.4071R
.0713 L
.0544R
.2946L
.217 7 R
Lateral Cricoarytenoid
Muscle
.0330L
0402R
1.6164L
1.4805R
. 6423 L
.6240R
. 06 21L
.0344R
Thyroarytenoid Muscle
.0964L
.1040R
1.9906L
1.7785R
.8567L
. 6959R
.1750L
.1241R
48-F1-5S
Posterior Cricoarytenoid
Muscle
. 017 0 L
.0060R
.77 7 6 L
.4200R
.0524L
.0359R
- 3097 L
. 1717 R
Lateral Cricoarytenoid
Muscle
. 05 7 0 L
.0480R
1.4869L
1.5244R
.6105 L
.6732R
. 0855 L
.0499R
Thyroarytenoid Muscle
.2059L
.1520R
2.5773L
2.1371R
.3108L
.87 37 R
.2413 L
. 17 7 3 R
48-F1-7S
Posterior Cricoarytenoid
Muscle
0092L
.0020R
.6432L
.2769R
0139L
.0142R
.254 6 L
.1242R
Lateral Cricoarytenoid
Muscle
. 1457L
.0897R
2.2453L
1.7136R
1.0320L
.7249R
. 1370L
.1619R
Thyroarytenoid Muscle
.0906L
0682R
2.4542L
1.4426R
1.0513L
5567R
. 1072L
-1351R


134
Table B-12--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide If Structure (Sq.Inch) (Inch) (Inch) (Inch)
69-F2-3P
(cont.) Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage .2497L
.1874R
-- Area of Vibratory Mass
.0768L
1.2560L
.2480L
.3079L
69-F2-6P
Posterior Cricoarytenoid
Muscle
0103L
.0154R
.4830L
5618R
. 1873L
. 2439R
.07 21L
0313R
Interarytenoideus Muscle
.0665
1.4223
.1470
.6689
Cricothyroid Muscle
.022 6L
.0320R
.97 95 L
.9225R
.4768L
.3552R
.1005 L
.09 33R
Thyroarytenoid Muscle
.0267R
.7566R
.2215R
.2202R
Thyroid Cartilage
Distance between
Superior Apexes
1.1492
Distance between
Inferior Prominences
1.0263
-- Height
1.2155R
69-F2-10P
Posterior Cricoarytenoid
Muscle
.0182L
.0453R
. 5877 L
1.2600R
.1988L
.5153R
0847L
.1030R
Cricothyroid Muscle
.0253L
.0949R
.9155L
2.0353R
.3621L
.6819R
.0865L
. 194 5 R
Thyroid Cartilage
-- Distance between
Inferior Prominences 1.0663
-- Height
3500R


45
Specimen 3, a coronal dissection, was divided into anterior and
posterior blocks. The previously intangible dimension of specimen 3
entailed a depth measurement as the unknown directional parameter, or
the anterior to posterior distance. The anterior block (Table D-5)
revealed the soft tissue structure of greatest range again represented
two equivalent range structures. Those structures were the
thyroarytenoid and cricoarytenoid muscles. Also the surface of the
true vocal fold demonstrated the same numerical value. However, the
vibratory mass, which extended beyond the limits of a single muscle
was even more extensive. The least range values of two structures
were of equivalent standing. Those structures were the
thyromuscularis and thyrovocalis bundles of the thyroarytenoid muscle.
The posterior block of specimen 3 (Table D-6) presented the
structure of greatest range as the cricothyroid muscle. Whereas the
structure of least range concerned a portion of the vibratory mass.
The portion referenced was the existing distance from the cricoid
cartilage to the true vocal fold. The surface of the cord itself
entailed a minute distance, but the intrinsic laryngeal muscle which
exhibited the least range was the lateral cricoarytenoid muscle.
Specimen 4 was set up into two blocks, left and right
respectively. This specimen was dissected in the sagittal plane from
the medial aspect, outward to the most lateral aspect of the
specimen. The missing dimension was determined by the summation of
the medial to lateral dimension. The soft tissue structure in the
left block (Table D-7) of greatest range was the cricothyroid
muscle. The least range value implicated the posterior cricoarytenoid


42
cricoarytenoid ligament, while the structure with the least change was
the lateral cricoarytenoid muscle.
Specimen 2 (Table C-3), a transverse dissection, indicated some
of the same musculature. The most transition or size change within
the superior block occurred in the thyroarytenoid muscle, while the
least transition occurred in the posterior cricoarytenoid ligament.
The medial block of the same specimen indicated the most transition in
the cricothyroid muscle and the least transition in the thyroarytenoid
muscle.
Specimen 3 (Table C-5) was a coronal dissection and was divided
into anterior and posterior blocks. Dissection yielded different
information in these blocks. The most extensive transition occurred
in the thyroarytenoid muscle and the least size transition in the
lateral cricoarytenoid muscle. The posterior block of the same
specimen again indicated the thyroarytenoid muscle as the structure
which demonstrated the most transition, and the lateral cricoarytenoid
muscle, the least transition.
Specimen 4 (Table C-7) was a sagittal specimen split into two
blocks, left and right respectively. The left block presented the
most extensive structural transition in the thyroarytenoid muscle and
the least transition in the anterior cricothyroid ligament. The
distribution of intrinsic musculature in the right block was somewhat
different. The most extensive structural transition occurred in the
cricothyroid muscle and the least in the interarytenoideus.
Specimen 5 (Table C-9) was the second of two transverse
specimens. This specimen was divided into six small blocks and then


61
measures of the cricoid cartilage to the true vocal fold, the medial
aspect of the thyroarytenoid muscle to the thyroid cartilage and the
phonatory position were documented as decreased in Figure 7. No value
was given for the analogous measure of the true vocal fold surface on
the left. '.Jhereas the area of the thyroarytenoid muscles and the area
of the right vibratory mass declined. No value was generated for the
same structure on the left. Finally, the cartilaginous framework
increased in all cases in Figure 7. Visual inspection of Figures 1
and 7 indicate definite configurational changes in musculature,
especially the thyroartenoid muscles. The right cricothyroid muscle
evidenced a definite boundary. The introduction of the arytenoid
cartilages and the pyriform sinus both by their presence indicated
posterior progression in block dissection.
Figure 8 (46-F1-17P) represents the 17th photographic slide on
film one of the posterior block. Specific structures identified
included the right thyroarytenoid muscle, the lateral cricoarytenoid
muscles, cricothyroid muscles, right conus elasticus, arytenoid,
cricoid and thyroid cartilages and the pyriform sinus. Tabular data
indicates the closest slide to Figure 8 (46-FI-17P) was 46-F2-1P.
Structural comparison between the measurement values generated for
Figure 7 (46-F1-3P) and those of slide 46-F2-1P indicated the
following: the left posterior cricoarytenoid muscle had been revealed
through sectioning. Also the lateral cricoarytenoid muscle exhibited
a definite boundary and was once again a measurable structure in the
specimen block. The area of the left cricothyroid and right
thyroarytenoid muscles had increased as had the area of the right


3
1972). It has been suggested that several hundred years elapsed
between the first and second individuals to address the larynx. The
first to identify the larynx is thought to have been Aristotle (Fink,
1975) and the second, Galen (Fink, 1975; Whicker & Devine, 1972).
Whicker and Devine (1972) credit Galen (192 A.D.) with referencing the
thyroid, arytenoid and cricoid cartilages. Galen is also purported to
have believed each muscle throughout the entire body possessed a
distinct function and he did attempt to designate function for the
laryngeal musculature. Galen is considered to be the father of early
anatomical dissection. His concepts remained widely employed and
undisputed for centuries.
Leonardo da Vinci (1452-1519) perhaps was the unheralded
anatomist of his period (Fink, 1975; Whicker & Devine, 1972). Da
Vinci believed the voice to be related to the larynx. To support his
theory da Vinci removed certain organs--the larynx, lungs and trachea
as a unit and forced air out through the trachea and lungs. Da Vinci
believed, in a live subject, this same action would result in voice.
Another early advocate of laryngeal study was Vesalius (Fink, 1975;
Whicker & Devine, 1972). Prior to his departure from the University
of Padua in 1543, Vesalius contributed much on the subject of many
different organ systems, including the larynx. Still another advocate
of laryngeal study was Bartolomaeous Eustachius (Fink, 1975; Whicker &
Devine, 1972). His contribution was that of laryngeal drawings.
Although Eustachius lived in the 1500s, his work was not revealed
until the 1700s. Studies often ascribed specific functions to certain
laryngeal musculature. Sometimes these ascribed functions were not


BIOGRAPHICAL SKETCH
T. L. Hardee was born in Aurora, Illinois, in the not so recent
past. Educational experiences included a brief acquaintance with the
Austrian countryside, a high school graduation from Riverview High
School in Sarasota, Florida, and then on to the University of South
Florida in Tampa, Florida, which culminated in the attainment of the
Master of Science degree in speech pathology. Educational process
continued as an interest in research necessitated the pursuit of the
Ph.D. in speech at the University of Florida, Gainesville. Miss
Hardee is a member of the American Speech-Language Hearing Association
and is both a Hobie sailor and a white-water enthusiast.
205


88
Table B-2--continued.
Slide ft
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
75-F3-17R
(cont.)
Thyroarytenoid Muscle
.0626
.9493
.1423
.2108
Thyroid Cartilage
.8343
75-F4-3R
Thyroid Cartilage
.9030
75-F4-6R
Thyroid Cartilage
1.1037


Figure 14. Slide 75-F2-17R/Specimen 1/Sagittal Plane/Right Block.
CO


SUMMATION:
APPENDIX D
THE MISSING DIMENSION DUE TO DISSECTION PLANE


95
Table B-5. Apparent Size of Structures/Specimen 3/Coronal
Piane/Anterior Block
Slide If
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
46-F1-4A
Cricothyroid Muscle
.0908L*
1.5171L
.6043L
. 2764L
Thyroarytenoid Muscle
0646L
.0172R
1.2746L
.6164R
.4120L
.2143R
5223L
. 1261R
Conus Elasticus
.4542L
. 5153 R
Surface Width of TVF
.2002L
. 1925R
Thyroid Cartilage
-- Distance between
Superior Apexes
1.1285
-- Distance between
Inferior Prominences
1.2552
-- Height
1.2024L
1.2296R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
Phonatory Position
(glottal width/2)
.34 76L
.4152R
.0878
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
3186L
. 2229R
-- Area of Vibratory Mass
.1898L
.1388R
1.8356L
1.4779R
.4141L
.2924L
.3934R
.5136L
3926L
.2554R
46-F1-8A
Cricothyroid Muscle
.0794L
1.4152L
.5114L
. 1684L
Thyroarytenoid Muscle
.0984L
.0608R
1.2688L
1.1227R
.3064 L
.3632R
. 2287 L
. 1768R


154
Table C-5--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral -
Structure Slide# (Sq.Inch) (Inch) (Inch) (Inch)
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
(cont.) 46-FI-11A 3009L
. 2470R
46-F1-14A 2947 L
. 2206R
46-F2-1A 2722L
.1851R
46-F2-6A
.2666L
. 1685 R
46-F2-13A
46-F2-18A
46-F3-5A
46-F3-9A
-- Area of Vibratory Mass 46-F1-4A
46-F1-3A
45-F1-11A
46-F1-14A
.2372L
. 1584R
. 1608L
0670R
.0769L
.0628R
.0440L
. 1577R
1898L
1.8356L
.4141L
.5136L
.2924 L
. 3926L
1388R
1.4779R
.3934R
. 2554R
1651L
1.5717L
.3560L
.3683L
1384R
1.4454R
4099R
. 2742R
1185L
1.2637L
.3550L
.3378L
1360R
1.4678R
.3487 R
.2649R
1518L
1.5276L
.4133L
.3516L
1534R
1.5675R
.5933R
. 2491R


103
Table B-5--continued.
Slide If
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
46-F3-9A
Cricothyroid Muscle
.0248L
.0104 R
.5790L
.45 95 R
.1228L
. 116 9 R
.1313L
. 0663R
Thyroarytenoid Muscle
.0184L
.0205R
. 6306L
. 7587 R
.2201L
.27 54 R
.0440L
. 1577R
Surface Width of TVF
. 1431L
. 1760R
Thyroid Cartilage
-- Distance between
Superior Apexes
.4235
-- Distance between
Inferior Prominences
.3998
-- Height
1.0588L
. 9675 R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
.6906L
.7 041R
-- Phonatory Position
(glottal width/2)
.0006
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.0440L
. 1577R
-- Area of Vibratory Mass
.0458L
.0383R
.9668L
- 9387 R
.2947L
3000R
.1682L
.157 7 R
46-F3-14A Thyroid Cartilage
-- Distance between
Superior Apexes
.4123
-- Distance between
Inferior Prominences
.3175


35
structure was measured on the graphics tablet which resulted in area,
perimeter, inferior-superior distance, and anterior-posterior distance
measures. The next slide listed in this set of tables is 75-F1-9L,
which contained measurement values for the posterior cricoarytenoid
muscle and the interarytenoideus muscle. This identification and
measurement of structures of interest continued all the way through
the block. The result was a roster of the structures of interest and
their measurement values as they appeared in the specimen organized by
slide. Upon examination of Table B-2 the same information was made
available for the right block of sagittal specimen 1. A progression
through the B set of tables, B-3, presents information on the superior
block of specimen 2. Specimen 2 was dissected in the transverse
plane, resulting in the measurement parameters to be slightly
different. Area, perimeter, and anterior-posterior distance were
still categories; however, medial-1ateral distance was a new
parameter. These parameters were valid for any transverse specimen,
and in this case applicable for both the superior and medial blocks.
The superior block was dissected from its inferior surface on up
through the epiglottis or the top of the superior block. The medial
block was dissected from its superior surface on down through the base
of the cricoid ring. Specimen 3 was a coronal specimen, which
resulted in both an anterior and a posterior block. Dissection began
at the medial aspect for both blocks. The parameters of measurement
dictated by the coronal plane of dissection include area, perimeter,
inferior-superior distance, and also medial-1ateral distance. Every
plane of dissection dictated essentially two directional parameters


128
Table B-ll--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
69-F2-3A
(cont.) Thyroid Cartilage
-- Height 1.0327L
9248R
Height .1013L
.0703R
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage 1013L
.0703R
-- Area of Vibratory Mass
.0377L
0438R
.9847L
1.0827R
.4050L
. 3659R
.1498L
. 1623R
69-F2-7A
Thyroarytenoid Muscle
.0091L
.0063R
.6005L
. 4941R
.2796L
.1882R
.0443L
.0847R
Surface Width of TVF
. 1312L
.0771R
Thyroid Cartilage
-- Distance between
Superior Apexes
.6030
-- Height
1.0652L
1.1009R
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.1513 L
. 1465R
-- Area of Vibratory Mass
.0218L
0168R
.62 77L
. 5663 R
.1611L
.1620R
.1621L
. 1489 R
69-F2-10A
Thyroid Cartilage
-- Height
.96 74 L
1.0363R
* L = left, R = right; no letter = neither L nor R is indicated.


78
each photographic slide. The suggested placement is one on each side
of the block. This will obviate any irregularities in camera angle
and insure an accurate scale of measure. Apart from suggestions
concerning improvements in the methodology utilized in the current
study, other research implications include the application of the
methodology indicated in additional investigations. One possible
study concerns the usage of the celloidin embedded block technique in
cases of laryngeal carcinoma. A far more descriptive study would
involve determination of the subject's vocal frequency prior to and
during a given disease state. Subsequent modeling attempts could best
be attempted by an engineer concerned with tissue thickness,
elasticity, mass differential and curve fitting to describe the
properties of the mass and therefore possible implications concerning
vibratory function.
In summary, the block embedding method and photography of the
exposed surface of the specimen, as opposed to the traditional
histological slice technique, was demonstrated to be a viable method
for laryngeal investigation. Though this method was not absolved of
all problems, there existed certain advantages in assessment of
structures in an intact specimen block. Soft tissue structures of
interest and cartilage maintained their proper relationships to one
another, while the course and configurational transitions were
revealed through serial sectioning. It was possible to consider
intrinsic musculature separately or as a group. The block was not
subject to tearing although certain stresses were undoubtedly
introduced onto the surface of the block from the microtome blade


84
Table B-l--continued.
Slide ft
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
75-F2-9L
(cont.)
Posterior Cricoarytenoid
Ligament
.1099
75-F2-14L
Posterior Cricoarytenoid
Muscle
.0626
1.5335
.6680
.1079
Lateral Cricoarytenoid
Muscle
.0497
1.1466
.2128
.3146
Cricothyroid Muscle
.3260
2.6021
.3953
1.0607
Thyroarytenoid Muscle
.3379
2.3723
.7633
.4423
Conus Elasticus --
Cricothyroid Ligament
.3567
75-F3-1L
Posterior Cricoarytenoid
Muscle
.0464
.9284
.3931
.1044
Cricothyroid Muscle
.2912
2.4133
.6381
.4925
Thyroarytenoid Muscle
.0723
1.2612
.2320
.4319
75-F3-5L
Thyroarytenoid Muscle
.2114
2.0595
.3273
.7110
75-F3-10L
Thyroarytenoid Muscle
.1304
1.9755
.1641
.6557
75-F3-14L
Thyroarytenoid Muscle
.2928
2.6509
.4667
.7022


198
Table D-12. Apparent Size of Structure/Specimen 6/Coronal
Plane/Posterior Block
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Anterior
to Posterior
Distance
Cricothyroid Muscle
69-F1-2P
to
69-F2-18P
10
35
microns
12250 microns
or
12.25 mm
Interarytenoideus Muscle
69-F1-18P
to
69-F2-15P
10
35
microns
5600 microns
or
5.6 mm
Lateral Cricoarytenoid
Muscle
69-F1-2P
to
69-F1-9P
10
35
microns
2800 microns
or
2.8 mm
Posterior Cricoarytenoid
Muscle
69-F1-9P
to
69-F3-3P
10
35
microns
10850 microns
or
10.85 mm
Thyroarytenoid Muscle
69-F1-2P
to
69-F2-6P
10
35
microns
8050 microns
or
8.05 mm
Conus Elasticus
69-F1-2P
to
69-F2-3P
10
35
microns
7000 microns
or
7.0 mm
Thyroid Cartilage
Superior Apexes Present
69-F1-2P
to
69-F2-6P
10
35
microns
8050 microns
or
8.05 mm
Thyroid Cartilage-
Inferior Prominences
Present
69-F1-2P
to
69-F2-10P
10
35
microns
9450 microns
or
9.45 mm
Body of Thyroid Cartilage
69-F1-2P
to
69-F2-10P
10
35
microns
9450 microns
or
9.45 mm
Vibratory Mass-
Thyroarytenoid to
Thyroid Cartilage
69-F1-2P
to
69-F2-3P
10
35
microns
7000 microns
or
7.0 mm


129
Table B-12. Apparent Size of Structures/Specimen 6/Coronal
Plane/Posterior Block
SI ide ff
Structure (Sq
Area
. Inch)
Peri- Inferior-
meter Superior
(Inch) (Inch)
Medial-
Lateral
(Inch)
69-F1-2P
Lateral Cricoarytenoid
Mus cle
. 0185 R
.69 55 R
. 15 7 7 R
- 22 76 R
Cricothyroid Muscle
.0472R
1.0663R
.4063R
.1974R
Thyroarytenoid Muscle
. 1022 R
1.5688R
5638R
. 37 66 R
Conus Elasticus
. 5098R
Thyroid Cartilage
-- Distance between
Superior Apexes
1.1672
-- Distance between
Inferior Prominences
1.0454
-- Height
1.1427L
9682R
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.37 66 R
-- Area of Vibratory Mass
.1725R
2.0100R
.5812R
.4071R
69-F1-4P
Lateral Cricoarytenoid
Muscle
.0124 R
.5409R
.0883R
.1424 R
Cricothyroid Muscle
.0428R
.9725R
.3665R
.1464R
Thyroarytenoid Muscle
.06 26 L
.0878R
1.1856L
1.3114R
.3766 L
.4027R
.2166 L
.2693R
Conus Elasticus
.4962 L
. 405 7 R
Thyroid Cartilage
-- Distance between
Superior Apexes
1.0519
Distance between
Inferior Prominences
.9038


Table D-l. Apparent Size of Structure/Specimen 1/Sagittal Plane/Left
Block
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Medial
to Lateral
Distance
Cricothyroid Muscle
75-F2-14L
to
75-F3-1L
5
35
microns
1050 microns
or
1.05 mm
Interarytenoideus Muscle
75-F1-5L
to
75-F2-5L
5
35
microns
3325 microns
or
3.325 mm
Lateral Cricoarytenoid
Muscle
75-F2-14L
(only in
1 slide)
5
35
microns
175 microns
or
.175 mm
Posterior Cricoarytenoid
Muscle
75-F1-9L
to
75-F3-1L
5
35
microns
1925 microns
or
1.925 mm
Thyroarytenoid Muscle
75-F1-13L
to
75-F3-14L
5
35
microns
6650 microns
or
6.65 mm
Conus Elasticus
75-F2-14L
5
35
microns
175 microns
or
.175 mm
Posterior Cricoarytenoid
Li gament
75-F1-13L
to
75-F2-9L
5
35
microns
2625 microns
or
2.625 mm
NOTE: Sagittal Plane: The missing dimension
the medial-1ateral distance. This table is a
dictated by
summation of
this plane is
that
distance.
184


191
Table D-6--continued.
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Anterior
to Posterior
Distance
Phonatory Position-
Presence of Glottal
Aperture
46-F1-3P
to
46-F3-9P
5
35
microns
7525 microns
or
7.525 mm
Vibratory Mass-
Thyroarytenoid to
Thyroid Cartilage
46-F1-3P
to
46-F2-16P
5
35
microns
5600 microns
or
5.6 mm
Area of Vibratory Mass
46-F1-3P
to
46-F2-16P
5
35
microns
5600 microns
or
5.6 mm
NOTE: Coronal Plane: The missing dimension dictated by this plane is
the anterior-posterior distance. This table is a summation of that
distance.


32
undesired change layers below. If that had been the case the
undesired change would have been compounded by each additional
staining and clearing. However, it is likely that the staining
irregularities were the result of surface changes in the block, as
well as constraints of stain absorption time, and finally the
thickness of the block. Another possible contributory factor was the
method of application of the stain. Initially the stain was applied
via a cotton tipped applicator which resulted in some remnants of
cotton on the surface of the block. The cotton tipped applicator was
then abandoned and a suctioned dropper used. Again, certain problems
appear to have resulted from the block itself. The block was
preferred intact to demonstrate the internal configuration of the
intrinsic musculature in relation to one another. The presumption was
made that the configuration would represent actual relationships if
the laryngeal structures was allowed to remain intact in the celloidin
block. Hence, for structural intactness, some sacrifice resulted in
less clearly defined fiber tracts.
The third hypothesis concerned demonstration of accurate life
measurements of soft tissue structures of interest related to the
block embedding technique. Specifically, was the block technique
preferable to the histologic slice technique for purposes of more
accurate depiction and therefore more accurate measurement, i.e.,
closely associated with in vivo specimens? One advantage of the block
technique was the maintenance of the specimens' original shape.
Furthermore, the intrinsic musculature remaining following dissection
was allowed to retain its shape and configuration. There was no


15
Decalcification
Decalcification softens cartilage and bone and allows it to be
cut. Since the specimens were adult larynges in which cartilages are
usually calcified to some extent, decalcification was necessary.
Fresh solution was used every other day. The old solution was poured
off and fresh solution was poured on the specimen. This procedure
generally continued for approximately 2 weeks. Specimens were x-rayed
every fifth day to determine the extent of calcification remaining.
At the end of decalcification, the specimen was rinsed in several
changes of running tap water during a 24 hour period.
Dehydration
Based upon previous research on dehydration (Lillie & Fullmer,
1976; Humason, 1979), specimens were placed in a 70% ethyl alcohol
solution which was changed twice during a 24 hour period. Immediately
afterwards specimens were placed in an 80% solution.
Specimens remained in the 80% ethyl alcohol solution for 12 hours
and then fresh 80% solution was poured on and remained on for the next
12 hours. Immediately afterwards specimens were placed in a 95%
solution.
Specimens remained in the 95% ethyl alcohol solution for 12 hours
and then were placed in fresh 95% solution for 12 subsequent hours.
Immediately afterwards specimens were placed in a 100% solution.
Specimens remained in the 100% (absolute) ethyl alcohol solution,
which was changed twice during a 24 hour period. Lastly, specimens
were immediately placed in a solution consisting of half ether and


29
The specimen was placed in 70% ethyl alcohol solution which was
changed twice during the course of the day. At the end of that 24
hour period the weight was 50.2 grams; inferior suture was .9 mm;
lateral suture was .6 mm; the hypotenuse was 1.3 mm; volume
displacement was 39 ml.
At the end of the dehydration phase the specimen was placed in an
ethyl ether or ether alcohol solution which was changed twice in a 24
hour period. Weight was 38.5 grams; inferior suture was .9 mm;
lateral suture was .6 mm; the hypotenuse was 1.2 mm; volume
displacement was 35 ml. At this point, overall shrinkage for the
inferior suture segment was 10%; for the lateral suture segment, 14%;
and for the hypotenuse segment, 14%. Total overall shrinkage due to
chemical processing was 18% by volume and 21% by weight.
Hypotheses: Empirical Reply
The first hypothesis was concerned with postulated laryngeal
behavior based on muscle fiber course revealed via serial
sectioning. More particularly, was it possible to infer cartilaginous
and soft tissue behavior based on the combined information of the
measurements and illustrations? It was possible to infer behavior and
in fact vibratory behavior was inferred for the vibratory mass (Hirano
et al., 1983). The mass encompassed tissue well beyond the
thyroarytenoid musculature proper as delineated in the coronal
specimens. This conjecture was based on the muscle fiber tracts
observed in the described musculature. However, behavior of the
laryngeal cartilage was not inferred, nor was behavior of any soft


4
the result of conclusive empirical investigation and later were proven
to be incorrect. Galen's work was ultimately subject to challenge.
One such example is found in the case of Casserius (1601) who
disproved Galen's theory on pitch (Fink, 1975). Other researchers
besides Casserius were also concerned with pitch. Dodart (1634-1707)
addressed the issue of pitch modulation and considered pitch to be
controlled by glottal tension and width. Perhaps even more profound
was the idea postulated by Winslow (1756) which supported
consideration of the laryngeal musculature functioning together as a
single unit. This concept circumvented the abyss of single muscle and
single action only theories. In 1724 the corniculate cartilages were
designated as additional entities in the laryngeal cartilaginous
framework by Santorini (Fink, 1975). Not quite 60 years later the
cuneform cartilages were identified. There is some discrepancy as to
whom the credit for this identification belongs, either Wrisberg
(1780) or Wrisberg's deceased associate Haller (1778), or even Camper
(1767) (Camper, 1779; Fink, 1975; Haller, 1973). The identification
of the cuneform cartilages probably should be credited to Camper
(1767) who did publish this information in 1779 and who apparently was
acknowledged by others prior to that publication as having identified
the cartilages. Giovanni Battista Morgagni (1682-1771) for whom the
ventricle of Morgagni is named studied various pathologies and the
resultant changes in anatomy. Particular areas of emphasis were areas
important for speech, the pharynx, larynx, and the palate (Canalis,
1980; Whicker & Devine, 1972). Significant anatomical identification
continued. Still later Francois Magendie discovered, by approximating


164
Table C-7--continued.
Peri- Inferior- Anterior-
Area meter Superior Posterior
Structure
Slide # (Sq.Inch)
(Inch) (Inch)
Anterior Cricothyroid
Ligament
68-F2-7L
.7165
Posterior Cricoarytenoid
Ligament
68-F3-4L
.4594
68-F3-7L
.3945
63-F3-9L
.3785
Thyroid Cartilage
68-F3-2L
1.8108
68-F3-4L
2.3446
68-F3-7L
1.0239
68-F3-9L
1.2068
63-F4-3L
.9510
68-F4-5L
.9909
68-F4-8L
.9218
68-F5-1L
.8860
68-F5-2L
.9072
68-F5-5L
.7418
68-F5-7L
1.1713
68-F5-9L
1.1249


178
Table C-12--continued.
Structure
SI ide If (Sq
Area
. Inch)
Peri- Inferior-
meter Superior
(Inch) (Inch)
Medial -
Lateral
(Inch)
Lateral Cricoarytenoid
Muscle (cont.)
69-F1-4P
.0124R
. 5409R
.0883R
. 1424R
69-F1-7P
.0265R
.6778R
.1593R
.1709R
69-F1-9P
.0184 L
.0250R
.5942 L
.5981R
. 1774 L
.1783R
. 1243L
.1297R
Posterior Cricoarytenoid
Muscle
69-F1-9P
.0127 R
.52 71R
.1523R
.12 74 R
69-F1-13P
.0085R
.4 965 R
.2889R
.0374R
69-F1-18P
.0019R
.1735R
.06 3 2 R
.0361R
69-F2-3P
.0116R
.6776R
.2680R
.0492R
69-F2-6P
. 0103L
.0154R
.4830L
.56I8R
. 187 3L
.'2439R
. 07 21L
.0813R
69-F2-10P
.0182L
.0453R
.5877L
1.2600R
.1988L
.5153R
.0847L
.1030R
69-F2-15P
.0207L
.0343R
.6591L
1.1502R
.2227L
.4287 R
.0828L
.0591R
69-F2-18P
.0169L
.0507R
.5623L
1.3550R
.1866L
. 5274R
0788L
.0707R
69-F3-3P
.0431R
1.3322R
.7255R
.0525R
Thyroarytenoid Muscle
69-F1-2P
.1022R
1.5688R
5638R
. 3766R
69-F1-4P
.0626L
.0878R
1.1856L
1.3114R
.3766L
- 4027 R
.2166L
2693R
69-F1-7P
.0943L
.07 7 6 R
1.2069L
1.0273R
.3271L
.2211R
.3216L
. 2745 R
69-F1-9P
.0855L
.0430R
1.16241
- 9750R
.2908L
.2072 R
.3078L
.3886R


49
appearance or disappearance of structure(s). The purpose of the
selection dictated the terms of the choice. Figures 1 through 10 are
depictions of specimen 3. Figure 1 (46-F1-11A) represents the 11th
photographic slide on film one in the anterior block. Specific
structures were identified as present in the remaining block. Those
structures included the left cricothyroid muscle, thyroarytenoid
muscles, conus elasticus, surface of the true vocal fold, cricoid and
thyroid cartilage and vibratory mass. In the event of unclear
boundaries, structures although identifiable as present, were not
measured. This particular figure is also listed in the tabular data,
Appendices B, C and D. Tabular listing was not always the case as not
all illustrated slides were measured.
Figure 2 (46-F1-17A) represents the 17th photographic slide on
film one in the anterior block. Specific structures identified
included the left cricothyroid muscle, thyroarytenoid muscles, conus
elasticus, cricoid and thyroid cartilages, and ventricle of
Morgagni. This specific slide was not chosen for measurement.
However surrounding slides (46-F1-14A; 46-F2-1A) were chosen and
support the identification of the same structures as depicted in this
illustration. Area and perimeter values for the left cricothyroid and
thyroarytenoid muscles, directional parameter measures for the conus
elasticus and the surface width of the true vocal fold, all thyroid
cartilage and phonatory position measures increased from Figure 1 to
slide 46-F1-14A; however, the medial aspect of the thyroarytenoid
muscle to the thyroid cartilage and the area of the vibratory mass
measures both decreased. Examination of slide 46-F2-1A indicated most


170
Table C-10--continued.
Structure
Area
SI ide # (Sq.Inch)
Peri- Anterior-
meter Posterior
(Inch) (Inch)
Medial -
Lateral
(Inch)
Posterior Cricoarytenoid
Muscle (cont.)
62-F4-10M
.0279
1.0450
.0308
.4792
Thyroarytenoid Muscle
62-F3-4M
.0618
1.0381
.4014
.1302
62-F3-8M
.0904
1.2385
.3856
.2549
62-F3-12M
.0666
1.0906
.3607
.1465
62-F3-16M
.1198
1.7964
.6236
.2418
62-F4-2M
.0557
1.1424
.3796
.1388
62-F4-6M
.1440
1.8049
.7477
.1486
62-F4-10M
.1483
1.9740
.8886
.1927


APPENDIX B
APPARENT SIZE OF STRUCTURES ARRANGED BY SLIDE


130
Table B-12--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide ft Structure (Sq.Inch) (Inch) (Inch) (Inch)
69-F1-4P
(cont.)
69-F1-7P
Thyroid Cartilage
-- Height
.90 7 6 L
.84 7 7 R
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.324 6 L
.3558R
-- Area of Vibratory Mass
.1393L
.1650R
1.7387L
1.7960R
.5517L
.4415 R
.3498L
3558R
Lateral Cricoarytenoid
Muscle
0265R
.6778R
. 1593R
.1709R
Cricothyroid Muscle
.0546L
.0717 R
1.7088L
1.4 901R
.7649L
. 7 311R
.1398L
. 1264R
Thyroarytenoid Muscle
.0943L
.07 7 6 R
1.2069L
1.0273R
.3271L
.2211R
.3216L
. 2745 R
Conus Elasticus
.5012L
.3709R
Thyroid Cartilage
-- Distance between
Superior Apexes
-- Distance between
Inferior Prominences
-- Height
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
1.1302
.9197
.9845L
.7946R
. 3545 L
. 3877R


90
Table B-3--continued.
SI ide #
Structure
Area
(Sq.Inch)
Peri -
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial-
Lateral
(Inch)
48-F1-9S
Posterior Cricoarytenoid
Muscle
.0075 L
. 5468L
.0211L
.2009L
Thyroarytenoid Muscle
.1448L
.1629R
2.1263L
1.9569R
8937L
. 7534R
.2528L
. 1991R
48-F1-11S
Interarytenoideus Muscle
.0641
1.5353
.1575
.5488
Thyroarytenoid Muscle
.2008L
.1700R
2.4097L
1.9276R
.8879L
.7193R
. 23 27 L
.1691R
Posterior Cricoarytenoid
Ligament
.0520
1.3507
.2008
.3505
48-F1-13S
Interarytenoideus Muscle
.1213
1.8233
.1381
.7961
Thyroarytenoid Muscle
.15 2 9L
.1054R
2.8661L
1.9985R
.77 6 2 L
.9418R
.25 2 7 L
. 1583R
48-F1-15S
Interarytenoideus Muscle
.0955
1.6081
.1082
.5586
Thyroarytenoid Muscle
. 1034 L
.0835R
2.1327L
1.8802R
. 8983 L
.7590R
.2468L
. 1946R
48-F2-1S
Interarytenoideus Muscle
.0873
1.6997
.0909
.7681
Thyroarytenoid Muscle
. 1179 L
.1266R
2.2061L
2.1804R
7507L
.8851R
. 1385L
. 1336R
48-F2-3S
Interarytenoideus Muscle
.0597
1.5798
.0721
.6667
Thyroarytenoid Muscle
0996L
.1087R
1.7850L
1.8041R
. 6382 L
.6907R
.1225 L
.1489R
48-F2-5S
Interarytenoideus Muscle
.0432
1.4788
.0930
.6529
Thyroarytenoid Muscle
. 1378L
.0802R
2.2892L
1.8075R
9084L
8836R
. 1250L
.0832R
48-F2-7S
Thyroarytenoid Muscle
. 1390L
. 1487R
2.1711L
2.1528R
.9096L
.825 7 R
.1854L
. 115 5 R


ACKNOWLEDGMENTS
My sincerest appreciation is expressed to my committee chairman,
Dr. Thomas B. Abbott, and to Dr. G. Paul Moore, for their skilled
direction, invaluable expertise, and contributions regarding this
project. Gratitude is also expressed to Drs. Linda J. Lombardino and
Russell M. Bauer, whose suggestions early in my graduate school
program guided my course selection preference and research
interests. Appreciation is also expressed to Robert Algozzine, whose
cooperative nature has facilitated growth in a positive setting for so
many of his students. And a simple thank you is extended to Dr. Doug
Hicks, Dr. Warren Rice, Dr. Floyd Thompson, Charles Mills and Terry
Ansman for their not so simple technical assistance.
i i i


Figure
Thyroid cartilage
Thyroid cartilage
. Slide 46-F3-18A/Specimen 3/Coronal Plane/Anterior Block.
cn
vo


175
Table C-ll--continued.
Structure
Slide § (Sq
Area
.Inch)
Peri
meter !
(Inch)
Inferior-
juperior
(Inch)
Med i a 1 -
Lateral -
(Inch)
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
(cont.)
69- FI -11A
. 1699L
.1313R
69-F1-14A
. 1518L
1030R
69-F1-18A
.1323L
. 1322 R
69-F2-3A
. 1013 L
.0703R
69-F2-7A
. 1513 L
. 1465 R
-- Area of Vibratory Mass
69-F1-3A
.1505L
.1349R
1.6719L
1.7276R
.5861L
. 5781R
.2778L
.27 5 7 R
69-F1-6A
.1467L
1280R
1.7024L
1.6996R
.7069L
.6406R
. 2443L
.2622 R
69-F1-9A
.1068L
. 1304R
1.4632L
1.5296R
.5427L
5089R
.2247L
.2268R
69-FI-11A
.1340L
.1649R
2.0242L
2.1098R
.7109L
.85 95 R
.2117 L
. 1547R
69-F1-14A
.0860L
. 1257R
1.7673L
1.9662R
.667 OL
7596R
.1542L
. 1804R
69-F1-18A
.0481L
.0444R
.9124L
.87 2 7 R
.3049L
.3020R
. 1341L
.1371R
69-F2-3A
.0377L
.0438R
.9847L
1.0827R
.4050L
.3659R
.1498L
.1623R


107
Table B-6--continued.
Slide H
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
46-F1-14P
(cont.)
Thyroid Cartilage
-- Distance between
Inferior Prominences
1.5995
-- Height
1.2618L
1.5103R
Vibratory Mass Measures
-- Phonatory Position
(glottal width/2)
.0837
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.4193L
.3631R
-- Area of Vibratory Mass
. 1337R
1.4625R
.3399R
.3958R
46-F2-1P
Posterior Cricoarytenoid
Muscle
0224L
. 6647 L
. 27 76 L
. 1189L
Lateral Cricoarytenoid
Muscle
. 0597 R
1.0220R
.2618R
.32 96 R
Cricothyroid Muscle
.0645R
1.3436R
.5986R
.1585R
Thyroarytenoid Muscle
. 2169R
1.8345R
. 5997 R
5212R
Conus Elasticus
.2040R
Thyroid Cartilage
-- Distance between
Superior Apexes 1.5532
Distance between
Inferior Prominences 1.2922
Height
1.3136L
.8739R


25
representing each plane. The illustrations in conjunction with the
tabular data clearly depict structural transition. The specimen which
received the most extensive illustrative depiction, including both the
anterior and posterior blocks, was specimen 3. Specific slides were
chosen in the progression through this specimen to convey the effect
of serial sectioning. Examination of additional illustrations
addressing the sagittal (specimen 1) and transverse (specimen 2)
planes displayed some of the same musculature. The plane of
dissection dictated the visual depiction of each muscle. A specific
muscle in one plane was not always easily recognized in another plane.
Originally it was intended that as many soft tissue structures as
possible would be measured. Among the intended was the quadrangular
membrane. This structure was never observed. It was also intended
that muscles known to have separate bundles would be identified by
those bundles. However, since it was not possible to consistently
identify both bundles throughout dissection, the structure was
referred to by the primary muscle name. For instance pars oblique and
pars recta were referred to as cricothyroid. This same format with
few exceptions was followed for the thyroarytenoid and
interarytenoideus muscles. Also the vibratory mass was measured only
on coronal specimens. The mass perimeter was defined as extending
from the medial border of the thyroarytenoid muscle including the
mucosa, measuring laterally to the thyroid cartilage, proceeding
interiorly to the level of the superior border of the cricoid
cartilage, and finally proceeding in a superior-medial progression
consistent with the lower border of the thyroarytenoid muscle.


54
Figure 4 (46-F2-12A) represents the 12th photographic slide on
film two in the anterior block. Specific structures identified
included the left cricothyroid muscle, thyroarytenoid muscles, the
left lateral cricoarytenoid muscle, conus elasticus, cricoid and
thyroid cartilages as well as the ventricle of Morgagni. This
specific slide was not chosen for measurement. However, surrounding
slides (46-F2-6A; 46-F2-13A) were chosen and support the
identification of the same structures as depicted in this
illustration. These slides were 35 microtome passes apart at 35
microns each. Intrinsic musculature area and perimeter or directional
parameter transition indicated a decrease in the left lateral
cricoarytenoid and thyroarytenoid muscles and a decrease in the conus
elasticus in both thyroid apexes and prominences, similarly there was
a decrease in height, and a decrement in the medial aspect of the
thyroarytenoid to the thyroid cartilage. However the cricothyroid
muscle and the height value from the cricoid cartilage to the true
vocal fold indicated an increase. In some instances the increased or
decreased values were not altered much from the previous value as
measurements were extended four decimal places. Measurement of the
area or directional parameter of the vibratory mass, phonatory
position and surface width of the true vocal fold were not made due to
lack of boundary clarity. The tabular data indicate change; however,
the visual depiction of Figures 3 and 4 demonstrate a marked
transition in the overall appearance and configuration of Figure 4.
From this point through Figures 5 and 6 marked visual configurational
transition again occurred.


93
Table B-4--continued.
Slide It Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Anterior-
Posterior
(Inch)
Medial-
Lateral
(Inch)
48-FI-1OM Posterior Cricoarytenoid
Muscle
- 0319L
.0204R
. 99 22 L
.7256R
- 0616 L
.0954R
.3884 L
.2921R
Lateral Cricoarytenoid
Muscle
. 0221L
.9665 L
.3392L
.067 3 L
Cricothyroid Muscle
.0945L
.0341R
2.3980L
1.8636R
.8588L
9708R
.0808L
. 0417 R
48-F1-12M Posterior Cricoarytenoid
Muscle
.0386L
.0309R
1.1756L
1.1624R
.1067L
.0361R
. 4907 L
.5470R
Lateral Cricoarytenoid
Muscle
0405L
1.1063L
. 3854 L
. 1163L
Cricothyroid Muscle
0758L
0499R
2.2403L
2.0943R
.9797L
. 915 OR
.0558L
0364R
48-F1-14M Posterior Cricoarytenoid
Muscle
. 02 92 L
. 02 97R
1 0321L
1.2766R
.1147 L
.0285R
. 4699L
.5856R
Lateral Cricoarytenoid
Muscle
.037 2 L
.97 68 L
.3903 L
. 145 4 L
Cricothyroid Muscle
.0876L
. 0216 R
2.3492L
1.2152R
1.1252L
.4292R
.0515L
.0174 R
48-F1-16M Posterior Cricoarytenoid
Muscle
.0224 L
.0191R
.95 35 L
1.1222R
.0817 L
.0274R
. 3226L
.5717R
Lateral Cricoarytenoid
Muscle
.0290L
8346L
- 3131L
. 1355L
Cricothyroid Muscle
.0599L
. 0181R
2.1333L
1.1947R
8408L
5432R
.0388L
. 0512 R
48-F1-18M Posterior Cricoarytenoid
Muscle
-0252L
.0195R
. 9875 L
1.0592R
.0413L
.0238R
.3616L
.3796R


149
Table C-5--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral -
Structure Slide # (Sq.Inch) (Inch) (Inch) (Inch)
Conus Elasticus
(cont.) 46-F2-13A .4976R
46-F2-18A .6277L
.6235R
Surface Width of TVF 46-F1-4A .2002L
.1925R
46-F1-8A .1908L
1868R
46-FI-11A .1489L
1563R
46-F1-14A .1997 L
.1908R
46-F2-1A .17 31L
1090R
46-F2-6A .2057L
.2380R
46-F2-18A .1885L
.1923R
46-F3-5A .1683L
1910R
46-F3-9A .1431L
. 1760R
Thyroid Cartilage
-- Distance between
Superior Apexes 46-F1-4A 1.1285
45-F1-8A 1.0641
46-F1-11A
1.1126


106
Table B-6--continued.
SIide #
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
46-F1-9P
(cont.)
Thyroid Cartilage
-- Distance between
Superior Apexes
1.7539
-- Distance between
Inferior Prominences
1.6197
-- Height
.7042L
1.5368R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
.2797R
-- Phonatory Position
(glottal width/2)
.0713
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.4674L
. 3478R
-- Area of Vibratory Mass
.1868R
1.6161R
.4423R
.3801R
46-FI-14 P
Posterior Cricoarytenoid
Muse!e
.02 06 L
. 6157 L
. 1877L
. 1700L
Lateral Cricoarytenoid
Muscle
.0280L
.0420R
. 7091L
.8419R
.3240L
.2482R
. 1757L
.2527R
Cricothyroid Muscle
.0493L
.0874R
1.2822L
1.4708R
4014L
. 6906 R
.2366L
. 2346 R
Thyroarytenoid Muscle
.0800L
.14 2 5 R
1.3600L
1.6227R
.2111L
. 4342 R
. 3331L
. 3659R
Conus Elasticus .3137R
Thyroid Cartilage
Distance between
Superior Apexes 1.7439


135
Table B-12--continued.
SI ide ff
Structure
Area
(Sq.Inch)
Peri
meter :
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
69-F2-15P
Posterior Cricoarytenoid
Muscle
0207L
.0343R
.65 91L
1.1502R
2227L
.4287R
0828L
.0591R
Interarytenoideus Muscle
.0117
1.3473
.0565
.5235
Cricothyroid Muscle
.03 71L
1.0632L
.387 7 L
. 07 54 L
69-F2-18P
Posterior Cricoarytenoid
Muscle
. 0169L
.0507R
. 5623L
1.3550R
.1866L
5274R
.0788L
.0707R
Cricothyroid Muscle
.0266L
.8715L
.2922L
.0657L
69-F3-3P
Posterior Cricoarytenoid
Muscle
.0431R
1.3322R
.72 5 5 R
.0525R
* L = left
, R = right; no letter =
neither L
nor R is
indicated



108
Table B-6--continued.
Slide #
Structure
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Medial -
Lateral
(Inch)
46-F2-IP
(cont.)
Vibratory Mass Measures
-- Phonatory Position
(glottal width/2)
.0794
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
. 1055L
- 297 OR
-- Area of Vibratory Mass
.1728R
1.6224R
.4211R
. 3592R
46-F2-6P
Posterior Cricoarytenoid
Muscle
. 0114L
. 4692 L
. 1849L
. 0731L
Lateral Cricoarytenoid
Muscle
.0211R
7150R
. 1880R
. 1836R
Cricothyroid Muscle
.0600R
1.3137R
.5853R
.2284R
Thyroarytenoid Muscle
.061OR
1.1619R
.2981R
2892R
Conus Elasticus
.2064R

Thyroid Cartilage
-- Distance between
Superior Apexes
1.5327
-- Distance between
Inferior Prominences
1.2827
-- Height
1.3113L
1.0926R
Vibratory Mass Measures
-- Phonatory Position
(glottal width/2)
.0853
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.3660R
-- Area of Vibratory Mass
.2076R
1.9591R
.4165R
4196R


203
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Run, W., & Chung, Y. (1983). Roentgenological measurement of
physiological vocal cord length. Folia Phoniatrica, 35, 289-293.
Silverman, P., & Korobkin, M. (1983). High-resolution computed
tomography of the normal larynx. American Journal of
Roentgenology, 140, 875-879.
Sobotta, J., & Uhlenhuth, E. (1957). Atlas of descriptive human
anatomy, Vol. II (7th English ed.). New York: Hafner Publishing
Co.


131
Table B-12--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide H Structure (Sq.Inch) (Inch) (Inch) (Inch)
69-F1-7P
(cont.)
Area of Vibratory Mass
1630L
.1237R
1.8518L
1.4590R
. 5286 L
. 3384R
.5006 L
.3960R
69-F1-9P
Posterior Cricoarytenoid
Muscle
.0127 R
.52 71R
. 1523R
1274R
Lateral Cricoarytenoid
Muscle
.0184L
.0250R
.5942 L
.5931R
. 1774L
. 1783R
. 1243L
.1297R
Cricothyroid Muscle
.0544L
.0407R
1.4229L
1.1372R
.6149L
. 507 3R
.1108L
.0981R
Thyroarytenoid Muscle
.0855L
.0430R
1.1624L
. 97 50R
.2908L
. 2072R
.3078L
.3886R
Conus Elasticus
.3667L
.2841R
Thyroid Cartilage
-- Distance between
Superior Apexes
.9925
-- Distance between
Inferior Prominences
.8742
-- Height
.8591L
7325R
Vibratory Mass Measures
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
2654L
. 2974R
-- Area of Vibratory Mass
. 1527L
.1989R
1.7791L
2.0116R
.5105L
.47 38 R
.3318L
.3112R
69-F1-13P
Posterior Cricoarytenoid
Muscle
0085R
. 4965 R
.2889R
.03 74 R


190
Table D-6. Apparent Size of Structure/Specimen 3/Coronal
Plane/Posterior Block
Structure
SI ide
Range
Number of
Microtome
Passes
Unit of
Measure
Total Anterior
to Posterior
Distance
Cricothyroid Muscle
46-F1-3P
to
46-F3-14P
5
35
microns
8400 microns
or
8.4 mm
Interarytenoideus Muscle
46-F2-16P
to
46-F4-6P
5
35
microns
4725 microns
or
4.725 mm
Lateral Cricoarytenoid
Muscle
46-F1-14P
to
45-F2-16P
5
35
microns
3675 microns
or
3.675 mm
Posterior Cricoarytenoid
Muscle
46-F1-14P
to
46-F4-6P
5
35
microns
8225 microns
or
8.225 mm
Thyroarytenoid Muscle
46-F1-3P
to
46-F2-16P
5
35
microns
5600 microns
or
5.6 mm
Conus Elasticus
46-F1-3P
to
46-F2-11P
5
35
microns
4725 microns
or
4.725 mm
Surface TVF
46-F1-3P
5
35
microns
175 microns
or
.175 mm
Thyroid Cartilage--
Superior Apexes Present
46-F1-3P
to
46-F3-14P
5
35
microns
8400 microns
or
8.4 mm
Thyroid Cartilage--
Inferior Prominences
Present
46-F1-3P
to
46-F3-9P
5
35
microns
7525 microns
or
7.525 mm
Body of Thyroid Cartilage
46-F1-3P
to
46-F4-11P
5
35
microns
11025 microns
or
11.025 mm
Vibratory Mass--
Cricoid to TVF
46-F1-3P
to
46-F1-9P
5
35
microns
350 microns
or
.35 mm


33
evident shearing, tearing, or stretching of the block resulting in
alteration of laryngeal tissue. However, to obtain an approximation
of accurate real life measurements, in as much as is possible, a
shrinkage study was conducted to determine the amount of shrinkage of
laryngeal muscular tissue due to chemical processing. The overall
shrinkage was determined to be 18% by volume and 21% by weight. The
measurement values taken together with the shrinkage data yield a more
accurate representation of structure size and configuration than wou 1 d
have been possible by just the measurements alone.
The fourth hypothesis addressed the possibility of observing
existing change in the structures of interest during progressive
serial sectioning in a given specimen. A specimen sectioned in one
plane throughout its entirety, can easily be examined for structural
transition. The actual question generated considered the ability to
measure the dimensions of critical structures, subsequent to the
removal of each slice, by viewing the remaining block. A second
question generated by this hypothesis concerned the ability to
demonstrate change in the dimensions of trise critical structures. As
a consequence of examination of the attached tabular data, it is
evident that it was possible to measure the critical structures in
block subsequent to serial sectioning and to demonstrate a definite
change in the dimensions of those structures.
The fifth and final hypothesis was concerned with a photographic
and/or illustrative reconstruction of the identified soft tissue
structures. The question generated addressed the reconstruction of a
specimen and the quality of that reconstruction through the use of


162
Table C-7. Apparent Size of Structures/Specimen 4/Sagittal Plane/Left
Block
Structure
SI ide If
Area
(Sq.Inch)
Peri
meter
(Inch)
Inferior-
Superior
(Inch)
Anterior-
Posterior
(Inch)
Cricothyroid Muscle
63-F5-1L
.0690
1.3063
.3597
.0953
68-F5-2L
.0870
1.5676
.6593
.1272
68-F5-5L
.1881
1.6636
.4965
.5172
68-F5-7L
.1656
1.5977
.3919
.3931
68-F5-9L
.1779
1.7146
.3168
.5183
Interarytenoideus Muscle
68-F1-7L
.0495
.8900
.2848
.1033
68-F2-1L
.0428
.8404
.2947
.8329
68-F2-3L
.0459
.9125
.3159
.1038
68-F2-6L
.0581
.9788
.2992
.1193
68-F2-7L
.1773
1.7639
.5951
.2457
68-F3-2L
.1630
1.7196
.6144
.2793
68-F3-4L
.1793
1.9606
.5772
.2059
68-F3-7L
.0517
1.0700
.3136
.1055
68-F3-9L
.0610
1.2134
.4784
.1085
63-F4-3L
.0166
.7302
.3086
.0420
68-F4-5L
.0221
.7896
.3417
.0462
68-F4-8L
.0102
.6754
.0152
.2687
Lateral Cricoarytenoid
Muse!e
68-F5-1L
.0123
.5366
.0906
.1869
68-F5-2L
.0087
.4292
.0394
.1271


52
soft tissue measures declined with the exception of the left conus
elasticus, the area of the right vibratory mass, and the height from
the cricoid cartilage to the true vocal folds which increased
bilaterally. The distance between the thyroid cartilage apexes and
inferior prominences both declined. Phonatory position also
declined. Visual inspection of Figures 1 and 2 do not reveal much
difference between the two illustrations.
Figure 3 (46-F2-4A) represents the fourth photographic slide on
film two in the anterior block. Specific structures identified
included the left cricothyroid muscle, left lateral cricoarytenoid
muscle, thyroarytenoid muscles, conus elasticus, thyroid and cricoid
cartilages and the ventricle of Morgagni. Comparison of the area and
perimeter measures when given, and the directional parameter for those
structures lacking an area measure indicated the alteration in the
soft tissue structures from 46-F2-4A to 46-F2-6A as listed: a
decrease in the lateral cricoarytenoid, cricothyroid, and
thyroarytenoid muscles, as well as a decrease in area of the medial
aspect of the thyroarytenoid muscle to the thyroid cartilage. The
vibratory mass area had decreased on the right and increased on the
left. Whereas the distance of the conus elasticus, surface width of
the true vocal fold, height from the cricoid cartilage to the true
vocal fold increased. Thyroid cartilage measures decreased with the
exception of the height of the left cartilage. Phonatory position
also decreased. Visual depiction indicated a change in shape or
configuration evident in the thyroarytenoid muscle and the left
cricothyroid muscle.


77
phonation, nor the possible function of a given muscle during
phonation, the structures were viewed concommitantly.
Implications for Future Research
Certain aspects of the method chosen for this study deserve
refinement. Block thickness may be altered by designating smaller
specimen blocks. Perhaps a smaller block would reduce obscurity due
to block thickness and improve visibility. Care, however, must be
taken to quantify the actual size of the whole specimen and markers
drawn on the specimen denoting the points of intended cut. It is
recommended that documentation occur as a result of actual measurement
and a photographic record made establishing the size of the whole
specimen prior to brain-knife cut. Slides should also be used to
demonstrate the areas on the specimen targeted for brain-knife cut and
lastly a photographic record should depict the specimen after the
block cuts have been established. This will display the actual
placement of the cut and assist in determination of what structures
are on the fresh surface of the cut. Another aspect of refinement
concerns the block surface. Alterations in the block surface perhaps
can be controlled for by careful monitoring of staining and clearing
procedures to insure consistency. It is also recommended that two
different types of trials be conducted, a stain absorption time trial
and then a clearing agent trial to better establish the optimal
conditions for staining and clearing to avoid any irregularities in
the block surface and the resulting stain. Lastly, it is also
recommended that two photographic half inch measurement grids be in


Thyroid cartilage
Thyroarytenoid m.
Cricothyroid m. -
Cricoid cartilage
Figure 1
Slide 46-Fl-llA/Specimen 3/Coronal Plane/Anterior Block
cn
o


172
Table C-ll--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral -
Structure Slide # (Sq.Inch) (Inch) (Inch) (Inch)
Surface Width of TVF
69-FI-3A
.0886L
.1360R
69-F1-6A
.0856L
.1089R
69-F1-9A
.1027L
.104 5 R
69-FI-11A
.1224L
.1294R
69-F1-14A
.1248L
69-F1-18A
. 1143 L
.1203R
69-F2-3A
.0791L
.0454R
Thyroid Cartilage
-- Distance between
69-F2-7A
.1312L
.0771R
Superior Apexes 69-F1-3A
69-F1-6A
69-F1-9A
69-FI-11A
69-F1-14A
69-F1-18A
69-F2-3A
.8727
.9350
.8642
.7961
.8022
.6770
.5754
69-F2-7A
6030


41
band-saw cut was further posterior on this specimen than it was on
specimen 3. This factor could possibly explain the presence of these
structures in the anterior block alone.
The impact of examination of these tables is such that some
differences and similarities across specimens should be clear. The
entire set of tables in Appendix B or the listing of structures by
slide was the most appropriate for targeting the structures of
interest in relation to one another leaving the internal configuration
intact. Further the concept of a system working together is conveyed.
Apparent Size of Structures Arranged by Structure Across Slides
Appendix C is the most appropriate set of tables for targeting
the specific structures of interest individually, as they appeared in
the slides. Information available herein best indicates change within
a structure. Change was determined by examination of the numerical
extremes in the area measure of a given structure. If an area measure
was not given, then the most and least values of the directional
parameter given were used. Change within a structure was significant
as it addressed the participation, size, or extent of involvement of a
structure. This information further contributed to the normative data
available for each specimen.
The left block of specimen 1 (Table C-l) indicated the structure
exhibiting the most change in size was that of the thyroarytenoid
muscle, while the least change was exhibited by the lateral
cricoarytenoid muscle and the cricothyroid ligament. The right block
of specimen 1 demonstrated the most change in size in the anterior


LIST OF FIGURES
Figure
Page
1 Slide 46-Fl-llA/Specimen 3/Coronal Plane/Anterior
Block 50
2 Slide 46-Fl-17A/Specimen 3/Coronal Plane/Anterior
B1 ock 51
3 Slide 46-F2-4A/Specimen 3/Coronal Plane/Anterior
Block 53
4 Slide 46-F2-12A/Specimen 3/Coronal Plane/Anterior
Block 55
5 Slide 46-F3-2A/Specimen 3/Coronal PIane/Anterior
Block 57
6 Slide 46-F3-18A/Specimen 3/Coronal Plane/Anterior
Block 59
7 Slide 46-Fl-3P/Specimen 3/Coronal Plane/Posterior
Block 60
8 Slide 46-Fl-17P/Specimen 3/Coronal Plane/Posterior
Block 62
9 Slide 45-F3-2P/Specimen 3/Coronal Plane/Posterior
Block 64
10 Slide 46-F3-12P/Specimen 3/Coronal Plane/Posterior
B1 ock 66
11 Slide 48-F2-7S/Specimen 2/Transverse Plane/Superior
Block 68
12 Slide 48-Fl-3M/Specimen 2/Transverse Plane/Medial
Block 70
13 Slide 75-Fl-16R/Specimen 1/Sagittal Plane/Right
Block 71
14 Slide 75-F2-17R/Specimen 1/Sagittal Plane/Right
Block 73
IX


126
Table B-ll--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
69-FI-11A
(cont.) Thyroid Cartilage
-- Height
Vibratory Mass Measures
-- Height from Cricoid
to TVF
Phonatory Position
(glottal width/2)
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
-- Area of Vibratory Mass
69-F1-14A Thyroarytenoid Muscle
Surface Width of TVF
Thyroid Cartilage
-- Distance between
Superior Apexes
-- Distance between
Inferior Prominences
-- Height
Vibratory Mass Measures
-- Height from Cricoid
to TVF
1.0981L
1.0571R
. 6472L
. 65 99 R
.0422
. 1699L
. 1313 R
1340L
2.0242L
.7109L
. 2117 L
1649R
2.1098R
.8595R
. 1547R
0581L
1.2176L
.55111
.1658L
0422R
1.1760R
. 5 3 7 5 R
.1134 R
.1248L
.8022
.2930
1.1902L
1.1634R
.4968L
.5458R


171
Table C-ll. Apparent Size of Structures/Specimen 6/Coronal
Plane/Anterior Block
Peri- Inferior- Medial -
Area meter Superior Lateral-
Structure Slide H (Sq.Inch) (Inch) (Inch) (Inch)
Cricothyroid Muscle 69-F1-3A
69-F1-6A
69-F1-9A
69-FI11A
Thyroarytenoid Muscle 69-F1-6A
69-F1-9A
69-FI-11A
69-F1-14A
69-F1-18A
69-F2-3A
69-F2-7A
Conus Elasticus 69-F1-3A
69-F1-6A
69-F1-9A
0423L
0257R
1.0559L
.785 OR
.4241L
.2821R
. 1644L
. 1788 R
0361L
0375R
.88 98L
8846R
.3675L
.3619R
.1618L
. 1773 R
0407L
0188R
.9085L
5578R
.3779L
.2314R
.1390L
1046R
0413L
0386R
8529L
. 9445 R
.2779L
.36 5 3 R
.1984L
. 0920R
0970L
0616R
1.4748L
1.2871R
. 6581L
.5517 R
.2606L
.2035 R
0884L
0578R
1.3891L
1.0025R
-6411L
.35 95 R
.2156L
.174 9 R
0529L
0567R
1.2082L
1.1407R
.47 00L
.4605 R
. 1618L
. 1532 R
0581L
0422R
1.2176L
1.1760R
.5511L
.5 3 75 R
. 1658L
.1134 R
0248L
0262R
.7825L
. 8543R
.3381L
.321 OR
.1272L
- 07 2 2 R
0117 L
0071R
.4923L
. 46 32 R
.2081L
. 15 6 6 R
.0608L
0402R
0091L
0063R
.6005L
.4941R
.2796L
. 1882 R
.0443L
0847R
.4850L
4950R
.4298L
. 465 6 R
.5050R


98
Table B-5--continued.
Peri- Inferior- Medial-
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
46-F1-14A
(cont.) Thyroid Cartilage
-- Distance between
Inferior Prominences
-- Height
Vibratory Mass Measures
-- Height from Cricoid
to TVF
Phonatory Position
(glottal width/2)
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
-- Area of Vibratory Mass
46-F2-1A Lateral Cricoarytenoid
Mus cle
Cricothyroid Muscle
Thyroarytenoid Muscle
Conus Elasticus
Surface Width of TVF
Thyroid Cartilage
-- Distance between
Superior Apexes
1.3148
1.2341L
1.0196R
.3546L
.4081R
.0926
.2 94 7 L
.2206R
1518L
1534R
1.5276L
1.5675R
.4133L
. 5938R
.3516L
.24 91R
0057L
.30 71L
.0846L
.0736L
0412L
.9792L
.3256L
.1243L
0637L
0604R
1.0864L
1.1418R
.3312 L
.4266R
.2587 L
.2246R
.4 9 98 L
.5140R
.1731L
.1090R
1.0305


174
Table C-ll--continued.
Structure
Peri- Inferior- Medial-
Area meter Superior Lateral -
Slide # (Sq.Inch) (Inch) (Inch) (Inch)
Thyroid Cartilage
-- Height
(cont.)
69-F2-10A .9674 L
1.0363R
Vibratory Mass Measures
-- Height from Cricoid
to TVF
69-F1-3A .4531L
.3224R
69-F1-6A .4000L
. 321 OR
69-F1-9A .5661L
. 4996R
69-FI-11A .6472L
.65 99 R
69-F1-14A .4968L
.5458R
-- Phonatory Position
(glottal width/2)
69-F1-3A .0491
69-F1-6A .0435
69-F1-9A .0496
69-FI-11A .0422
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
69-F1-3A .2636 L
.27 22R
69-F1-6A .2405L
. 24 HR
69-F1-9A
1752L
1858R


no
Table B-6--continued.
Peri- Inferior- Medial -
Area meter Superior Lateral
Slide # Structure (Sq.Inch) (Inch) (Inch) (Inch)
46-F2-16P
(cont.) Thyroid Cartilage
-- Distance between
Superior Apexes 1.7542
-- Distance between
Inferior Prominences 1.2983
45-F3-4P
-- Height
1.3072L
1.1630R
Vibratory Mass Measures
-- Phonatory Position
(glottal width/2)
.0977
-- Medial Aspect of
Thyroarytenoid to
Thyroid Cartilage
.3331R
-- Area of Vibratory Mass
. 1292R
1.7040R
.3720R
.3411R
Posterior Cricoarytenoid
Muscle
.06 2 7 L
.0208R
1.5894L
.6511R
.8020L
.2971R
. 1249L
.0980R
Interarytenoideus Muscle
.1340
1.7089
.3489
.6986
Cricothyroid Muscle
.05 27 R
1.2340R
.56 02 R
1599R
Thyroid Cartilage
-- Distance between
Superior Apexes
1.8488
-- Distance between
Inferior Prominences
1.2735
-- Height
.8954L
1.0996R
Vibratory Mass Measures
-- Phonatory Position
(glottal width/2) .0900