Objective: Reinke's space (RS) is a highly specific structure in which the majority of vocal fold pathology occurs. The vibratory equivalents of structurally normal RS are regular vocal fold vibrations and normal glottic mucosal waves. Recently, RS has been considered to be composed not only of fibres but also of extracellular matrix (ECM), which is an extremely important component of a normal mucosal wave. As Reinke's oedema (RO) is characterized by excessive ECM in RS, we investigated the cell activity in RO tissue which is possibly responsible for excessive ECM production.
Material and methods: Tissue samples were obtained from 20 RO patients during microlaryngeal surgery. Tissue was analysed histochemically using the AgNOR method and the proliferation activity was assessed immunohistochemically using Ki67 monoclonal antibodies.
Results: AgNOR activity was detected in prominent stromal cells in 16 patients. Also, more pronounced activity, compared to the surrounding control tissue, was demonstrated in the epithelial cells of 17 patients using a Ki67 proliferation marker. Electron microscopy showed thickening and decomposition of the basement membrane in all RO tissue samples.
Conclusions: Vocal fold mucosa that has been damaged by smoking and phonotrauma may react by producing excessive ECM, resulting in RO. Both epithelial and stromal cells are in a state of higher metabolic activity, indicating their role in this production.