The epiglottis plays an important role in deglutition in humans. The present study investigated age-related changes in the epiglottis using macroscopic and microscopic measurements. Epiglottic specimens from 281 Japanese adult cadavers (177 males, 104 females) were obtained. Specimens were divided into three groups according to age: group I: 20–39 years old (32 males, 26 females), group II: 50–69 years old (82 males, 36 females), and group III: 80–98 years old (63 males, 42 females). Width, height, and thickness were measured macroscopically. To evaluate the degree of calcium deposition, the calcium volume in digitalized von Kossa-stained sections was assessed using a quantitative analysis. An elemental analysis of the area detected with von Kossa staining was done using energy-dispersive X-ray fluorescence spectrometer (EDX). Measurements of the thickness and cell density in the superficial and deep layers of epiglottic cartilage were performed in horizontal histological sections. No significant differences in macroscopic width or height were found across the age groups in either sex. A series of three measurements in males was significantly larger than in females (p < 0.05). The volume of the calcium deposit area was greater in males than in females (p < 0.05) and was significantly increased in group III in males (p < 0.05). The lower level of the epiglottic cartilage showed a greater calcium deposit area than the upper level. In the scanning image by line and surface analysis using EDX, the calcium deposit areas detected with von Kossa staining indicated a close association of calcium and phosphorus ions. The mean Ca/P molar ratio in the calcium deposit area was 1.32 ± 0.12. Microscopic cartilage thickness increased significantly with age (p < 0.05), and was greater in males than in females (p < 0.05). Cartilage cell density in the superficial cartilage layer was higher than in the deep layer and was decreased in group III (p < 0.05). Cartilage cell density was lower in males compared to females. Diameter of chondrocytes significantly increased in group III (p < 0.05) and was larger in males than in females in group III (p < 0.05). Epiglottic cartilage exhibited marked sex-related differences and progression of calcification with age. Calcification of epiglottic cartilage in elderly individuals may affect movement patterns in deglutition.

1.
Adams, C.S., W.E. Horton, Jr. (1998) Chondrocyte apoptosis increases with age in the articular cartilage of adult animals. Anat Rec 250: 418–425.
2.
Ajmani, M.L., S.P. Jain, S.K. Saxena (1980) A metrical study of laryngeal cartilages and their ossification. Anat Anz 148: 42–48.
3.
Barnett, C.H., W. Cochrane, A.J. Palfrey (1963) Age changes in articular cartilage of rabbits. Ann Rheum Dis 22: 389–400.
4.
Buckwalter, J.A., H.J. Mankin (1998) Articular cartilage repair and transplantation. Arthritis Rheum 41: 1331–1342.
5.
Calcaterra, T.C. (1985) Epiglottic reconstruction after supraglottic laryngectomy. Laryngoscope 95: 786–789.
6.
Cox, R.W., M.A. Peacock (1977) The fine structure of developing elastic cartilage. J Anat 123: 283–296.
7.
Curtis, D.J., D.F. Cruess, A.H. Dachman (1985) Normal erect swallowing. Normal function and incidence of variations. Invest Radiol 20: 717–726.
8.
Curtis, D.J., G.U. Sepulveda (1983) Epiglottic motion: Video recording of muscular dysfunction. Radiology 148: 473–477.
9.
Ekberg, O. (1983) Epiglottic dysfunction during deglutition in patients with dysphagia. Arch Otolaryngol 109: 376–380.
10.
Ekberg, O., G. Nylander (1982) Cineradiography of the pharyngeal stage of deglutition in 150 individuals without dysphagia. Br J Radiol 55: 253–257.
11.
Ekberg, O., S.V. Sigurjònsson (1982) Movement of the epiglottis during deglutition. A cineradiographic study. Gastrointest Radiol 7: 101–107.
12.
Ekberg, O., L. Wahlgren (1985) Dysfunction of pharyngeal swallowing. A cineradiographic investigation in 854 dysphagial patients. Acta Radiol Diagn 26: 389–395.
13.
Elkeles, A. (1966) Sex differences in the calcification of the costal cartilages. J Am Geriatr Soc 14: 456–462.
14.
Engelmann, G., G. Leutert (1989) Aging processes of the arytaenoid cartilage. Z Mikrosk Anat Forsch 103(suppl): 597–619.
15.
Garon, B.R., Z. Huang, S. Hommeyer, D. Eckmann, G.A. Stern, C. Ormiston (2002) Epiglottic dysfunction: Abnormal epiglottic movement patterns. Dysphagia 17: 57–68.
16.
Glasgold, M.J., Y.P. Kato, D. Christiansen, J.A. Hauge, A.I. Glasgold, F.H. Silver (1988) Mechanical properties of septal cartilage homografts. Otolaryngol Head Neck Surg 99: 374–379.
17.
Hardingham, T., M. Bayliss (1990) Proteoglycans of articular cartilage: Changes in aging and in joint disease. Semin Arthritis Rheum 20 (suppl): 12–33.
18.
Hashimoto, S., R.L. Ochs, F. Rosen, J. Quach, G. McCabe, J. Solan, J.E. Seegmiller, R. Terkeltaub, M. Lotz (1998) Chondrocyte-derived apoptotic bodies and calcification of articular cartilage. Proc Natl Acad Sci USA 95: 3094–3099.
19.
Holas, M., K. Halvorson, M. Reding (1990) Videofluoroscopic evidence of aspiration and relative risk of pneumonia or death following stroke. Clin Res 38: 796A.
20.
Inoi, T. (1997) Estimation of sex and age by calcification pattern of costal cartilage in Japanese. Nippon Hoigaku Zasshi 51: 89–94.
21.
Ito, I., M. Imada, M. Ikeda, K. Sueno, T. Arikuni, A. Kida (2001) A morphological study of age changes in adult human auricular cartilage with special emphasis on elastic fibers. Laryngoscope 111: 881–886.
22.
Jibiki, M., S. Shimida, Y. Nakagawa, K. Kawasaki, K. Asada, K. Ishibashi (1999) Calcifications of the disc of the temporomandibular joint. J Oral Pathol Med 28: 413–419.
23.
Jones, B., M.W. Donner (1989) How I do it: Examination of the patient with dysphagia. Dysphagia 4: 162–172.
24.
Kobayashi, M., K. Watanabe, O. Miyakawa (1996) A new sampling technique to obtain the elemental mapping of a bio-tissue section by means of the EPMA equipped with WDX. Niigata Dent J 26: 29–37.
25.
Kourí, J.B., J.M. Aguilera, J. Reyes, K.A. Lozoya, S. González (2000) Apoptotic chondrocytes from osteoarthrotic human articular cartilage and abnormal calcification of subchondral bone. J Rheumatol 27: 1005–1019.
26.
Kusafuka, K., A. Yamaguchi, T. Kayano, T. Takemura (2001) Ossification of tracheal cartilage in aged humans: A histological and immunohistochemical analysis. J Bone Miner Metab 19: 168–174.
27.
Last, R.J. (1966) Tissues and Structures: Anatomy, Regional and Applied. New York, Churchill Livingstone, pp 1–20.
28.
Laufer, A. (1981) The function of the epiglottis in speech. Lang Speech 24: 39–61.
29.
Lee, K., B. Lanske, A.C. Karaplis, J.D. Deeds, H. Kohno, R.A. Nissenson, H.M. Kronenberg, G.V. Segre (1996) Parathyroid hormone-related peptide delays terminal differentiation of chondrocytes during endochondral bone development. Endocrinology 137: 5109–5118.
30.
Leutert, G. (1980) Morphological aging changes in human articular cartilage. Mech Ageing Dev 14: 469–475.
31.
Lister, G.D. (1969) Ossification in the elastic cartilage of the ear. Br J Surg 56: 399–400.
32.
Lotz, M., S. Hashimoto, K. Kühn (1999) Mechanisms of chondrocyte apoptosis. Osteoarthritis Cartilage 7: 389–391.
33.
Mafee, M.F. (1984) CT of the normal larynx. Radiol Clin North Am 22: 251–264.
34.
Malinowski, A. (1967) The shape, dimensions and process of calcification of the cartilaginous framework of the larynx in relation to age and sex in the Polish population. Folia Morphol (Warsz) 26: 121–132.
35.
McCormick, W.F. (1980) Mineralization of the costal cartilages as an indicator of age: Preliminary observations. J Forensic Sci 25: 736–741.
36.
McCormick, W.F., J.H. Stewart (1983) Ossification patterns of costal cartilages as an indicator of sex. Arch Pathol Lab Med 107: 206–210.
37.
Michelson, N. (1934) The calcification of the first costal cartilage among Whites and Negroes. Hum Biol 6: 543–557.
38.
Mitrovic, D., M. Quintero, A. Stankovic, A. Ryckewaert (1983) Cell density of adult human femoral codylar articular cartilage. Joints with normal and fibrillated surfaces. Lab Invest 49: 309–316.
39.
Navani, S., J.R. Shah, P.S. Levy (1970) Determination of sex by costal cartilage calcification. AJR Rad Ther 108: 771–774.
40.
Nielsen, E.H. (1976) The elastic cartilage in the normal rat epiglottis. Cell Tissue Res 173: 179–191.
41.
Nielsen, E.H. (1978) Ultrahistochemistry of matrix vesicles in elastic cartilage. Acta Anat 100: 268–272.
42.
Rotter, N., G. Tobias, M. Lebl, A.K. Roy, M.C. Hansen, C.A. Vacanti, L.J. Banassar (2002) Age-related changes in the composition and mechanical properties of human nasal cartilage. Arch Biochem Biophys 403: 132–140.
43.
Sanders, C.F. (1966) Sexing by costal cartilage calcification. Br J Radiol 39: 233–234.
44.
Selley, W.G., F.C. Flack, R.E. Ellis, W.A. Brooks (1990) The exeter dysphagia assessment technique. Dysphagia 4: 227–235.
45.
Semine, A.A., A. Damon (1975) Costochondral ossification and aging in five populations. Hum Biol 47: 101–116.
46.
Sprinzl, G.M., H.E. Eckel, C. Sittel, C. Pototschnig, J. Koebke (1999) Morphometric measurements of the cartilaginous larynx: An anatomic correlate of laryngeal surgery. Head Neck 21: 743–750.
47.
Stockwell, R.A. (1967) The cell density of human articular and costal cartilage. J Anat 101: 753–763.
48.
Stockwell, R.A. (1971) The interrelationship of cell density and cartilage thickness in mammalian articular cartilage. J Anat 109: 411–421.
49.
Suzuki, F. (1996) Roles of cartilage matrix proteins, chondromodulin-I and -II, in endochondral bone formation: A review. Connect Tissue Res 35: 357–361.
50.
Tsai, C.L., T.K. Liu (1992) Osteoarthritis in women: Its relationship to estrogen and current trends. Life Sci 50: 1737–1744.
51.
Watanabe, H., K. Kurihara, T. Murai (1982) A morphometrical study of laryngeal cartilages. Med Sci Law 22: 255–260.
52.
Yokoyama, M., N. Mitomi, K. Tetsuka, N. Tayama, S. Niimi (2000) Role of laryngeal movement and effect of aging on swallowing pressure in the pharynx and upper esophageal sphincter. Laryngoscope 110: 434–439.
53.
Zieliński, R. (2001) Morphometrical study on senile larynx. Folia Morphol 60: 73–78.
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