Introduction Of The 23nd Daniel C. Baker, Jr, Memorial Lecturer:
by Michael E. Johns, MD

The Daniel C. Baker, Jr, Lectureship was established in 1975 by the Baker family and the friends, patients, and colleagues of Dr Baker in his memory and in appreciation of his dedication to the field of laryngology. Dr Baker was President of the American Laryngological Association in 1974 and a recipient of its Newcomb Award in 1971.

This year's Baker Lecture will be delivered by Professor Mario Andrea, who was elected Corresponding Member of the American Laryngological Association in 1991. Mario is Professor and Chairman of the Department of Otolaryngology Faculty of Medicine at the University of Lisbon. He received his MD degree in 1969 and his PhD in 1975 from the University of Lisbon, where he also performed his residency training in otolaryngology. He is a member of numerous societies, including the Collegium, the Cartesian Society, the American Society for Head and Neck Surgery, the American Broncho-Esophagological Association, and the Triological Society, to mention a few among many. He serves as founding editor and chief of the premier otolaryngology journal in his native country of Portugal and also serves on many editorial boards. He has been extremely active in continuing medical education courses on the European continent and abroad and has been very active in research. He has authored four books in our field, contributed chapters, and has authored over 170 publications in peerreviewed journals. It is an extreme pleasure and honor to introduce to you this afternoon Professor Mario Andrea, who will discuss "Contact Laryngoscopy: An Update" as his 1997 Daniel C. Baker Lecture.

First of all I would like to thank our President, Bob Cantrell, for this kind invitation. I am deeply honored to be here and am deeply pleased also to see so many friends around this room. It is a privilege to present what has been done in the last years in Lisbon to this society.

Technology has improved the clinical evaluation of the larynx. Newer techniques improve evaluation of the mucosal alterations in the endolarynx and contribute to early diagnosis of involvement of the deep structures of the larynx. However, laryngeal assessment has several basic limitations.

In general, endoscopic procedures, including office techniques and microlaryngoscopy, only allow the observation of the larynx along a vertical axis, which limits diagnosis, physiopathologic interpretation of diseases' management, and follow-up.

Rigid endoscopy associated with microlaryngeal surgery (REMS) improves the assessment of the entire endolarynx, including regions considered difficult or impossible to visualize. Various endoscopes (0, 30, 70, and 120 degrees) allow multiperspective reconstruction of the lesion and its neighboring regions.

Important parameters in the evaluation of premalignant and malignant lesions are analyzed in great detail. REMS is also of benefit for benign disease, because phonosurgery techniques can be modified to allow a more accurate assessment of the lesion and subsequent excision.

The quality and detail of the information obtained by REMS justify its routine use during microlaryngoscopy or microlaryngeal surgery. Besides the endoscopes, it does not require any equipment that is not currently available in most institutions.

Contact video endoscopy during microlaryngoscopy allows in vivo and in situ assessment of the superficial layers of the epithelium previously stained with methylene blue. With the magnifications permitted with this technique (60x and 150x), there is direct access to the cells and their characteristics.

Several parameters are evaluated: regularity of the epithelium, dimensions and color of the nucleus, nucleus-cytoplasm ratio, nucleus and cytoplasm contours, presence of nucleolus, mitosis, cytoplasmic inclusions, keratosis, koilocytes, and inflammatory infiltrations.

Specific cellular epithelial patterns have been defined in contact endoscopy: chronic laryngitis, keratosis, dysplasia, papilloma, and malignant tumor. Further studies will define the normal characteristics and distribution of the epithelium in light of several factors and define its clinical role when used with pathologic and cytopathologic examinations.

Contact endoscopy offers global information about disease along the superficial layers of the entire mucosa, allowing a mapping of the disease in different sites and in different stages. On the other hand, with high magnification it is possible to assess abnormalities of individual cells.

Accuracy of contact endoscopy will certainly be enhanced with improvements in the optical system, new cell dyes and markers, fluorescent products, distinct lighting, and better imaging techniques.

Contact endoscopy represents a new phase in the development of laryngeal endoscopy. With experience from different centers and technologic progress, new ideas, concepts, and instruments will be developed. This progress will facilitate more thorough examination of the larynx, necessitating more profound knowledge and understanding of the larynx and intense interdisciplinary work.