[Restoration of the vocal function in the patients with laryngeal cancer after organ-saving surgery]

The objective of the present study was to enhance the effectiveness of vocal rehabilitation and to improve the quality of life in the patients presenting with laryngeal cancer after organ-preserving surgical interventions. The study included 98 patients presenting with stage II-III laryngeal cancer who underwent organ-preserving surgery and postoperative vocal rehabilitation. The comprehensive approach to the restoration of the vocal function has been developed and clinically applied that includes rational psychotherapy, respiratory gymnastics for the correction of physiological and phonation breathing, activation of the neuromuscular apparatus of the external and the residual internal larynx and neck muscles , coordination of the vocal apparatus at the expense of compensation of the remaining part of the larynx taking advantage of the biological feedback mechanism based on the results of mathematical simulation. The application of this approach in clinical settings made it possible to increase the effectiveness of vocal rehabilitation up to 93%, reduce the number of disabled subjects, restore the working abilities in the patients of the employable age, significantly promote their social adaptation, and improve the life quality.

Infiltrative laryngeal lipoma in a Yorkshire Terrier as cause of severe dyspnoea

A 10-year-old Yorkshire Terrier with suspected laryngeal paralysis was referred for further examination and surgical treatment. The dog displayed severe dyspnoea and dysphonia. Ventrolateral to the larynx a soft-elastic mass of 2 cm diameter was palpated and confirmed by radiography. Histopathological examination of the resected mass revealed an infiltrative lipoma/lipoma. Although the dog totally recovered after surgery, the prognosis remains guarded due to the high risk of a recurrence. Tumours of the larynx in general and an infiltrative lipoma specifically should be added to the list of differential diagnosis in dogs presented with clinical signs that could be misinterpreted as laryngeal paralysis.

Influential factors, complications and survival rate of primary and salvage total laryngectomy for advanced laryngeal cancer

This is a retrospective review of patients with advanced malignant neoplasms of the larynx treated with total laryngectomy. 387 total laryngectomies for advanced squamous cell carcinoma of larynx performed in the period between 1995 and 2007 were analyzed. Primary total laryngectomy (PRT) was performed in 316 patients, while initial radiotherapy radiotherapy (60-70 Gy) and concomitant chemotherapy (cisplatin-5 fluorouracil) with radiotherapy were applied in totally 71 patients who later received salvage total laryngectomy (STL). All the laryngectomies were performed by four surgeons, using the same routine surgical technique. Postoperative clinical examination was made every three months during five years. We documented the occurrence of: local and general complications, survival rate, residual and recurrent disease, lymph node metastasis, and other changes. Salvage total laryngectomy after previous radiotherapy (STL-pRT) and after chemoradiotherapy (STL-pCTRT) caused more frequent local complications than primary total laryngectomy (PTL). TNM stage and localization of primary laryngeal tumor had significant influence on five year survival rate. It amounted: 61.4% for PTL, 52.6% for STL-pCTRT, and 48.5% for STL-pRT. Incomplete response to initial treatment produced low survival rate. Salvage total laryngectomy caused more frequent local complications, especially after chemoradiotherapy when compared to primary laryngectomy. Survival rate was increased when chemotherapy is added to radiotherapy. Five year survival rate depended on TNM stage and localization of primary tumor.

Laryngeal cancer and silica dust exposure: a systematic review and meta-analysis

BACKGROUND

Individual epidemiological studies generally lack the power to examine the association between silica exposure or silicosis and laryngeal cancer. We summarized pertinent evidence from published literature by using meta-analysis.

METHODS

A systematic literature search was performed to identify cohort and case-control studies, and the method of meta-analysis was used to combine standardized mortality ratios (SMRs) or standardized incidence ratios (SIRs) from cohort studies and odds ratios (ORs) from case-control studies.

RESULTS

A significantly increased risk of laryngeal cancer (pooled OR = 1.39, 95% confidence interval (95% CI): 1.17-1.67) among workers exposed to silica dust was observed by combining six case-control studies with adjustment for smoking and alcohol consumption. A similarly increased but statistically non-significant risk estimate was observed from cohort studies, with a pooled SMR of 1.38 (95% CI: 0.79-1.96) for silicosis cases; and a pooled SMR of 1.13 (95% CI: 0.82-1.45) and a pooled SIR of 1.50 (95% CI: 0.59-2.42) for workers with silica dust exposure.

CONCLUSION

This systematic review demonstrated a weak association between silica or silicosis and laryngeal cancer. Owing to the inherent limitations of the original studies, interpretation of the results of this meta-analysis should be cautious.

Extramedullary plasmacytoma of the true vocal fold

We report a rare case of extramedullary plasmacytoma (EMP) of the true vocal fold. Our patient, a 62-year-old woman, presented with dysphonia. On workup, fiberoptic laryngoscopy detected a lesion arising from the anterior half of her left true vocal fold. No evidence of other pathology was noted. The patient underwent radical radiotherapy, and the lesion resolved. Follow-up revealed no sign of recurrence. A type of myeloma, EMP is rare, especially in the larynx. To the best of our knowledge, our patient represents the sixth case of glottic EMP to be reported in the literature.

Primary angiosarcoma of the larynx: a rare entity

Angiosarcomas are extremely rare malignant tumours of the larynx. We present a case of laryngeal angiosarcoma in a 58-year-old man who presented with hoarseness of voice, dysphagia and neck swelling. The patient underwent a total laryngectomy with a pre-operative and frozen section diagnosis of a poorly differentiated carcinoma of the larynx. Histopathological and immunohistochemical evaluation revealed features of a laryngeal angiosarcoma. The case is presented for its rarity and diagnostic difficulty.

Presentation of laryngeal papilloma in childhood: the Leeds experience

INTRODUCTION

The human papilloma virus (HPV) can cause laryngeal papillomatosis in childhood. The aetiology is thought to be vertical transmission. Clinically these children are usually asymptomatic for the first 6 months of life. As the papillomas develop locally, symptoms begin to develop. The symptoms range from voice change to frank hoarseness, and 'noisy' breathing, most commonly inspiratory stridor.

METHOD

Clinical images from microlaryngoscopy and bronchoscopy over a 12-year period were assessed for laryngeal papilloma.

RESULTS

In Leeds seven cases presented to the specialist centre over the past 12 years, the average age at presentation was 6.8 years and duration of onset of symptoms to specialist review was 21 months. Five of the children had been treated for asthma and two presented in extremis.

CONCLUSION

The take home message for clinicians is hoarse voice associated with shortness of breath needs specialist referral.

Primary composite lymphoma of the larynx, composed of diffuse large B-cell lymphoma and peripheral T-cell lymphoma, not otherwise specified, presenting as left subglottic tracheal fistula, esophageal diverticulum, and neck abscess

Primary laryngeal lymphoma occurs very rarely, accounting for far less than 1% of primary malignant laryngeal neoplasms. To the best of our knowledge, primary laryngeal composite lymphoma has not been reported in the literature. Herein, we report the first case of primary laryngeal composite lymphoma composed of diffuse large B-cell lymphoma (DLBCL) and peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS), in a 43-year-old man. Of special interest is the patient's unique clinical presentation of left subglottic tracheal fistula, esophageal diverticulum, and neck abscess with no discrete mass identified. We describe the clinical and pathological characteristics of this case and review the literature.

Factors influencing quality of life after total laryngectomy: a study of 92 patients

BACKGROUND AND OBJECTIVES

Total laryngectomy is a radical surgery for advanced laryngeal cancer. In the present study we evaluate the influencing factors for long term quality of life of 92 laryngectomees.

PATIENTS AND METHODS

92 patients who underwent laryngectomy for laryngeal cancer in the University Hospital of Patras, Greece were evaluated using a modified version of the EORTC-QOL-C30 questionnaire. The patients were distributed into 6 groups based on time elapsed between surgical treatment and completion of the questionnaire, ranging from 2 years for group 1 to 9-10 years for group 6.

RESULTS

The mean value of psychological status (p=0.01), smelling disorders (p=0.032), mood change (p=0.003) were statistically significant in regard to the patient's overall view of their life postsurgically. Coexisting illness (defined as diabetes, hypertension or prostate disease which required medication on daily basis or hospitalization more than two times a year) was also significantly affecting (p=0.021) the patient's oral communication skills.

CONCLUSION

Quality of life is affected by functional disabilities and the psychological state of the patients. No statistically significant improvement over time was noted in our series.

Twist modulates lymphangiogenesis and correlates with lymph node metastasis in supraglottic carcinoma

BACKGROUND

Twist is a highly conserved epithelial-mesenchymal transcription factor that has been reported to be a key factor in tumor malignancy, including lymph node metastasis. It represents the major step of dissemination and serves as a chief prognostic indicator of disease progression. However, the mechanism by which Twist regulates lymph node metastasis remains incompletely understood. Studies on the mechanism of metastasis are thus required for determining appropriate therapeutic strategies.

METHODS

Immunohistochemistry for lymphatic vessel endothelial receptor 1 (LYVE-1), Ki-67, Twist, vascular endothelial growth factor C (VEGF-C), and vascular endothelial growth factor receptor 3 (VEGFR-3) was performed to detect lymphatic vessel density (LVD), cell proliferation levels and the expressions of Twist, VEGF-C, and VEGFR-3 were determined from 66 primary supraglottic carcinoma tissue samples from 36 patients with lymph node metastasis (pathological N+, pN+) and 30 patients without metastasis (pathological N0, pN0). Western blotting analysis of the proteins in pN+ and pN0 primary tumors was used to characterize the expressions of Twist, VEGF-C, and VEGFR-3 further.

RESULTS

The LVD was 22.4 ± 10.3 in pN+ patients and 6.8 ± 4.1 in pN0 ones. For Ki-67, the number of proliferous cells in pN+ patients was greater than that in pN0 ones. Both, however, were associated with their clinical nodal stages. In pN+ patients, Twist, VEGF-C, and VEGFR-3 expressions were 86.11% (31/36), 80.56% (29/36), and 58.33% (21/36), respectively. These values were higher than those found for pN0 patients (i.e., 13/30, 11/30, and 7/30, respectively) (P < 0.05). Among the samples with Twist expression, 88.64% were VEGF-C-positive and 59.09% were VEGFR-3-positive. The pN0 counterparts were 4.55% and 9.09%, respectively (P < 0.05). The expressions of Twist, VEGF-C, and VEGFR-3 in pN+ patients obtained through Western blotting analysis were significantly higher than those in pN0 patients, and the levels of VEGF-C and VEGFR-3 were positively correlated with that of Twist.

CONCLUSIONS

Twist expression correlates with lymph node metastasis. The mechanism involved in such a correlation may be related to lymphangiogenesis.

Subglottic stenosis induced by extranodal mucosa-associated lymphoid tissue lymphoma

Mucosa-associated lymphoid tissue (MALT) lymphoma is usually associated with a chronic inflammatory disease or autoimmune disorders from which lymphoid tissue of MALT type arises as a prerequisite for lymphoma proliferation. Primary hematopoietic neoplasms of the larynx are rare. MALT lymphomas of the larynx are believed to arise from preexisting or acquired lymphoid tissue of the upper airway which is documented in the supraglottic region. Therefore, these are mainly located in the supraglottic and glottic areas, with only a few reported in the subglottic region. We report on a 50-year-old woman with a hoarseness, stridor, and developing exertional dyspnea. On indirect laryngoscope, multiple nodular lesions with smooth surface over the subglottis with subglottic steonsis was found. The biopsy confirmed the diagnosis of a MALT lymphoma. We hope to promote awareness and consideration of MALT lymphoma in the differential diagnosis in subglottic steonsis.

Laryngeal tumours: clinical pattern in Sokoto, Northwestern Nigeria

BACKGROUND

Laryngeal tumours may be benign or malignant presenting with progressive voice hoarseness and upper airway obstruction which may be misdiagnosed.

METHOD

Patients were prospectively recruited over 6years from July 1999 to July 2005 in a tertiary health centre.

RESULTS

Thirty seven cases of laryngeal tumours were seen (30 males (81.1%), 7 females (18.9%). The incidence was 6.2 cases per year. Histological diagnosis was only obtained in 30 patients (25 (83.3%) males, 5 females (16.7%). The age range was 3 months to 75 years with the mean ages (benign 6.1 years, and malignant 47.9 years). Histology of the 30 patients showed 20 (66.7%) to be malignant (Squamous cell carcinoma) out of which 17 (85%) were males and 3 (15%) females with male to female sex ratio of 5.7:1. Ten (33.3%) of the 30 cases were benign out of which 8 were males (80%) and 2 females (20%) with male to female sex ratio of 4:1.Malignant cases who had total laryngectomy, selective neck dissection with radiotherapy lived longer (minimum of 4 years) than those who had only total laryngectomy (maximum of 2(1/2) years) or only radiotherapy (6 months - 1 year). There was recurrent nodal neck lesions in 6 (30%) patients, five of which did not go for radiotherapy after surgery while one had postoperative radiotherapy. Two of these died from carotid artery rupture. Two female patients with malignant tumor who had total laryngectomy had babies born through safe vaginal delivery but eventually succumbed to the disease.

CONCLUSION

There were more malignant (66.7%) laryngeal tumors than benign (33.3%) lesions with a male preponderance and strong association with cigarette smoking but no alcohol consumption. The mean age for malignant lesions was 47.9 years which signifies a considerably younger population while that of benign lesion was 6.1 years.

Laryngocele associated with laryngeal carcinoma

Laryngocele is an abnormal dilatation of Morgagni ventricle (saccule) in direct communication with the laryngeal lumen. Symptoms are not characteristic: hoarseness, dyspnea, foreign body sensation and cough. Sometimes it is presented as cervical swelling causing airway obstruction and need an emergency tracheotomy. In this paper, we report a case of upper airway obstruction due to laryngocele associated with a laryngeal carcinoma who was treated by emergency tracheotomy and, finally by total laryngectomy. A review of the literature is also presented.

[Helicobacter pylori infection: a potential pathogenic factor for laryngeal squamous cell carcinoma]

OBJECTIVE

To investigate the difference in Helicobacter pylori (Hp) infection rate between the patients with laryngeal squamous cell carcinoma and the patients with benign laryngeal lesions and to explore the role of Hp infection in the pathogenesis of laryngeal squamous carcinoma.

METHODS

Nested polymerase chain reaction (nPCR) and Hp culture were used to identify the Hp in laryngeal mucosa in 30 patients with laryngeal carcinoma and 15 patients with benign laryngeal lesions including polyps of vocal cords or epiglottic cysts.

RESULTS

nPCR showed that Hp-positive rate (73.3%) of patients with laryngeal carcinoma was significantly higher than that (20.0%) of control patients with benign laryngeal lesions (χ(2) = 11.520, P = 0.010). Regarding the 22 positive neoplastic cases that have 44 tissues, out of the 22 tumor tissues, 10 were positive with Hp (45.4%), and among 22 tissues beside the tumor, 19 were positive (86.4%). This event also indicated a statistical significance (χ(2) = 4.697, P = 0.030). Hp culture showed that Hp was negative in all specimens.

CONCLUSIONS

Hp exist in the laryngeal mucosa, but with the higher rate of Hp infection in the patients with laryngeal squamous cell carcinoma than that in the patients with benign laryngeal lesions, which suggests Hp may be one of pathogenic factors of laryngeal squamous cell carcinoma.

Propranolol for the treatment of airway hemangiomas: a case series and treatment algorithm

OBJECTIVES

(1) To present six patients with symptomatic airway hemangiomas treated with oral propranolol. (2) To review the diagnostic and treatment options for airway hemangiomas and propose a new management protocol.

STUDY DESIGN

Retrospective review.

SETTING

Tertiary care children's hospital.

SUBJECTS AND METHODS

Pediatric patients diagnosed with obstructive airway hemangiomas treated with oral propranolol. Patients were followed for symptomatic improvement and relief of airway obstruction on imaging or laryngoscopy.

RESULTS

Seven patients presenting with airway obstruction were treated with propranolol. One patient had a focal hemangioma confined to the subglottis. Four patients had airway hemangiomas that extended beyond the confines of the larynx and trachea. A sixth patient had a bulky supraglottic hemangioma. A seventh patient with an extensive maxillofacial lesion failed propranolol therapy and was found to have a pyogenic granuloma on final pathology after excision. Six patients had failed standard medical therapy and/or surgical interventions and were treated successfully with oral propranolol with improvements in airway symptoms and oral intake, requiring no further surgical intervention. Treatment was initiated as early as 1.5 months of age, and as late as 22 months. No adverse side effects of propranolol were noted.

CONCLUSIONS

Oral propranolol was successfully used to treat airway hemangiomas, resulting in rapid airway stabilization, obviating the need for operative intervention, and reducing the duration of systemic corticosteroid therapy while causing no obvious adverse effects. These outstanding results enable the possibility of use of a standardized diagnostic and treatment algorithm for airway hemangiomas that incorporates systemic propranolol.

Recurrent vascular leiomyoma of the larynx: clinical and histopathologic characteristics and treatment

Laryngeal vascular leiomyomas are uncommon benign tumors that seldom recur following complete excision. The choice of excision procedure-via direct laryngoscopy or an open approach-is dictated by tumor size, the expected amount of blood loss, and any comorbidities the patient may have. We report an unusual case of a recurrent laryngeal vascular leiomyoma in a 64-year-old woman who also had a concurrent parathyroid adenoma and a history of breast carcinoma. A surgical resection via an external approach along with laser resection of a small glottic component was needed.

Distal marginal stenosis: a contributing factor in delayed carotid occlusion of a patient with carotid blowout syndrome treated with stent grafts

Distal marginal stenosis is rarely reported to be a factor associated with poor long-term patency of patients of head and neck cancers with carotid blowout syndrome treated with stent grafts. We report a case of laryngeal cancer with rupture of the right common carotid artery. A self-expandable stent graft was deployed, but bleeding recurred. Another stent graft was deployed for the pseudoaneurysm located distal to the first stent graft. Rebleeding occurred because of pseudoaneurysm formation from reconstituted branches of the right superior thyroid artery. We performed direct percutaneous puncture of the proximal superior thyroid artery for successful embolization. Distal marginal stenosis and asymptomatic thrombosis of the carotid artery were noted at 3.5- and 5-month follow-ups, respectively. We suggest aggressive early follow-up and reintervention for distal marginal stenosis by combined antibiotic therapy and angioplasty and stenting to improve the long-term patency of stent-graft deployment for management of carotid blowout syndrome.