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Mullins RA, Stanley BJ, Flanders JA, López PP, Collivignarelli F, Doyle RS, Schuenemann R, Oechtering G, Steffey MA, Lipscomb VJ, Hardie RJ, Kirby BM, McAlinden AB. Intraoperative and major postoperative complications and survival of dogs undergoing surgical management of epiglottic retroversion: 50 dogs (2003-2017). Vet Surg 2019; 48:803-819. [PMID: 31111521 DOI: 10.1111/vsu.13226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 06/14/2018] [Accepted: 07/18/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report intraoperative and major postoperative complications in dogs treated surgically for epiglottic retroversion (ER), compare the incidence of major postoperative complications between procedures, and report survival of surgically treated dogs. STUDY DESIGN Multi-institutional retrospective study. SAMPLE POPULATION Fifty dogs treated with 78 procedures. METHODS Medical records of dogs diagnosed and surgically treated for ER from 2003 to 2017 at 11 institutions were reviewed. Complications were divided into intraoperative and major postoperative complications. RESULTS Intraoperative complications occurred during 2 of 78 (2.6%) procedures. Thirty-six major postoperative complications were documented in 22 dogs after 36 of 74 (48.7%) procedures. Postoperative complications occurred after 7 of 12 (58.3%) nonincisional epiglottopexy, 23 of 43 (53.5%) incisional epiglottopexy, 2 of 4 (50%) partial epiglottectomy, 2 of 12 (16.7%) subtotal epiglottectomy, and 2 of 3 (66.7%) other surgical procedures. Epiglottopexy failure was the most common major postoperative complication. The incidence of major postoperative complications did not differ between procedures (P = .1239), although, when combined, epiglottopexy procedures (30/55) had a higher incidence of complications than epiglottectomy procedures (4/16; P = .048). Thirty (60%) dogs were alive at a median of 928 days (range, 114-2805), 8 (16%) were lost to follow-up after 411 days (range, 43-1158), and 12 (24%) were dead/euthanized after 301.5 days (range, 3-1212). Median survival time was not reached after a median of 716 days. CONCLUSION Although intraoperative complications were uncommon, major postoperative complications were common, especially after epiglottopexy procedures. CLINICAL SIGNIFICANCE Although surgical treatment of ER is associated with a high rate of major postoperative complications, especially epiglottopexy procedures, long-term survival can be achieved.
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Affiliation(s)
- Ronan A Mullins
- Section of Veterinary Clinical Sciences, University College Dublin, Belfield, Dublin 4, Ireland
| | - Bryden J Stanley
- Department of Small Animal Clinical Sciences, Michigan State University, College of Veterinary Medicine, East Lansing, Michigan
| | - James A Flanders
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Pablo Pérez López
- Dick White Referrals, Station Farm, Six Mile Bottom, Cambridgeshire, UK
| | | | - Ronan S Doyle
- Davies Veterinary Specialists, Higham Gobion, Hitchin, UK
| | - Riccarda Schuenemann
- Small Animal Department, Ear Nose and Throat Unit, College of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Gerhard Oechtering
- Small Animal Department, Ear Nose and Throat Unit, College of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Michele A Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Victoria J Lipscomb
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - Robert J Hardie
- Department of Surgical Sciences, University of Wisconsin, School of Veterinary Medicine, Madison, Wisconsin
| | - Barbara M Kirby
- Section of Veterinary Clinical Sciences, University College Dublin, Belfield, Dublin 4, Ireland
| | - Aidan B McAlinden
- Section of Veterinary Clinical Sciences, University College Dublin, Belfield, Dublin 4, Ireland.,Earlswood Veterinary Hospital, Belfast, UK
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Zeitels SM, Kobler JB, Heaton JT, Faquin W. Carbon Dioxide Laser Fiber for Laryngeal Cancer Surgery. Ann Otol Rhinol Laryngol 2016; 115:535-41. [PMID: 16900808 DOI: 10.1177/000348940611500708] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: The carbon dioxide laser has evolved to be the premier dissecting instrument for hemostatic cutting during endolaryngeal cancer resection. However, dissection is limited to mirror-reflected line-of-sight delivery of the laser. A recently developed flexible, hollow photonic bandgap fiber (PBF) appears to offer advantages in endolaryngeal dissection. Methods: The suitability of the PBF for human application was evaluated in a canine experiment in which human surgical procedures for microlaryngoscopic en bloc partial laryngectomy were simulated. The specimens that were resected endoscopically and the completion laryngectomy specimen were evaluated histologically. Results: Observations from this experiment revealed that en bloc partial laryngectomy procedures were substantially easier to achieve as compared with prior experience in humans. This improvement resulted from three factors: 1) enhanced tangential dissection due to increased angulation of the laser energy, 2) enhanced procedural orientation due to proprioception of the tissues in contact mode, and 3) improved hemostasis. Histopathologic analysis of the resection margins revealed minimal thermal trauma. Conclusions: The PBF shows substantial promise for human application in endoscopic partial laryngectomy. It will likely enhance the ability of any surgeon to extend his or her indications for performing endoscopic laryngeal cancer resections regardless of philosophy (en bloc resection or piecemeal).
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Affiliation(s)
- Steven M Zeitels
- Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, One Bowdoin Square, 11th Floor, Boston, MA 02114, USA
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Zeitels SM, Burns JA, Akst LM, Hillman RE, Broadhurst MS, Anderson RR. Office-Based and Microlaryngeal Applications of a Fiber-Based Thulium Laser. Ann Otol Rhinol Laryngol 2016; 115:891-6. [PMID: 17214262 DOI: 10.1177/000348940611501206] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: The carbon dioxide (CO2) laser is the premier dissecting instrument for hemostatic cutting and ablation during endolaryngeal surgery. However, microlaryngeal tangential dissection and office-based photoablation have been limited by the lack of a fiber-based delivery system. To address this limitation, a new laser was designed, which is a diode-pumped solid-state laser with a thulium-doped yttrium-aluminum-garnet laser rod. It produces a continuous-wave beam with a wavelength of 2,013 nm and a target chromophore of water. This new laser functions similarly to a CO2 laser with the benefit of being delivered through a small glass fiber (0.365 to 0.550 mm). Methods: A prospective pilot trial was done in 74 cases to explore applications of the new thulium laser. Thirty-two procedures were done with the laser used as an ablating instrument and topical anesthesia through a flexible laryngoscope (papillomatosis, 20; microinvasive carcinoma, 6; benign supraglottic lesions, 3; edema, 2; granuloma, 1). Forty-two procedures were done with the laser used as a cutting or ablating instrument for microlaryngeal dissection and general anesthesia. These included 27 partial laryngeal resections (supraglottis, 15; glottis, 10; subglottis, 2) and 8 posterior glottic laryngoplasties. The laser was also used as an ablative instrument during microlaryngoscopy in 7 cases. Results: The thulium laser was used effectively in all cases, under both local and general anesthesia. In microlaryngeal dissection, electrocautery was not needed to control bleeding, even during cutting in the highly vascular paraglottic space. No complications related to the use of the thulium laser were experienced in any case. Conclusions: Because of the fiber-based delivery system, the 2,013-nm continuous-wave thulium laser shows substantial promise for tangential dissection during microlaryngoscopy and soft tissue photoablation during office-based flexible laryngoscopy. Hemostasis was judged to be superior to experiences with the CO2 laser. In this pilot study, performing en bloc laryngeal cancer resection procedures was facilitated by use of the thulium laser.
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De Lorenzi D, Bertoncello D, Dentini A. Intraoral diode laser epiglottectomy for treatment of epiglottis chondrosarcoma in a dog. J Small Anim Pract 2015; 56:675-8. [DOI: 10.1111/jsap.12356] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 02/03/2015] [Accepted: 02/09/2015] [Indexed: 11/29/2022]
Affiliation(s)
- D. De Lorenzi
- Veterinary Hospital “I Portoni Rossi”, Interventional Pneumology and ENT Medicine and Surgery Department; 40069 Zola Predosa Bologna Italy
| | - D. Bertoncello
- Veterinary Hospital “I Portoni Rossi”, Interventional Pneumology and ENT Medicine and Surgery Department; 40069 Zola Predosa Bologna Italy
| | - A. Dentini
- Veterinary Clinic “Tyrus”; 05100 Terni Italy
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Kim YH, Oh BM, Jung IY, Lee JC, Lee GJ, Han TR. Spatiotemporal characteristics of swallowing in Parkinson's disease. Laryngoscope 2014; 125:389-95. [PMID: 25093527 DOI: 10.1002/lary.24869] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/16/2014] [Accepted: 07/15/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of this study was to quantitatively investigate spatiotemporal movement abnormalities during the pharyngeal phase of swallowing in individuals with Parkinson's disease (PD) and to investigate relationships between disease and dysphagia severities. STUDY DESIGN Retrospective study. METHODS We performed two-dimensional motion analysis of the hyoid bone, epiglottis, and vocal folds using videofluoroscopic images from 33 PD patients and 33 age-matched, healthy controls. The outcome measures were spatial and temporal movement variables during swallowing. Additionally, three subgroups of patients were compared based on the Hoehn and Yahr scale to identify the relationship between disease and dysphagia severities. RESULTS Individuals with PD showed a reduced anterior hyoid bone displacement after normalization for each individual. The maximal angle of the epiglottic rotation was smaller in PD patients. The time to maximal displacement of the hyoid bone, epiglottis, and vocal folds were significantly delayed in PD patients (P = 0.001, 0.002, and < 0.001, respectively); the mean velocities of the hyoid bone and epiglottic movements were also reduced in PD patients (P < 0.001 and < 0.001, respectively). The velocity curves of the hyoid bone revealed more peaks in individuals with PD, representing incoordination during swallowing. Clinical disease severity was related to level of diet and supervision but not with dysphagia severity. CONCLUSION This study shows that oropharyngeal bradykinesia, incoordination, reduced anterior hyoid bone movement, and decreased epiglottic rotation angle during swallowing are the most noticeable findings in individuals with PD. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Yeo H Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Mullins R, McAlinden AB, Goodfellow M. Subtotal epiglottectomy for the management of epiglottic retroversion in a dog. J Small Anim Pract 2014; 55:383-5. [DOI: 10.1111/jsap.12207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2014] [Indexed: 11/30/2022]
Affiliation(s)
- R. Mullins
- Davies Veterinary Specialists; Higham Gobion Hertfordshire SG5 3HR
| | - A. B. McAlinden
- Davies Veterinary Specialists; Higham Gobion Hertfordshire SG5 3HR
| | - M. Goodfellow
- Davies Veterinary Specialists; Higham Gobion Hertfordshire SG5 3HR
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Jamal N, Erman A, Chhetri DK. Transoral partial epiglottidectomy to treat dysphagia in post-treatment head and neck cancer patients: a preliminary report. Laryngoscope 2013; 124:665-71. [PMID: 23794244 DOI: 10.1002/lary.24278] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 06/20/2013] [Accepted: 06/06/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To determine symptoms and findings in patients with dysphagia related to epiglottic dysfunction. To analyze outcomes in patients who underwent partial epiglottidectomy due to dysphagia related to epiglottic dysfunction. STUDY DESIGN Review and analysis of clinical data obtained as part of the diagnosis and treatment of patients with dysphagia related to epiglottic dysfunction. METHODS A retrospective review was performed of all post-treatment head and neck cancer patients who underwent epiglottidectomy at a single tertiary care referral center. Objective pre- and postprocedure swallow findings, endoscopic evaluation, and subjective improvement based on patient self-reports were reviewed. RESULTS Seven patients were identified based on endoscopic evaluation and modified barium swallow study (MBSS) as having epiglottic pathology leading to dysphagia. Specific anatomic and functional findings included thickening of the epiglottis, absence of epiglottic deflection, vallecular bolus retention during and after the swallow, and bolus backflow from the pharynx to the oral or nasal cavity. Partial epiglottidectomy was performed in these patients. Postoperative MBSS was analyzed for changes in swallow efficiency and safety. Nearly all patients demonstrated improved pharyngeal bolus passage with little to no added swallowing morbidity. CONCLUSIONS Preliminary findings suggest a role for partial epiglottidectomy in post-treatment head and neck cancer patients with swallowing disorders. Ideal candidates have intact tongue base contraction and poor retroflexion of the epiglottis, which results in bolus obstruction at the level of the valleculae. Partial epiglottic resection enables improved bolus passage in the pharyngeal phase. Minimal postoperative morbidity occurs in the appropriately selected patient.
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Affiliation(s)
- Nausheen Jamal
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, U.S.A
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Terrón-Canedo N, Franklin S. Dynamic epiglottic retroversion as a cause of abnormal inspiratory noise in six adult horses. EQUINE VET EDUC 2012. [DOI: 10.1111/j.2042-3292.2012.00460.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - S. Franklin
- Equine Centre; University of Bristol; Bristol; UK
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Csanády M, Czigner J, Vass G, Jóri J. Transoral CO2 laser management for selected supraglottic tumors and neck dissection. Eur Arch Otorhinolaryngol 2011; 268:1181-1186. [DOI: 10.1007/s00405-011-1603-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 04/06/2011] [Indexed: 11/24/2022]
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Leder SB, Burrell MI, Van Daele DJ. Epiglottis is Not Essential for Successful Swallowing in Humans. Ann Otol Rhinol Laryngol 2010; 119:795-8. [DOI: 10.1177/000348941011901202] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Controversy has continued for well over 100 years regarding the role of the epiglottis in deglutition. We describe the effect of isolated epiglottectomy on swallowing success in a case series of 3 adult human subjects with isolated epiglottectomy due to trauma, surgery, or cancerous erosion. The patients were 42, 51, and 70 years of age, and swallowing was analyzed objectively with videofluoroscopy. All subjects exhibited successful swallowing with all food types: Thin liquid, puree, and solid food. Specifically, the patient with traumatic epiglottectomy exhibited rapid swallowing success, the patient with surgical epiglottectomy exhibited a short period of dysphagia due to postoperative edema, followed by swallowing success, and the patient with epiglottectomy due to cancerous erosion of the entire epiglottis exhibited long-term adaptation, with successful swallowing maintained. We conclude that the epiglottis is not essential for successful swallowing in humans, because individuals can readily adapt to isolated epiglottectomy and avoid tracheal aspiration.
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Peretti G, Piazza C, Ansarin M, De Benedetto L, Cocco D, Cattaneo A, Nicolai P, Chiesa F. Transoral CO2 laser microsurgery for Tis-T3 supraglottic squamous cell carcinomas. Eur Arch Otorhinolaryngol 2010; 267:1735-42. [DOI: 10.1007/s00405-010-1284-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 05/07/2010] [Indexed: 10/19/2022]
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Pérez Delgado L, Abeida MEU, de Miguel García F, Peña PA, Tolosana SH, Lisbona Alquézar MP, Tejero-Garcés Galve G, Navarro JS, Martinez-Berganza R, García AO. CO2 laser surgery of supraglottic carcinoma: our experience over 6 years. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s2173-5735(10)70003-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Flanders JA, Thompson MS. Dyspnea caused by epiglottic retroversion in two dogs. J Am Vet Med Assoc 2009; 235:1330-5. [DOI: 10.2460/javma.235.11.1330] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pérez Delgado L, El-Uali Abeida M, de Miguel García F, Astier Peña P, Herrera Tolosana S, Lisbona Alquézar MP, Tejero-Garcés Galve G, Sevil Navarro J, Martinez-Berganza R, Ortiz García A. CO2 laser surgery of supraglottic carcinoma: our experience over 6 years. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2009; 61:12-8. [PMID: 19926066 DOI: 10.1016/j.otorri.2009.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 09/20/2009] [Accepted: 09/25/2009] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES The study goal was to analyze the oncologic and functional outcomes of transoral laser microsurgery in the treatment of carcinoma of the supraglottic larynx. MATERIAL AND METHODS A total of 53 patients were included in this retrospective review between 2000 and 2006. The follow-up period was more than 2 years and the mean follow-up for all patients was 49 months. RESULTS Tumour extension was as follows: T1 in 12 (22.6%), T2 in 37 (69.8%) and T3 in 4 (7.5%). Forty-seven patients (88.7%) had neck dissections. Nineteen patients (35.8%) received adjuvant radiotherapy. Kaplan-Meier estimates for disease-specific survival were 80%, 74.11% and 65%, at 2, 3 and 5 years, respectively. The overall functional laryngeal preservation rate was 90.56%. (48 of 53), and local control 81.13%. During follow up, 13.2% of patients developed local recurrence, 11.3% regional recurrence and 5.7% loco-regional recurrence. Patients started swallowing early after surgery, with a mean time of 5.83 days, and the mean hospital stay was 14.69 days. Complications included 20.75% who suffered pneumonia and 11.32% with bleeding. Only one patient (1.88%) received total laryngectomy due to the impossibility of swallowing. CONCLUSIONS With careful selection of patients, laser supraglottic laryngectomy is a safe and effective treatment for cancer of the supraglottic larynx.
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Affiliation(s)
- Laura Pérez Delgado
- Servicio de Otorrinolaringología, Hospital Universitario Miguel Servet de Zaragoza, Zaragoza, España.
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Bussu F, Almadori G, De Corso E, Rizzo D, Rigante M, Parrilla C, Valentini V, Paludetti G. Endoscopic horizontal partial laryngectomy by CO(2) laser in the management of supraglottic squamous cell carcinoma. Head Neck 2009; 31:1196-206. [PMID: 19360749 DOI: 10.1002/hed.21085] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the results of endoscopic horizontal supraglottic laryngectomy (EHSL) by CO(2) laser. METHODS Between 1996 and 2005, 78 patients underwent a horizontal supraglottic laryngectomy operation (HSL) with an external approach and 70 underwent laser EHSL, as treatment for supraglottic laryngeal squamous cell carcinoma (LSCC). We evaluated oncological endpoints, comparing the external and the endoscopic approach. RESULTS Among patients primarily treated by EHSL, the 5-year disease-specific survival (DSS) was 89% (vs 80% in the external approach group). Statistical analysis did not reveal significant differences between the 2 groups as for survival nor for organ preservation. The most significant clinical predictor for DSS is neck relapse (p < .0001). CONCLUSIONS This study confirms the effectiveness of laser EHSL in which oncological outcome is similar to the external approach and functional results are probably better. Neck management in this setting is fundamental to warrant the best survival.
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Affiliation(s)
- Francesco Bussu
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy.
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Endoscopic supraglottic laryngectomy: a proposal for a classification by the working committee on nomenclature, European Laryngological Society. Eur Arch Otorhinolaryngol 2009; 266:993-8. [DOI: 10.1007/s00405-008-0901-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Accepted: 12/08/2008] [Indexed: 10/21/2022]
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Li SP, Fang TJ, Lee SW, Li HY. A rudimentary epiglottis associated with Pierre Robin sequence. Int J Oral Maxillofac Surg 2006; 35:668-70. [PMID: 16545943 DOI: 10.1016/j.ijom.2006.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2005] [Revised: 11/11/2005] [Accepted: 02/01/2006] [Indexed: 11/28/2022]
Abstract
Epiglottis anomaly associated with Pierre Robin sequence (PRS) is a rare occurrence. To the knowledge of the authors, this is the first reported case of epiglottic anomaly associated with PRS. Doctors should remain aware of this atypical presentation in a PRS patient, and the presented case highlights the clinical challenges that must be met to ensure effective treatment of the defect in terms of compromised respiration, swallowing and feeding.
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Affiliation(s)
- S-P Li
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Motta G, Esposito E, Testa D, Iovine R, Motta S. CO2 laser treatment of supraglottic cancer. Head Neck 2004; 26:442-6. [PMID: 15122661 DOI: 10.1002/hed.10395] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The aim of the study was to evaluate the effectiveness of endoscopic CO(2) laser microsurgery in the management of supraglottic cancer. METHODS One hundred twenty-four patients (116 men and eight women; mean age, 59 years; range 31-81 years) with supraglottic cancer underwent CO(2) laser surgery (mean follow-up 5 years). The study patients were classified as follows: 45 patients, T1N0M0; 61 patients, T2N0M0; and 18 patients, T3N0M0. According to the staging, the following procedures were adopted: epiglottectomy, resection of aryepiglottic fold or false vocal cord in T1 patients (group A); resection of the false vocal cord and adjacent structures in T2 patients (group B); and supraglottic laryngectomy in T3 patients (group C). Statistical comparison of survival parameters was carried out with Wilcoxon test, considering p <.05 the minimum significance value. RESULTS Overall actuarial survival, adjusted actuarial survival, and no evidence of disease at 5 years were 91%, 97%, and 82% in group A; 88%, 94%, and 59% in group B; and 81%, 81%, and 51% in group C, respectively. The statistical analysis of survival parameters showed a significant difference in the comparison of T1 versus T2 and T2 versus T3 tumors (p <.01). Actuarial local control, actuarial nodal control, and actuarial distant metastasis control at 5 years were 82%, 82%, and 100% in T1 patients; 63%, 90%, and 98% in T2 patients; and 77%, 75%, and 93% in T3 patients. Laryngeal preservation rate was 88.6% in T1 patients, 85.4% in T2 patients, and 93.7% in T3 patients. Patients in groups A and B were discharged after 3 to 12 days, and patients in group C, were discharged after 14 to 20 days. CONCLUSIONS The results of this study show that endoscopic CO(2) laser surgery is highly effective in the treatment of T1 and T2 supraglottic cancer. In T3 cancer, the CO(2) laser should be implemented in those cases where radical excision by endoscopic route is feasible.
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Affiliation(s)
- Gaetano Motta
- Institute of Otorhinolaryngology, II University of Naples, Naples, Italy
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Medda BK, Kern M, Ren J, Xie P, Ulualp SO, Lang IM, Shaker R. Relative contribution of various airway protective mechanisms to prevention of aspiration during swallowing. Am J Physiol Gastrointest Liver Physiol 2003; 284:G933-9. [PMID: 12529264 DOI: 10.1152/ajpgi.00395.2002] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Deglutitive airway protective mechanisms include glottal closure, epiglottal descent, and anterosuperior displacement of the larynx. Aspiration of swallowed material may occur during the pre-, intra-, or postpharyngeal phase of swallowing. Our objectives were to determine the relative contribution of the airway protective mechanisms during each phase of swallow in 14 decerebrated cats before and after suprahyoid myotomy, epiglottectomy, and unilateral cordectomy. After myotomy, superior excursions of the hyoid, thyroid, and cricoid cartilages and anteroposterior diameter of maximum upper esophageal spincter (UES) opening were significantly diminished, but the incidence of pharyngeal residue significantly increased (P < 0.05). No aspiration was observed in the predeglutitive period. After myotomy, the incidence of aspiration significantly increased in both intra- and postdeglutitive periods. Epiglottectomy did not alter aspiration incidence, but unilateral cordectomy resulted in a 100% incidence of intra- and postdeglutitive aspiration. In conclusion, glottal closure constitutes the primary mechanism for prevention of intra- and postdeglutitive aspiration, but laryngeal elevation may assist this function. Bolus pulsion without laryngeal distraction can open the UES, but at risk of aspiration due to decreased pharyngeal clearance. The epiglottis provides no apparent airway protection during any phase of swallowing.
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Affiliation(s)
- Bidyut K Medda
- Medical College of Wisconsin Dysphagia Institute, Division of Gastroenterology and Hepatology, and Department of Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Shvero J, Koren R, Zohar L, Hadar T, Marshak G, Gal R, Feinmesser R, Segal K. Laser surgery for the treatment of glottic carcinomas. Am J Otolaryngol 2003; 24:28-33. [PMID: 12579480 DOI: 10.1053/ajot.2003.2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The standard treatment for patients with early glottic carcinoma in Israel has been radiotherapy. In recent years, encouraging results with laryngo-microscopic carbon dioxide laser surgery as a treatment for early glottic carcinoma has changed our treatment strategy. We conducted a retrospective study to investigate the results of carbon dioxide laser excisional technique for early glottic carcinoma (T1, T2). MATERIALS AND METHODS Twenty-six had squamous cell carcinoma (SCC), (21 patients with T1 and 5 patients with T2 lesions), 3 had carcinoma in situ, (CIS) and 3 had verrucous carcinoma (VC). RESULTS All patients were free of disease after salvage treatment at the most recent follow-up. CONCLUSIONS Careful patient selection with endoscopic staging and strict follow-up are essential to secure good results in the treatment of carbon dioxide laser for early laryngeal carcinoma.
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Affiliation(s)
- Jacob Shvero
- Departments of Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
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21
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Affiliation(s)
- Jonathan C Smith
- Department of Otolaryngology, University of Pittsburgh School of Medicine, The Eye & Ear Institute, Suite 500, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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22
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Affiliation(s)
- Alfio Ferlito
- Department of Otolaryngology--Head and Neck Surgery, University of Udine, Italy.
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23
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Golz A, Goldenberg D, Westerman ST, Catalfumo FJ, Netzer A, Westerman LM, Joachims HZ. Laser partial epiglottidectomy as a treatment for obstructive sleep apnea and laryngomalacia. Ann Otol Rhinol Laryngol 2000; 109:1140-5. [PMID: 11130827 DOI: 10.1177/000348940010901211] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Obstructive sleep apnea (OSA) and laryngomalacia are two different entities. Occasionally, they may have a common etiology: an elongated, flaccid, and lax epiglottis that is displaced posteriorly during inspiration causing airway obstruction. Twenty-seven adults with a diagnosis of airway obstruction or OSA of various degrees, and 12 infants with severe stridor associated with frequent apneas due to laryngomalacia, who on fiberoptic examination were found to have a posteriorly displaced epiglottis, underwent partial epiglottidectomy with a CO2 laser. Their postoperative recovery was uneventful. Polysomnographic studies performed after operation in the adult patients demonstrated statistically significant improvement in 85% of the patients. In all the cases of laryngomalacia, stridor ceased permanently after surgery, together with complete cessation of the apneic episodes. This study demonstrates that similar pathophysiological mechanisms may be involved in both laryngomalacia and in OSA. Effective and relatively safe treatment can be achieved by partial resection of the epiglottis with a microlaryngoscopic CO2 laser.
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Affiliation(s)
- A Golz
- Department of Otolaryngology-Head and Neck Surgery, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Laccourreye O, Lawson G, Muscatello L, Biacabe B, Laccourreye L, Brasnu D. Carbon dioxide laser debulking for obstructing endolaryngeal carcinoma: a 10-year experience. Ann Otol Rhinol Laryngol 1999; 108:490-4. [PMID: 10335712 DOI: 10.1177/000348949910800513] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The results of the carbon dioxide (CO2) laser debulking procedure for obstructing endolaryngeal carcinoma were analyzed in terms of efficiency, complications, secondary tracheotomy rate, and peristomal recurrence rate in a series of 50 patients consecutively managed at our department. The CO2 laser was used to reestablish a safe airway without resorting to tracheotomy and without performing a transoral resection. Our series included 42 patients in a pre-definitive treatment group (group 1) and 8 patients in a palliation group (group 2). Complications included death, pneumonia from inhalation, and cutaneous burns in 2 patients, 1 patient, and 1 patient, respectively. Thirty-two percent of patients required a repeat laser treatment to maintain the airway. Overall success rates of 92.8% and 87.5% were achieved in group 1 and group 2 patients, respectively. None of the variables under analysis could predict the success of the CO2 laser debulking procedure. The overall incidences for secondary tracheotomy were 4.7% and 0% in group 1 and group 2 patients, respectively. Peristomal recurrence was not encountered in patients managed with definitive therapy with curative intent.
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Affiliation(s)
- O Laccourreye
- Department of Otorhinolaryngology-Head and Neck Surgery, Laënnec Hospital, Assistance Publique des Hôpitaux de Paris, University Paris V, France
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25
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Abstract
The congenital absence of the epiglottis is a very rare anomaly. We present a patient who has a complete absence of the epiglottis, illustrated with an endoscopic photograph, review the literature and discuss the management of patients with this condition.
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26
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Eckel HE. Endoscopic Laser Resection of Supraglottic Carcinoma. Otolaryngol Head Neck Surg 1997; 117:681-7. [PMID: 9419098 DOI: 10.1016/s0194-59989770052-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Forty-six patients with infiltrating supraglottic carcinoma were treated prospectively for cure between 1986 and 1992 with transoral laser resection of the primary. Nine primaries were classified as T1, and 37 as T2. Thirty-three had staged unilateral or bilateral neck dissections, and 16 had postoperative radiotherapy. All patients were followed up for 2 to 8 years unless they died. Of the 46 patients, 33 are alive without disease, 8 died with disease, and 5 died of intercurrent disease. Among the 8 patients who died with disease, 4 had uncontrollable local or regional recurrences, and 4 had distant metastases but were free of local or regional recurrence. Calculated overall survival was 59% and adjusted survival was 72% after 5 years. Four patients had tracheostomies perioperatively, and 2 required temporary postoperative tracheostomies. The remaining 40 patients needed no artificial airway other than orotracheal intubation for the endolaryngeal intervention. Thirty-seven patients relearned undisturbed deglutition within 2 weeks from surgery, and 4, within 4 weeks. However, 5 (10.9%) patients failed to relearn swallowing and consecutively underwent “completion” total laryngectomy. Among them were the two patients who had previously had unsuccessful surgical or radiologic treatment of their primaries and the patient with a history of oral cavity carcinoma. This study confirms that transoral laser resection can effectively control early supraglottic carcinoma. Tracheostomies are not routinely required, and phonatory function is not compromised. However, transoral laser resection could not steadily preserve undisturbed deglutition in the patients included In this study. Patients with histories of unsuccessful attempts of other larynx-sparing therapeutic modalities or of previous major head and neck interventions were not successfully managed with transoral laser resection in this series. Criteria for patient selection remain to be established.
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Affiliation(s)
- H E Eckel
- Department of Otorhinolaryngology, University of Cologne, Germany
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27
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Myers EN, Alvi A. Management of carcinoma of the supraglottic larynx: evolution, current concepts, and future trends. Laryngoscope 1996; 106:559-67. [PMID: 8628081 DOI: 10.1097/00005537-199605000-00008] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The treatment of cancer of the supraglottic larynx has undergone an evolution. Better understanding of the anatomy and biology of cancer in this anatomic site has enabled surgeons to devise effective oncologic strategies while making every effort to preserve the function of the larynx. Certain recent concepts and changing trends have emerged in the treatment of cancer of the supraglottic larynx, including the treatment of the neck, significance of extracapsular spread of tumor in cervical lymph nodes, and conservation laser surgery. In 1985, Snyderman et al. reported the prognostic significance of extracapsular spread in patients with cancer of the supraglottic larynx. In 1990, Lutz et al. reported the results of our experience with the treatment of 202 patients. The review verified the significant risk of bilateral neck disease in these patients, even with adjuvant radiation therapy. Accordingly, since 1990 all patients having cancer of the supraglottic larynx have been treated in the Department of Otolaryngology at the University of Pittsburgh with bilateral neck dissections. The use of adjuvant radiation therapy has been based on the presence of extracapsular spread. This study documents the oncologic effectiveness of this treatment and confirms the efficacy of bilateral neck dissections in an attempt to control neck disease and the prognostic significance of extracapsular spread. We review the evolution of the treatment of cancer of the supraglottic larynx, present our results, and consider innovative surgical approaches.
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Affiliation(s)
- E N Myers
- Department of Otolaryngology, University of Pittsburgh School of Medicine, PA 15213, USA
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Abstract
Current concepts of endoscopic management of supraglottic cancer are an extension of precepts fostered by Jackson. The current approach has been facilitated by a half century of technological developments: the surgical microscope, the CO2 laser, improved laryngoscopes, and general endotracheal anesthesia. Selected small-volume cancers can be curatively resected, whereas excisional biopsy can be performed on larger neoplasms. With this cost effective minimally-invasive surgical approach, there is less disturbance of normal tissue, thereby minimizing morbidity rate and hospitalization. If the transoral excision is inadequate, radiotherapy can not be depended on to eradicate known residual disease. Endoscopic resection of supraglottic cancer should not alter the surgeon's standard management of the neck.
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Affiliation(s)
- S M Zeitels
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston 02130, USA
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Reyes BG, Arnold JE, Brooks LJ. Congenital absence of the epiglottis and its potential role in obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 1994; 30:223-6. [PMID: 7836035 DOI: 10.1016/0165-5876(94)90063-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 3 month old girl with congenital absence of the epiglottis presents with inspiratory stridor. Over the next 8 years frank obstructive sleep apnea (OSA) develops, confirmed by polysomnography. She has no difficulty in swallowing or phonation as assessed clinically and with barium swallow. This suggests that the epiglottis may help stabilize the upper airway, and any role in swallowing or phonation may, in its absence, be compensated by other mechanisms.
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Affiliation(s)
- B G Reyes
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106
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Abstract
The tendency of epiglottic cancer to invade the preepiglottic space and the significance of this invasion was evaluated in 36 surgical specimens of epiglottic carcinoma originally staged T1 or T2. None of the 9 lesions originating above the hyoepiglottic ligament invaded the preepiglottic space. Twenty-four of the 27 (89%) lesions originating below the hyoepiglottic ligament showed invasion of the preepiglottic space and were clinically understaged. Of the 3 infrahyoid lesions showing no invasion of the preepiglottic space, 1 was a verrucous carcinoma and another was a mucoepidermoid carcinoma arising on the petiole. All other lesions were squamous cell carcinoma. In 12 of the 24 patients (50%) with preepiglottic space invasion, cervical node metastasis was present despite the preoperative staging of T1 or T2.
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Affiliation(s)
- S M Zeitels
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Dept of Otology and Laryngology, Boston 02114
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Zeitels SM, Vaughan CW, Domanowski GF. Endoscopic management of early supraglottic cancer. Ann Otol Rhinol Laryngol 1990; 99:951-6. [PMID: 2244727 DOI: 10.1177/000348949009901204] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
An initial endoscopic surgical approach to early supraglottic cancer provides the surgeon with the ability to accurately stage these lesions, avoiding possible undertreatment while allowing for a valuable treatment option for those supraglottic cancers with histologically incontrovertibly superficial disease. Early invasion of the preepiglottic and paraglottic spaces can be determined accurately without altering or delaying any treatment option (open surgical excision, radiotherapy, or chemotherapy). The tendency of supraglottic cancers to transgress the natural foramina of the epiglottis is well established, and the concern about this depth of invasion is reflected by the 1977 revised staging criteria, which required assessment of the preepiglottic space (PES). Along with the microscope and the carbon dioxide laser, the adjustable supraglottiscope facilitates the determination of PES invasion and facilitates en bloc excision of superficial supraglottic cancers. The resulting morbidity typically is no different from that with routine direct endoscopy and biopsy.
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Affiliation(s)
- S M Zeitels
- Otolaryngology Section, Boston Veterans Administration Medical Center, Massachusetts
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