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Wu C, Yan X, Xie F, Lai X, Wang L, Jiang Y. Development of a nomogram for predicting pharyngocutaneous fistula based on skeletal muscle mass and systemic inflammation indices. Head Neck 2024; 46:571-580. [PMID: 38124665 DOI: 10.1002/hed.27614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/16/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Laryngeal and hypopharyngeal cancers often require surgical treatment, which can lead to the development of pharyngocutaneous fistula (PCF). Our research aimed to assess the predictive value of skeletal muscle mass (SMM) and systemic inflammation indices for PCF and construct a clinically effective nomogram. METHODS A nested case-control study of 244 patients matched from 1171 patients with laryngeal or hypopharyngeal cancer was conducted. SMM was measured at the third cervical level based on CT scans. A PCF nomogram was developed based on the univariate and multivariate analyses. RESULTS Glucose, white blood cell count, platelet-to-lymphocyte ratio, and skeletal muscle index were independent risk factors for PCF. The area under the curve for the PCF nomogram was 0.841 (95% CI 0.786-0.897). The calibration and decision curves indicated that the nomogram was well-calibrated with good clinical utility. CONCLUSIONS The nomogram we constructed may help clinicians predict PCF risk early in the postoperative period, pending external validation.
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Affiliation(s)
- Ce Wu
- Department of Otolaryngology - Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xudong Yan
- Department of Otolaryngology - Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Feng Xie
- Department of Otolaryngology - Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaolong Lai
- Department of Otolaryngology - Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lin Wang
- Department of Otolaryngology - Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yan Jiang
- Department of Otolaryngology - Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Gimenez-Laso I, Gau-Okroglic A, Mulder A, Thimmesch M. [Stridor due to a subglottic hemangioma compressing the trachea]. Rev Med Liege 2024; 79:65-67. [PMID: 38356420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Subglottic haemangioma can cause stridor in young children, and sometimes be life-threatening. Larynx ultrasound is a useful, non-irradiating screening test, but the diagnosis must be confirmed by bronchial fibroscopy and injected chest CT scan. Nowadays propranolol is the first-line treatment. If treated early, the prognosis is excellent.
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Affiliation(s)
| | | | - André Mulder
- Service des Soins intensifs pédiatriques, CHC MontLégia, Liège, Belgique
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Fujiki RB, Sanders PW, Anthony BP, Parker NP, Sivasankar MP, Halum S. Can Resident Auditory-Perceptual Voice Assessments Predict Medical Urgency of Voice Disorders? J Voice 2024; 38:181-188. [PMID: 34479778 DOI: 10.1016/j.jvoice.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVES Growing reliance on telemedicine has created new triaging challenges. This study investigated how effectively otolaryngology resident auditory-perceptual voice assessments performed via telemedicine determined the need for urgent in-person clinic visits. METHODS Twelve otolaryngology resident physicians (PGY1-PGY5) performed auditory-perceptual assessments on 25 voice samples recorded during initial voice evaluations. Voice samples were balanced in severity and taken in equal numbers from patients with the following diagnoses: benign laryngeal lesions, laryngeal cancer, functional voice disorders, laryngeal edema (associated with LPR), and laryngeal paralysis/paresis. Urgent diagnoses were defined as laryngeal cancer and severe unilateral laryngeal paralysis. For each voice sample, residents were initially blinded to patient medical history. Residents rated severity of voice disorder, predicted patient diagnosis, and determined the urgency of seeing the patient in clinic. Residents then reviewed information from the patient's medical history and again rated urgency of voice disorder. RESULTS On average, residents identified urgent voice disorders in 56% of cases. After reviewing medical history, this number significantly increased to 77% (P = 0.001). Voice severity, smoking history, time since onset, and course of symptoms were considered most influential when determining medical urgency of voice patients. Year in residency program had no effect on rating accuracy. As expected, diagnostic accuracy of auditory-perceptual assessments was low, ranging from 40% for laryngeal paralysis/paresis to 5% for laryngeal edema. CONCLUSION Auditory-perceptual voice assessment, combined with medical history, predicted most medically urgent voice disorders. Further work should investigate if task-specific training might improve these results and which medical history items are most critical. Until accuracy of auditory-perceptual assessment of medical urgency is improved, these data underscore the importance of laryngeal examination in identifying medical urgency and etiology of dysphonia.
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Affiliation(s)
| | | | - Benjamin P Anthony
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine
| | - Noah P Parker
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine
| | | | - Stacey Halum
- Department of Speech, Language, and Hearing Sciences, Purdue University; Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine.
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Gurău P, Sencu E, Vetricean S. Endoscopic ablation for glottic cancer in a patient with temporomandibular joint ankylosis. Acta Otorrinolaringol Esp (Engl Ed) 2024; 75:67-69. [PMID: 37722654 DOI: 10.1016/j.otoeng.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/27/2023] [Indexed: 09/20/2023]
Affiliation(s)
- Petru Gurău
- Department of Thoracic Surgery, "Timofei Moșneaga" Republican Clinical Hospital, str. N. Testemițanu 29, MD-2025, Chișinău, Republic of Moldova.
| | - Eusebiu Sencu
- Clinic of Otolaryngology, "N.Testemițanu" University of Medicine and Pharmacy, str. N. Testemițanu 29, MD-2025, Chișinău, Republic of Moldova
| | - Sergiu Vetricean
- Clinic of Otolaryngology, "N.Testemițanu" University of Medicine and Pharmacy, str. N. Testemițanu 29, MD-2025, Chișinău, Republic of Moldova
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Matthews CN, Salman S, Mustafa SF, Misra D. Cardiogenic and obstructive shock: primary laryngeal synovial sarcoma with cardiac metastasis. BMJ Case Rep 2023; 16:e257431. [PMID: 38042527 PMCID: PMC10693874 DOI: 10.1136/bcr-2023-257431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023] Open
Abstract
A man in his 20s with a history of laryngeal synovial sarcoma presented with dyspnoea. Imaging revealed a large right ventricular (RV) mass, which was resected, and histological analysis indicated synovial sarcoma recurrence. Within 1 month of RV mass resection, the tumour progressed with paratracheal metastasis. The lumen was nearly obliterated, and right ventricular outflow tract (RVOT) obstruction led to rapid deterioration with mixed cardiogenic and obstructive shock. We present a rare case of primary laryngeal synovial sarcoma metastasising to the heart.
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Affiliation(s)
- Christopher N Matthews
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sidra Salman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Syed Farrukh Mustafa
- Mount Sinai Fuster Heart Hospital, Mount Sinai Health System, New York, New York, USA
| | - Deepika Misra
- Mount Sinai Fuster Heart Hospital, Mount Sinai Health System, New York, New York, USA
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Kiss B, Neagos CM, Jimborean G, Sárközi HK, Szathmary M, Neagos A. Comorbidities and Laryngeal Cancer in Patients with Obstructive Sleep Apnea: A Review. Medicina (Kaunas) 2023; 59:1959. [PMID: 38004008 PMCID: PMC10672902 DOI: 10.3390/medicina59111959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 10/24/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Abstract
Introductions: The global prevalence of obstructive sleep apnea shows that this disease appears in 1 billion people, with the prevalence exceeding 50% in some countries. Treatment is necessary to minimize negative health impacts. Obstructive sleep apnea (OSA) is defined as a cause of daytime sleepiness, as well as a clinical manifestation of sleep-disordered breathing. In the literature, there are numerous controversial studies regarding the etiology of this condition, but it is universally accepted that reduced activity in the upper airway muscles plays a significant role in its onset. Additionally, OSA has been associated with a series of comorbidities, such as type II diabetes, metabolic syndrome, and cardiovascular and pulmonary conditions, as well as head and neck tumors, especially oropharyngeal and laryngeal tumors. This is a review of the subject of OSA that considers several aspects: an analysis of the comorbidities associated with OSA, the involvement of tumor pathology in the onset of OSA, and the association of OSA with various types of laryngeal cancers. Additionally, it includes an evaluation of postoperative and medical outcomes for patients with OSA and laryngeal tumors treated surgically and medically, including chemotherapy. Relevant Sections: By taking into consideration the stated objective, a systematic analysis of the available literature was conducted, encompassing the PubMed, Medline, and Scopus databases. The evaluation was based on several keywords, including head and neck cancer, diabetes, diabetic, overlap syndrome, cardiovascular conditions, laryngeal neoplasm, radiotherapy, and chemotherapy, as well as the concept of quality of life in laryngectomized patients and patients with OSA. Discussions: The review evaluates the involvement of OSA in the presence of comorbidities, as well as the increased incidence of OSA in patients with laryngeal cancer. It is important to note that surgical and post-surgical treatment can play a significant role in triggering OSA in these patients. Conclusions: The studies regarding the correlations between OSA, comorbidities, and head and neck tumors indicate a significantly increased risk of OSA in association with conditions such as diabetes, metabolic syndrome, cardiovascular diseases, and head and neck tumors, particularly laryngeal tumors. This association has a physio-pathological basis. The various surgical methods followed by radiation and chemotherapy for tumor treatment do not exclude an increased risk of developing OSA after treatment. This significantly influences the quality of life of patients who survive these types of tumors. Future directions: Due to the multiple comorbidities associated with OSA, the extension of polysomnography associated with investigations during sleep, such as drug-induced sleep endoscopy, represents a tendency for the early diagnosis of this pathology, which affects the quality of life of these patients. Patients with head and neck cancer are at high risk of developing obstructive sleep apnea; this is why it is necessary to expand the polysomnographic investigation of these patients after surgical procedures or after radiotherapy and chemotherapy.
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Affiliation(s)
- Beata Kiss
- Department of Otorinolaryngology, Emergency County Hospital Targu Mures, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540136 Târgu Mures, Romania (C.M.N.)
| | - Cristian Mircea Neagos
- Department of Otorinolaryngology, Emergency County Hospital Targu Mures, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540136 Târgu Mures, Romania (C.M.N.)
| | - Gabriela Jimborean
- Pneumologic Department, George Emil Palade University of Medicine Science and Technology, 540136 Târgu Mures, Romania; (G.J.); (H.K.S.); (M.S.)
| | - Hédi Katalin Sárközi
- Pneumologic Department, George Emil Palade University of Medicine Science and Technology, 540136 Târgu Mures, Romania; (G.J.); (H.K.S.); (M.S.)
| | - Mioara Szathmary
- Pneumologic Department, George Emil Palade University of Medicine Science and Technology, 540136 Târgu Mures, Romania; (G.J.); (H.K.S.); (M.S.)
| | - Adriana Neagos
- Department of Otorinolaryngology, Emergency County Hospital Targu Mures, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540136 Târgu Mures, Romania (C.M.N.)
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Hu Z, Guo X, Chen L, Lei W. Transnasal negative pressure therapy for accelerating healing and improving the prognosis of pharyngocutaneous fistula. Head Neck 2023; 45:2809-2818. [PMID: 37695059 DOI: 10.1002/hed.27505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Pharyngocutaneous fistula (PCF) is one of the most common complications of total laryngectomy. This study is to investigate the efficacy of a novel platform called transnasal negative pressure therapy (TNPT) in the management of PCF. METHODS We retrospectively reviewed 47 patients who underwent total laryngectomy between April 2015 and February 2021 and developed PCF in our hospital. We focused on the healing rate, dressing change frequency, and healing time between the TNPT and non-TNPT groups. The 2 years overall survival (OS) was compared through the log-rank test. RESULTS There were 18 patients in the TNPT group and 29 in the non-TNPT group. There was no significant between-group difference in the healing rate (chi-square test). However, the frequency of dressing changes was significantly lower (p < 0.001) and the healing time was significantly shorter (p = 0.0194) in the TNPT group than in the non-TNPT group. The 2-year OS rate was significantly higher in the TNPT group (p = 0.0473, log-rank test). CONCLUSION TNPT promoted wound healing after surgery for PCF and improved the 2-year OS rate. This tool is worthy of clinical application and promotion.
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Affiliation(s)
- Zhangwei Hu
- Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, China
| | - Xueqin Guo
- Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, China
| | - Lin Chen
- Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, China
| | - Wenbin Lei
- Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Otorhinolaryngology Institute, Sun Yat-sen University, Guangzhou, China
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Milinis K, Parikh C, Williams S, Davies K, Fleming JC. Gastrostomy dependence following pharyngolaryngectomy: The effect of preoperative tube insertion. Head Neck 2023; 45:2649-2656. [PMID: 37622194 DOI: 10.1002/hed.27490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/09/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND The aim of this study is to investigate the impact of preoperative gastrostomy in patients undergoing pharyngolaryngectomy (PL) on gastrostomy tube dependence at 6 months postoperatively. METHODS A retrospective review of patients undergoing PL for laryngeal squamous cell carcinoma between 2005 and 2019 was performed. Parameters were collected and analyzed within the multivariate models. RESULTS Ninety-three patients (82% male, mean age 63.4 [SD 9.4]) were included. Preoperative tube placement and pharyngocutaneous fistula (PCF) were associated with an increased likelihood of gastrostomy tube dependence at 6 months (odds ratio 6.43, CI 1.1-38.3, p = 0.041) after adjusting for multiple confounding factors. There was no difference in the incidence of delayed oral feeding, PCF, or hospital stay between the groups. CONCLUSIONS Preoperative tube and PCF are associated with an increased likelihood of tube dependence at 6 months. Patients for preoperative tube insertion should be carefully selected and early oral feeding reintroduction should be encouraged.
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Affiliation(s)
- Kristijonas Milinis
- Department of Otorhinolaryngology - Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Chinar Parikh
- Department of Otorhinolaryngology - Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Stephen Williams
- Department of Otorhinolaryngology - Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Katharine Davies
- Department of Otorhinolaryngology - Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Jason C Fleming
- Department of Otorhinolaryngology - Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
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Chang X, Hu Y. Effect of possible risk factors for pharyngocutaneous fistula after total laryngectomy of laryngeal carcinomas and surgical wound infection: A meta-analysis. Int Wound J 2023; 20:2664-2672. [PMID: 37243402 PMCID: PMC10410319 DOI: 10.1111/iwj.14140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 02/20/2023] [Indexed: 05/28/2023] Open
Abstract
A meta-analysis study to assess the effect of possible risk factors for pharyngocutaneous fistula (PCF) after total laryngectomy of laryngeal carcinoma. A comprehensive literature examination till January 2023 was implemented and 1794 linked studies were appraised. The picked studies contained 3140 subjects with total laryngectomy of laryngeal carcinomas in the picked studies' baseline, 760 of them were PCF, and 2380 were no PCF. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to calculate the consequence of possible risk factors for PCF after total laryngectomy of laryngeal carcinomas and surgical wound infection after total laryngectomy of laryngeal carcinoma by the dichotomous and continuous styles and a fixed or random model. The PCF had a significantly higher surgical wound infection (OR, 6.34; 95% CI, 1.89-21.27, P = .003) compared with the no PCF in total laryngectomy of laryngeal carcinomas. The smoking (OR, 1.73; 95% CI, 1.15-2.61, P = .008), and preoperative radiation (OR, 1.90; 95% CI, 1.37-2.65, P < .001) had significantly higher PCF as a risk factor in total laryngectomy of laryngeal carcinomas. The preoperative radiation had a significantly lower spontaneous PCF closure (OR, 0.33; 95% CI, 0.14-0.79, P = .01) compared with the no preoperative radiation in total laryngectomy of laryngeal carcinomas. However, the neck dissection (OR, 1.34; 95% CI, 0.75-2.38, P = .32), and alcohol intake (OR, 1.95; 95% CI, 0.76-5.05, P = .17), had no significant effect on PCF in total laryngectomy of the PCF had a significantly higher surgical wound infection, and preoperative radiation had a significantly lower spontaneous PCF closure in total laryngectomy of laryngeal carcinomas. Smoking and preoperative radiation were shown to be risk factors for PCF, however, neck dissection and alcohol intake were not shown to be risk factors for PCF in total laryngectomy of laryngeal carcinomas. Although precautions should be taken when commerce with the consequences because some of the picked studies for this meta-analysis was with low sample sizes.
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Affiliation(s)
- Xiaojing Chang
- Department of Otolaryngology Head and Neck Surgerythe Sixth Hospital of WuhanWuhanChina
| | - Yuan Hu
- Department of Otorhinolaryngology Head and Neck Surgery, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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Li N, Yin G, Guo W, Huang Z. Relationship between dysphagia and surgical treatment for supraglottic laryngeal carcinoma: A meta-analysis. Am J Otolaryngol 2023; 44:103788. [PMID: 36706715 DOI: 10.1016/j.amjoto.2023.103788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/27/2022] [Accepted: 01/14/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To systematically evaluate differences in swallowing disorder-related manifestations in patients with supraglottic laryngeal cancer, who underwent traditional open partial horizontal laryngectomy (OPHL) and endoscopic supraglottic laryngectomy (ESL). METHODS A systematic review of the literature and a meta-analysis were performed. The CNKI, Wan Fang, PubMed, EMBASE, Cochrane Library, Web of Science, and Clinical Trials databases for clinical studies data sources were investigated. The efficiency of recovery, postoperative swallowing function, and complications related to dysphagia were investigated to compare the effects of surgical procedures. RESULTS The meta-analysis included 8 studies with 281 patients. ESL surgery played a positive role in the recovery of patients. Preservation of the anterior epiglottic space, ventricular band, and arytenoid cartilage without destroying the external framework of the larynx can effectively reduce the risk of aspiration pneumonia in patients. CONCLUSIONS ESL has advantages in postoperative recovery and retention of swallowing function in patients with supraglottic laryngeal cancer.
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Affiliation(s)
- Nuan Li
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Gaofei Yin
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Guo
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhigang Huang
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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Zhang Q, Zhang C, Yin Y. Emergency treatment of airway obstruction caused by a laryngeal neuroendocrine tumor: A case report. Medicine (Baltimore) 2023; 102:e33081. [PMID: 36827047 DOI: 10.1097/md.0000000000033081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
RATIONALE Laryngeal obstruction is a life-threatening adverse event that requires urgent and appropriate management, particularly in patients with coexisting cardiopulmonary and brain comorbidities. However, laryngeal obstruction caused by laryngeal neuroendocrine tumors has rarely been reported. PATIENT CONCERNS Neuroendocrine tumors can cause pathological changes in the neuro-humoral system, and asphyxia caused by airway obstruction has a more adverse effect on patients with neuroendocrine tumors. DIAGNOSES We report the case of a 64-year-old man with clinical manifestations of dyspnea. Preoperative and intraoperative pathological examination indicated that the patient was diagnosed with life-threatening airway obstruction caused by a laryngeal neuroendocrine tumor, pneumonia, and scoliosis. INTERVENTIONS The patient underwent laryngeal tumor resection under general anesthesia. He was recovered well and was generally good without the necessity of undergoing radiotherapy and chemotherapy at the 6-months follow-up. OUTCOMES This case report has provided an emergency treatment strategy associated with awake intubation. We concluded that flexible establishment of an artificial airway, skilled anesthesia and surgical manipulation, and necessary postoperative intensive care are extremely important for improving the prognosis of patients with severely difficult airway. It is noteworthy that the timely adjust for endotracheal intubation strategy according to the patient's response is needed. It is important for the long-term prognosis of patients to avoid the establishment of a traumatic artificial airway and the occurrence of adverse complications. LESSONS 1. Introduction; 2. Case presentation; 3. Discussion; 4. Conclusion.
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Affiliation(s)
- Qiulei Zhang
- Department of Emergency and Critical Care, The Second Hospital of Jilin University, Changchun, China
| | - Chengwei Zhang
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, China
| | - Yongjie Yin
- Department of Emergency and Critical Care, The Second Hospital of Jilin University, Changchun, China
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Lee HI, Lee J, Lee JH, Wu HG, Kim JH, Kim Y, Eom KY. Evaluation of Optimal Assessment Schedules for Surveillance After Definitive Locoregional Treatment of Locally Advanced Head and Neck Cancer: A Retrospective Cohort Study With Parametric Modeling of Event-Free Survival. JAMA Otolaryngol Head Neck Surg 2022; 148:1059-1067. [PMID: 36173618 PMCID: PMC9523554 DOI: 10.1001/jamaoto.2022.2561] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/08/2022] [Indexed: 12/13/2022]
Abstract
Importance In clinical practice, assessment schedules are often arbitrarily determined after definitive treatment of head and neck cancer (HNC), producing heterogeneous and inconsistent surveillance plans. Objective To establish an optimal assessment schedule for patients with definitively treated locally advanced HNC, stratified by the primary subsite and HPV status, using a parametric model of standardized event-free survival curves. Design, Setting, and Participants This was a retrospective study including 2 tertiary referral hospitals and a total of 673 patients with definitive locoregional treatment of locally advanced HNC (227 patients with nasopharyngeal cancer [NPC]; 237 patients with human papillomavirus-positive oropharyngeal cancer [HPV+ OPC]; 47 patients with HPV-negative [HPV-] OPC; 65 patients with hypopharyngeal cancer [HPC]; and 97 patients with laryngeal cancer [LC]). Patients had received primary treatment in 2008 through 2019. The median (range) follow-up duration was 57.8 (6.4-158.1) months. Data analyses were performed from April to October 2021. Main Outcomes and Measures Tumor recurrence and secondary malignant neoplasms. Event-free survival was defined as the period from the end of treatment to occurrence of any event. Event-free survival curves were estimated using a piecewise exponential model and divided into 3 phases of regular follow-up. A 5% event rate criterion determined optimal follow-up time point and interval. Results The median (range) age of the 673 patients at HNC diagnosis was 58 (15-83) years; 555 (82.5%) were men; race and ethnicity were not considered. The event rates of NPC, HPV+ OPC, HPV- OPC, HPC, and LC were 18.9% (43 of 227), 14.8% (35 of 237), 36.2% (17 of 47), 44.6% (29 of 65), and 30.9% (30 of 97), respectively. Parametric modeling demonstrated optimal follow-up intervals for HPC, LC, and NPC, respectively, every 2.1, 3.2, and 6.1 months; 3.7, 5.6, and 10.8 months; and 9.1, 13.8, and 26.5 months until 16.5, 16.5 to 25.0, and 25.0 to 99.0 months posttreatment (open follow-up thereafter). For HPV- OPC, assessment was recommended every 2.7, 4.8, and 11.8 months until 16.5, 16.5 to 25.0, and 25 to 99 months posttreatment, respectively. In contrast, HPV+ OPC optimal intervals were every 7.7, 13.7, and 33.7 months until 16.5, 16.5 to 25.0, and 25 to 99 months posttreatment, respectively. Five, 4, 12, 15, and 10 follow-up visits were recommended for NPC, HPV+ OPC, HPV- OPC, HPC, and LC, respectively. Conclusions and Relevance This retrospective cohort study using parametric modeling suggests that the HNC assessment schedules should be patient tailored and evidence based to consider primary subsites and HPV status. Given limited health care resources and rising detection rates and costs of HNC, the guidelines offered by these findings could benefit patients and health systems and aid in developing future consensus guidelines.
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Affiliation(s)
- Hye In Lee
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jongjin Lee
- Department of Statistics, Seoul National University, Seoul, Korea
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yongdai Kim
- Department of Statistics, Seoul National University, Seoul, Korea
| | - Keun-Yong Eom
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Gong XY, Chen HB, Zhang LQ, Chen DS, Li W, Chen DH, Xu J, Zhou H, Zhao LL, Song YJ, Xiao MZ, Deng WL, Qi C, Wang XR, Chen X. NOTCH1 mutation associates with impaired immune response and decreased relapse-free survival in patients with resected T1-2N0 laryngeal cancer. Front Immunol 2022; 13:920253. [PMID: 35911687 PMCID: PMC9336464 DOI: 10.3389/fimmu.2022.920253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Patients with early-stage laryngeal cancer, even stage T1-2N0, are at considerable risk of recurrence and death. The genetic and immunologic characteristics of recurrent laryngeal cancer remain unclear. Methods A total of 52 T1-2N0 laryngeal cancer patients were enrolled. Of these, 42 tissue samples were performed by targeted DNA sequencing, and 21 cases were performed by NanoString immuno-oncology targeted RNA sequencing to identify the distinct molecular bases and immunologic features associated with relapse in patients with early laryngeal cancer, respectively. Results To the best to our knowledge, we present for the first time an overview of the genomic mutation spectrum of early-stage laryngeal cancers. A total of 469 genomic alterations were detected in 211 distinct cancer-relevant genes, and the genes found to be mutated in more than five patients (>10%) included tumor protein p53 (TP53, 78.5%), FAT atypical cadherin 1 (FAT1, 26%), LDL receptor related protein 1B (LRP1B, 19%), cyclin dependent kinase inhibitor 2A (CDKN2A, 17%), tet methylcytosine dioxygenase 2 (TET2, 17%), notch receptor 1 (NOTCH1, 12%) and neuregulin 1 (NRG1, 12%). Recurrent laryngeal cancer demonstrated a higher tumor mutation burden (TMB), as well as higher LRP1B mutation and NOTCH1 mutation rates. Univariate and multivariate analyses revealed that high TMB (TMB-H) and NOTCH1 mutation are independent genetic factors that are significantly associated with shorter relapse-free survival (RFS). Simultaneously, the results of the transcriptome analysis presented recurrent tumors with NOTCH1 mutation displayed upregulation of the cell cycle pathway, along with decreased B cells score, T cells score, immune signature score and tumor-infiltrating lymphocytes (TILs) score. The Cancer Genome Atlas (TCGA)-laryngeal cancer dataset also revealed weakened immune response and impaired adhesion functions in NOTCH1-mutant patients. Conclusions Genomic instability and impaired immune response are key features of the immunosurveillance escape and recurrence of early laryngeal cancer after surgery. These findings revealed immunophenotypic attenuation in recurrent tumors and provided valuable information for improving the management of these high-risk patients. Due to the small number of patients in this study, these differences need to be further validated in a larger cohort.
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Affiliation(s)
- Xiao-yang Gong
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Hai-bin Chen
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Li-qing Zhang
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Dong-sheng Chen
- Jiangsu Simcere Diagnostics Co., Ltd, The State Key Laboratory of Translational Medicine and Innovative Drug Development, Nanjing, China
| | - Wang Li
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Dong-hui Chen
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Jin Xu
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Han Zhou
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Le-le Zhao
- Jiangsu Simcere Diagnostics Co., Ltd, The State Key Laboratory of Translational Medicine and Innovative Drug Development, Nanjing, China
| | - Yun-jie Song
- Jiangsu Simcere Diagnostics Co., Ltd, The State Key Laboratory of Translational Medicine and Innovative Drug Development, Nanjing, China
| | - Ming-zhe Xiao
- Jiangsu Simcere Diagnostics Co., Ltd, The State Key Laboratory of Translational Medicine and Innovative Drug Development, Nanjing, China
| | - Wang-long Deng
- Jiangsu Simcere Diagnostics Co., Ltd, The State Key Laboratory of Translational Medicine and Innovative Drug Development, Nanjing, China
| | - Chuang Qi
- Jiangsu Simcere Diagnostics Co., Ltd, The State Key Laboratory of Translational Medicine and Innovative Drug Development, Nanjing, China
| | - Xue-rong Wang
- Department of Pharmacology, Nanjing Medical University, Nanjing, China
- *Correspondence: Xi Chen, ; Xue-rong Wang,
| | - Xi Chen
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
- *Correspondence: Xi Chen, ; Xue-rong Wang,
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Abstract
PURPOSE The purpose of this study was to explore the effects of medical masks on the voice quality of patients with voice disorders. METHOD We included 106 patients diagnosed with voice disorders. Among them, 59 were diagnosed with vocal-fold benign lesions, 27 with insufficient glottis closure, and 20 with precancerous lesions/early-stage glottic carcinoma. Perceptual parameters (GRBAS [grade, roughness, breathiness, asthenia, strain] scale), acoustic parameters (f o, sound pressure level [SPL], jitter, shimmer, noise-to-harmonic ratio [NHR], and cepstral peak prominence [CPP]), and maximum phonation time (MPT) without and with medical masks were analyzed. Changes in the GRBAS scale after wearing medical masks were also evaluated. RESULTS With medical mask wearing, the G, R, and B scales in the vocal-fold benign lesion and insufficient glottic closure groups decreased, with a statistical significance seen in the G and R scales of the vocal-fold benign lesion group (G 1.07 ± 0.59, 0.95 ± 0.68, p < .01; R 1.07 ± 0.59, 0.95 ± 0.68, p < .01). The B scale in the precancerous lesions/early-stage glottic carcinoma (95%) and vocal-fold benign lesion groups (83%) and R scale in the insufficient glottic closure group (77.8%) were stable with mask wearing. f o and SPL in the vocal-fold benign lesion group and f o and jitter in the insufficient glottic closure group increased significantly with medical masks. The NHR and CPP in each group changed little, and all the parameters in the precancerous lesions/early-stage glottic carcinoma group showed no significant change. CONCLUSIONS The effects of medical masks on the voice quality of patients with voice disorders were associated with the type of the disease, degree of hoarseness, and subjective scale influencing specific voice disorder. When wearing medical masks, the pitch and loudness of patients increased as compensation. Medical masks had the least impact on the precancerous lesions/early-stage glottic carcinoma group.
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Affiliation(s)
- Yuhong Lin
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, China
| | - Liyu Cheng
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, China
| | - Qingcui Wang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, China
| | - Wen Xu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, China
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15
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Feng HY, Zhou Y, Zhou SP, Tian FY, Xiao JYMYP, Xiao Y, Mo BY, Xie H, Zhu HP. Surgical strategies for glottic carcinoma with a giant thyroid tumor A case report and literature review. Ann Ital Chir 2021; 10:S2239253X21033041. [PMID: 35232898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED Description of strategies for preventing surgical complications in the treatment of laryngeal carcinomas associated with giant thyroid cancer. For this study, the clinical data of an elderly patient with laryngeal carcinoma associated with a large thyroid tumor, diabetes and hypertension were used. The patient's tumor was removed with simultaneous surgery performed by the thyroid surgery department and the laryngeal surgery department; the patient was followed for more than 3 years and the scars of tracheal granulation and laryngeal adhesions were removed with repeated laser interventions. The literature review was carried out on the Wanfang database, on the China How Net database and on the MEDLINE database via Computer. The final research keywords used for the study were "squamous cell carcinoma" and "glottis" or "larynx" / "larynx", "surgery", "thyroid cancer" and "simultaneous surgery". RESULTS After completion of the intervention, the nasogastric tube and tracheal cannula were successfully removed, the glottis was successfully reconstituted and oral respiration, phonation and oral feeding were normally resumed. CONCLUSION The multidisciplinary approach for the simultaneous removal of a laryngeal carcinoma associated with a bulky thyroid tumor in elderly subjects with multi-system and multi-organ damage has been successfully implemented. There are only a few such cases presented in the literature to illustrate risk prevention strategies for postoperative complications, including postoperative infection, extubation difficulties and loss of speech, which deserve to be known. KEY WORDS Glottic carcinoma, Thyroid tumor, Laser surgery multidisciplinary, Tracheal cannula, Vocal cords.
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16
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Cruz J, Vargas D, Goecke A, Molina ML. An unusual extranodal natural killer/T-cell lymphoma presenting as chronic laryngitis: A case report. Medicine (Baltimore) 2021; 100:e26314. [PMID: 34160395 PMCID: PMC8238288 DOI: 10.1097/md.0000000000026314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Nasal-type, extranodal natural killer (NK)/T-cell lymphoma is a rare lymphoma. The tumor usually shows ulcerative and necrotic lesions in the nasal cavities and sinuses. Tissue involvement outside the nasal cavity is uncommon. PATIENT CONCERN We describe a 30-year-old man with a 2-month history of hoarseness, weight loss, and dyspnea. DIAGNOSIS Magnetic resonance image (MRI) showed edema of the larynx with obliteration of the airway. Laryngoscopic examination described necrotic tissue in the glottis and larynx. The biopsy showed chronic, necrotizing laryngitis, with no granulomas, vasculitis, or atypical cells. The immunologic and microbiologic study was negative. Later, after immunosuppressive therapy, the patient presented erythema and diffuse enlargement of the right arm. MRI showed myositis of the biceps and brachial muscles. Infection was rule out, and direct microscopy showed an extensive muscle infiltration by mononuclear cells and abundant mitosis. Immunohistochemistry was positive for CD3, CD8, Ki 67 (90%), and CD56 compatible with extranodal NK/T cell lymphoma. INTERVENTIONS The patient initially received immunosuppression treatments (corticoids, cyclofosfamide, and Rituximab) with relapsing episodes. When lymphoma was diagnosed, chemotherapy was started. OUTCOMES The patient died during chemotherapy. LESSONS Nasal-type, extranodal NK/T-cell lymphoma should be suspected even when there are no classical findings of neoplasms on histology. Immunohistochemistry is mandatory to rule it out.
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Ke JXC, Wafa K, Piccott D, Galgay S. Near-complete glottic obstruction from a loose glottic cancer mass. Can J Anaesth 2021; 68:1437-1439. [PMID: 33948906 DOI: 10.1007/s12630-021-02009-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/28/2021] [Accepted: 04/10/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Janny Xue Chen Ke
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Karim Wafa
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Devin Piccott
- Department of Surgery, Division of Otolaryngology, Dalhousie University, Halifax, NS, Canada
| | - Susan Galgay
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
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Sheng J, Li C, Tang P, Hu J, Ma L, Qin G. Comparison of the efficacy of the anterolateral thigh flap for perforator localization in the repair of head and neck soft tissue defects patients: A protocol study for a randomized controlled trial. Medicine (Baltimore) 2020; 99:e23080. [PMID: 33327231 PMCID: PMC7738077 DOI: 10.1097/md.0000000000023080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Head and neck tissue defects cause great physical and psychological damage to patients. Therefore, accurate positioning of perforating vessels before operation is of great significance for improving the success rate of flap preparation and avoiding unnecessary incision injury. METHODS/DESIGN A total of 60 patients with laryngeal cancer in otolaryngology, Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Southwest Medical University and the Third People's Hospital of Mianyang city from October 2020 to October 2021 will be selected and randomly divided into CT angiogram (CTA) group (n=20), mimics group (n = 20) and CTA + mimics group (n = 20) according to the numerical table. Patients in the CTA group will receive CTA examination of lower extremities. Patients in mimics group will receive digital technology in the positioning of perforator. Patients in CTA + mimics group will receive CTA + digital technology. All the patients will receive the flap cutting and the flap making; the doctor will determine the perforation branch of the flap with 3-D visual positioning, measure the preoperative indicators intraoperatively and complete the wound repair. Finally, the survival rate, sensitivity, specificity and accuracy of the flap will be measured. DISCUSSION The anterolateral thigh flap has been widely used to repair various tissue defects and has obtained good clinical results. The extensive clinical application mainly focuses on 2 aspects, namely the study of vascular anatomy of lateral flap and the exploration of preoperative flap design technology. Perforator is the direct blood supply source of anterolateral thigh flap, so it is particularly important to study the anatomy of perforator. Therefore, this study will reveal CTA combined with digital technology in the vascular anatomy of the anterior external femoral flap and the design of the flap before and during surgery, so as to provide help for the repair of tissue defects. TRIAL REGISTRATION It has been registered at http://www.chictr.org.cn/listbycreater.aspx (Identifier: ChiCTR2000038951), Registered on October 10th, 2020.
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Affiliation(s)
- Jiangfeng Sheng
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Southwest Medical University
| | - Chao Li
- Department of Head and Neck Surgery, Sichuan Cancer Hospital
| | - Ping Tang
- Department of Thyroid, Head, Nneck and Maxillofacial Surgery, The Third People's Hospital of Mianyang City
| | - Jun Hu
- Department of Thyroid, Head, Nneck and Maxillofacial Surgery, The Third People's Hospital of Mianyang City
| | - Liying Ma
- Department of Thyroid, Head, Nneck and Maxillofacial Surgery, The Third People's Hospital of Mianyang City
| | - Gang Qin
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Southwest Medical University
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Rafie A, Jolly K, Darr A, Thompson S. Adult cavernous haemangioma of the vocal cords with a unique presentation of acute respiratory distress: a case report. Ann R Coll Surg Engl 2020; 102:e152-e154. [PMID: 32306741 PMCID: PMC7450425 DOI: 10.1308/rcsann.2020.0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2020] [Indexed: 11/22/2022] Open
Abstract
Laryngeal haemangiomas can commonly be seen in children, and first-line treatment is usually propranolol. However, in adults, cavernous haemangioma of the vocal cord(s) is an extremely rare condition - with this being the only published adult case presenting with acute respiratory distress - the mainstay of treatment is surgical excision under microlaryngoscopy. Presentation in adults can be unpredictable, but primarily consists of hoarseness which can be associated with, dyspnoea, dysphagia, and haemoptysis - and in one documented case stenosis of the aero-digestive tract led to death. Due to these airway difficulties, surgery can often prove challenging. In this study, we explore the unusual case of a previously well 71-year-old gentleman presenting to the Emergency Department, with worsening shortness of breath as his primary complaint. Uniquely, in this case, an awake fibre-optic intubation was undertaken to manage the difficult airway and a microlaryngoscopy was performed. A 20x10x15mm lesion was excised, which had characteristics in keeping with a cavernous haemangioma on microscopic examination.
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Affiliation(s)
- A Rafie
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - K Jolly
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - A Darr
- New Cross Hospital, Wolverhampton, UK
| | - S Thompson
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
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20
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Abstract
Background: The current global COVID-19 pandemic is caused by the novel coronavirus Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). Given that SARS-CoV-2 is highly transmissible, surgical societies have recommended that procedures with a high risk of aerosolization be avoided or delayed. However, some high-risk procedures, such as those related to head and neck malignancies, cannot always be delayed. Care must be taken during aerosol-generating procedures to minimize viral transmission as much as possible. Preoperative testing for COVID-19, limited operating room personnel, adequate personal protective equipment, and surgical technique are factors to consider for high-risk procedures. Methods: This article presents the case of an awake tracheotomy performed for a transglottic mass causing airway obstruction. Results: With detailed planning and specific techniques, the amount of aerosolization was reduced, and the procedure was performed as safely as possible. Conclusion: This case provides a template for future aerosol-generating procedures during respiratory pandemics.
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Affiliation(s)
- Jason Crossley
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Christine Clark
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Fredrick Brody
- Department of Surgery, Washington DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Jessica H Maxwell
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Surgery, Washington DC Veterans Affairs Medical Center, Washington, DC, USA
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21
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Earasi K, Jaworek AJ, Sataloff RT. Atypical Vocal Fold Mass. Ear Nose Throat J 2019; 99:NP52-NP53. [PMID: 30974992 DOI: 10.1177/0145561319840146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Kranthi Earasi
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Aaron J Jaworek
- Department of Otolaryngology, Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Robert T Sataloff
- Department of Otolaryngology, Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
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22
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Fisher CP, Romak JJ, Benito DA, Sataloff RT. Diverse Endoscopic Techniques for Diagnosing Recurrent Respiratory Papillomatosis. Ear Nose Throat J 2019; 98:473-474. [PMID: 30897951 DOI: 10.1177/0145561319837450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Casey P Fisher
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Jonathan J Romak
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Daniel A Benito
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Robert T Sataloff
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
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23
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Labouret G. [Laryngeal dyspnea in infants and children]. Rev Prat 2019; 69:e17-e18. [PMID: 30983302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Géraldine Labouret
- Service de pneumoallergologie pédiatrique, Hôpital des Enfants, CHU, 31059 Toulouse Cedex 9, France
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24
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Bickford JM, Coveney J, Baker J, Hersh D. Self-expression and identity after total laryngectomy: Implications for support. Psychooncology 2018; 27:2638-2644. [PMID: 29927018 DOI: 10.1002/pon.4818] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/03/2018] [Accepted: 06/11/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To explore how individuals with a laryngectomy (IWL) from diverse backgrounds make meaning and adjust to the physical and functional changes from a total laryngectomy. To examine the extent primary supporters (PS) and health professionals (HP) are able to support IWL with the psychosocial and existential challenges rendered by a surgery that significantly impacts a person's talking, breathing, swallowing, and appearance. METHODS A constructivist grounded theory approach and symbolic interactionism were used to guide data collection and analysis. Semi-structured interviewing occurred. RESULTS Twenty-eight participants (12 IWL, 9 PS, and 7 HP) were interviewed. The findings suggest that IWL experience significant change to their self-identity and there is evidence of a range of passive and active reframing patterns (destabilised, resigned, resolute, and transformed). The loss of self-expression included changes to communicative participation, personal style, food preferences, and social roles. Short and longer-term supports appear to influence outcomes but are often ill-equipped to manage the psychosocial needs of IWL. CONCLUSIONS Loss of self-expression after total laryngectomy influences self-identity and adjustment. How individuals reframe their identity appears to be tied with how they view their disabilities and disfigurement. These perceptions also appear to be influenced by the reactions of others and the support available. Further resourcing, education, and training are needed so that PS and HP can provide holistic care.
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Affiliation(s)
- Jane M Bickford
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - John Coveney
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Janet Baker
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia
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25
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Zhang MJ, Mu JW, Qu XS, Feng C, Zhao W. Effect of neuromuscular electrical stimulation for fatigue management in patients with advanced laryngeal cancer receiving chemoradiotherapy. Medicine (Baltimore) 2018; 97:e11370. [PMID: 29995774 PMCID: PMC6076145 DOI: 10.1097/md.0000000000011370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study retrospectively investigated the effect of neuromuscular electrical stimulation (NMES) for fatigue management in patients with advanced laryngeal cancer (ALC) receiving chemoradiotherapy.A total of 60 eligible patients with ALC receiving chemoradiotherapy were included. These patients were assigned equally to a treatment group and a control group. Patients in the treatment group received NMES therapy and were treated for a total of 8 weeks, while the patients in the control group did not receive NMES therapy. The primary outcome was fatigue, measured by the multidimensional fatigue inventory (MFI). The secondary outcomes included anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS), and sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI). All outcomes were evaluated before and after 8-week NMES treatmentAfter 8-week NMES treatment, the patients in the treatment group did not exert better effect than patients in the control group in fatigue relief, measured by the MFI score, anxiety and depression decrease, assessed by HADS, and sleep quality improvement, evaluated by PSQI.The results of this study demonstrate that NMES may not benefit for fatigue relief in patients with ALC receiving chemoradiotherapy. Future studies should still focus on this topic and warrant these results.
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Affiliation(s)
- Mei-jia Zhang
- Department of Otolaryngology, First Affiliated Hospital of Jiamusi University
| | - Ji-wei Mu
- Department of Otolaryngology, First Affiliated Hospital of Jiamusi University
| | - Xiu-sheng Qu
- Department of Radiotherapy, Second Affiliated Hospital of Jiamusi University, Jiamusi
| | - Chong Feng
- Department of Ultrasound, Hongqi Affiliated Hospital of Mudanjiang Medical University
| | - Wei Zhao
- Department of Anatomy, Mudanjiang Medical University, Mudanjiang, China
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Abstract
This retrospective study examined the effect of voice rehabilitation training (VRT) for patients with laryngeal cancer (LC) after radiotherapy.Eighty-three eligible patients with LC were included. Forty-three patients were assigned to a treatment group, and underwent VRT, while the other 40 subjects were assigned to a control group, and were at waiting list. Primary outcome was measured by the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale. Secondary outcome was measured by Patient Perception Measures. All outcomes were measured before and 3 months after VRT intervention.Patients in the treatment group did not show better outcomes, measured by GRBAS scale (Grade, P = .78; Roughness, P = .61; Breathiness, P = .83; Ashenia, P = .89; and Strain, P = .41), and Patient Perception Measures (Vocal quality, P = .17; Acceptability, P = .35; Hoarseness, P = .23; Vocal fatigue, P = .39; and Ashamed, P = .51), compared with patients in the control group.The results of this study did not exert better outcomes in patients received VRT than those at waiting list.
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Affiliation(s)
- Mei-Jia Zhang
- Department of Otolaryngology, First Affiliated Hospital of Jiamusi University, Jiamusi Department of Ultrasound, Second Affiliated Hospital of Mudanjiang Medical University Department of Ultrasound, Hongqi Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
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27
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Abstract
RATIONALE Laryngeal cysts are rare lesions that may occur at any mucosa-lined location within the larynx. Papillomas are also benign lesions of the larynx. PATIENT CONCERNS We report a 34 year-old-patient with a laryngeal cyst incidentally found during screening endoscopy and presenting as a soft tissue mass on a computerized tomography scan. A papilloma concomitant with the cyst was detected intraoperatively. DIAGNOSES Concomitant tonsillar cyst and papilloma of the larynx. INTERVENTIONS The lesion was completely resected with a bipolar radiofrequency plasma ablation (RFA) device. OUTCOMES Pathologic examination showed a tonsillar cyst and papilloma in the larynx. Six months later, there has been no evidence of recurrence. LESSONS To our knowledge, this is the first report of a concomitant tonsillar cyst and a papilloma in the larynx. Asymptomatic laryngeal cysts can be detected endoscopically. RFA is safe and effective for endoscopic management.
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Russo A, Crosignani P, Berrino F. Tobacco Smoking, Alcohol Drinking and Dietary Factors as Determinants of New Primaries among Male Laryngeal Cancer Patients: A Case-Cohort Study. Tumori 2018; 82:519-25. [PMID: 9061057 DOI: 10.1177/030089169608200602] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background The paper examines the determinants associated with second primary occurrence in laryngeal cancer cases. Methods A series of 220 incident male laryngeal cancer cases was interviewed 10 years ago within the framework of a population-based, case-control study. The occurrence of other primaries among these patients was assessed by means of the Lombardy Cancer Registry, which covers their area of residence. The relationship between tobacco, alcohol, dietary factors and the risk of occurrence of new primaries was analyzed by means of a nested case-control study. Cases were defined as those subjects who developed a new primary, and controls as those without. Results New primaries occurred among 36 subjects during an 8-year follow-up; 147 control cancer patients were matched for age and length of follow-up. A twofold risk increase was associated with the highest tobacco consumption, as registered at time of first primary; a weaker relationship, i.e. risk of 1.2 for the highest tertile, was seen for alcohol drinking. The occurrence of new primaries was also influenced by dietary habits. In particular, those who had a high intake of monosaturated fatty acids had a one-third lower risk of developing a new primary. Conclusions Our results support the hypothesis that a healthy diet is protective among those who experience a laryngeal neoplasm and suggests that diet could be a potential preventive agent against the occurrence of new primaries among these patients.
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Affiliation(s)
- A Russo
- Servizio di Epidemiologia, Centro di Riferimento Oncologico, Aviano (PN), Italy
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Abstract
Laryngeal chondrosarcomas are rare cartilaginous tumors that usually present with hoarseness, dyspnea and, occasionally, dysphagia and dysphonia. We report the case of a low-grade chondrosarcoma of the cricoid cartilage coexisting with a right thyroid nodule, which presented with homolateral vocal fold paralysis. After a precautionary tracheotomy the patient underwent a laryngofissure in which the mass arising from the posterior plate of the cricoid cartilage was entirely enucleated. The histopathological analysis was compatible with a low-grade chondrosarcoma involving the posterior resection margin. For this reason, in agreement with the patient's wishes, a total laryngectomy and simultaneous right hemithyroidectomy were performed. We here discuss the peculiarity of the presentation and the therapeutic dilemma posed by this rare neoplasm.
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Affiliation(s)
- Lorenzo Pignataro
- Department of Otorhinolaryngology and Ophthalmological Sciences, Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, IRCCS, Milan, Italy.
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Tuite K, Oosthuizen JC, Subramaniam T, Kinsella JB. Laryngeal Chondrosarcoma: A rare cause of critical upper airway obstruction. Ir Med J 2018; 111:676. [PMID: 29869857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Laryngeal cancers are rare, encompassing around one percent of all cancers. Suspicion should be raised if a patient presents with classical signs and symptoms; i.e. dysphonia, inspiratory stridor, dysphagia, odynophagia, neck mass, or persistent cough. Laryngeal chondrosarcoma is a rare form of laryngeal cancer, the diagnosis of which can be difficult. The case in question describes an unusual presentation of one such case, and its subsequent investigation, management and outcome.
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Affiliation(s)
- K Tuite
- St. James' Hospital, Dublin, Ireland
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House SA, Fisher EL. Hoarseness in Adults. Am Fam Physician 2017; 96:720-728. [PMID: 29431404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hoarseness is a common presentation in primary care practices. Combined with other voice-related changes, it falls under the umbrella diagnosis of dysphonia. Hoarseness has a number of causes, ranging from simple inflammatory processes to less common psychiatric disorders to more serious systemic, neurologic, or cancerous conditions. Medication-induced hoarseness is common and should be considered. The initial evaluation begins with a targeted history and physical examination, while also looking for signs of potential systemic etiologies. Treatment should begin with voice rest, especially avoidance of whispering, and conservative management directed toward a presumptive cause. For example, proton pump inhibitors are appropriate for hoarseness due to reflux, and proper vocal hygiene is recommended for vocal abuse-related indications. In the absence of a clear indication, antibiotics, oral corticosteroids, and proton pump inhibitors should not be used for the empiric treatment of hoarseness. Direct visualization of the larynx and vocal folds, commonly mislabeled as vocal cords, should be performed within three months if an etiology has not been determined or if conservative management has been ineffective. Patients who experience symptoms lasting longer than two weeks and who have risk factors for dysplasia (e.g., tobacco use, heavy alcohol use, hemoptysis) may require earlier laryngoscopic evaluation. Voice therapy is effective for improving voice quality in patients with dysphonia if conservative measures are unsuccessful, and it can also be helpful for prophylaxis in high-risk individuals (e.g., vocalists, public speakers). Surgical management is indicated for laryngeal or vocal fold dysplasia or malignancy, airway obstruction, or benign pathology resistant to conservative treatment.
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Affiliation(s)
- Steven A House
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Eric L Fisher
- University of Louisville School of Medicine, Louisville, KY, USA
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Abstract
RATIONALE Infantile desmoid fibromatosis of the postcricoid area is a rare disease and is characterized by a proliferation of fibrous tissue with non-metastasis, local infiltration, and a high rate of recurrence after surgical resection. Currently, ultrasound is scarcely used in the hypopharynx and larynx area. PATIENT CONCERNS A 4-year-old boy presented with hoarseness, deep voice and snoring for 2∼4 years without any surgical history. On sonography, the lesion was found in the postcricoid area, and the left larynx showed impaired mobility in real time observation. Complete excision with a negative margin in this pivotal anatomic area is impossible, and necessitates a long-time surveillance. DIAGNOSES Infantile desmoid fibromatosis of the postcricoid area was diagnosed according to surgery and histopathology. INTERVENTIONS Local excision was carried out to relieve the upper airway narrowing. OUTCOMES Relieved hoarseness and snoring were reported on the latest follow-up. A residual lesion was seen in the surgical bed and maintained a stable extent on ultrasound and MR imaging after a year. LESSONS Considering the non-radiation merit and diagnostic ability, ultrasonography is advocated as a valuable supplementary imaging method to CT, MR and laryngoscopy in the juvenile larynx and hypopharynx.
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Affiliation(s)
- Chunxia Xia
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University
| | - Qiang Zhu
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University
| | - Changli Yue
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University
| | - Minxia Hu
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University
| | - Pingdong Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University
| | - Zheng Li
- Department of Diagnostic Ultrasound, Beijing Aerospace General Hospital, Beijing, China
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Bergström L, Ward EC, Finizia C. Voice rehabilitation after laryngeal cancer: Associated effects on psychological well-being. Support Care Cancer 2017; 25:2683-2690. [PMID: 28365896 PMCID: PMC5527056 DOI: 10.1007/s00520-017-3676-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 03/15/2017] [Indexed: 01/19/2023]
Abstract
Purpose Psychological distress after laryngeal cancer treatment is prevalent. Although voice rehabilitation has shown to improve functional outcomes and positively affect health-related quality of life, to date, there has been limited study of the associated effect of behavioural voice intervention on psychological well-being/distress post laryngeal cancer. Method Sixty-three patients with Tis-T4 laryngeal cancer treated with (chemo)radiotherapy were prospectively recruited and randomised to either a voice rehabilitation (VR, n = 31) or control group (n = 32). The VR group received 10 speech pathology sessions consisting of both direct and indirect voice intervention post (chemo)radiotherapy. The control group received general voice education but not specific intervention. As part of a multidisciplinary assessment battery, psychological well-being/distress was measured using the Hospital Anxiety and Depression Scale (HADS) pre, six and 12 months post VR. Results Within-group analysis revealed a significant (p = 0.03) reduction in the proportion of patients with anxiety in the VR group between baseline and 12 months. No change over time was observed in controls. Between-group analysis revealed a trend for fewer VR cases demonstrating anxiety (p = 0.06) or depression (p = 0.08) at 6 months and significantly fewer demonstrating anxiety (p = 0.04) and depression (p = 0.04) at 12 months, compared to controls. Significant correlations were observed between patients’ voice perceptions and reduced anxiety (rpb = −0.38) and depression (rpb = −0.66) within the VR group at 12 months. Conclusions The positive correlations and between-group analyses indicate a positive effect on psychological well-being associated with completing voice rehabilitation. Results highlight potential additional benefits of behavioural voice intervention beyond achieving direct change to voice function.
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Affiliation(s)
- Liza Bergström
- Department of Otorhinolaryngology, The Sahlgrenska Academy at the University of Gothenburg, Gothenberg, Sweden.
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
- Center for Functioning and Health Research (CFAHR), Queensland Health, Brisbane, Australia.
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- Center for Functioning and Health Research (CFAHR), Queensland Health, Brisbane, Australia
| | - Caterina Finizia
- Department of Otorhinolaryngology, The Sahlgrenska Academy at the University of Gothenburg, Gothenberg, Sweden
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Scholfield DW, Virk JS, Stimpson P. Stridor secondary to a subglottic neuroendocrine tumour. QJM 2017; 110:181-182. [PMID: 28040707 DOI: 10.1093/qjmed/hcw233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Indexed: 11/13/2022] Open
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Blanchard A, Nguyen JB, Daroca P, Friedlander P, Lewin E, Vu J, Palacios E. Rare primary mucosal melanoma of the larynx. Ear Nose Throat J 2016; 95:E28-E31. [PMID: 27929604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Few cases of primary mucosal melanoma of the larynx have been documented in the literature, so only a limited amount of data exists regarding its diagnosis and treatment. The prognosis is poor, as patients often present at a late stage with regional or distant metastases. We describe the case of a 66-year-old man who presented with hoarseness and dysphagia. Laryngoscopy identified a dark discoloration of the supraglottic larynx and incomplete mobility of the right vocal fold; an excisional biopsy confirmed the diagnosis. We discuss the epidemiology, clinical features, diagnosis, interpretation of imaging findings, and management of this rare malignant melanoma.
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Affiliation(s)
- Adam Blanchard
- Department of Radiology, Tulane University School of Medicine, 1415 Tulane Ave., New Orleans, LA 70121, USA
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Schwartz SR, Yueh B, Maynard C, Daley J, Henderson W, Khuri SF. Predictors of wound complications after laryngectomy: A study of over 2000 patients. Otolaryngol Head Neck Surg 2016; 131:61-8. [PMID: 15243559 DOI: 10.1016/j.otohns.2003.08.028] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES: To identify risk factors for and the rate of wound complications after laryngectomy in a large, prospectively collected national dataset, and to generate a predictive model. STUDY DESIGN: We used the National Surgical Quality Improvement Program (NSQIP) registry created by the Department of Veterans Affairs (VA) to identify patients undergoing total laryngectomy from 1989 to 1999 (n = 2063). We linked these data to inpatient and outpatient VA administrative records to capture data for prior radiation. Over 20 preoperative and intraoperative risk factors were analyzed using bivariate techniques. Those significant at the P < 0.01 level were analyzed with logistic regression and conjunctive consolidation to identify independent predictors of wound complications. RESULTS: The overall wound complication rate was 10.0%. In adjusted analyses, prolonged operative time (> 10 hours, odds ratio = 2.10, 95% confidence interval: 1.32-3.36), exposure to prior radiation therapy (OR =1.63, 1.07-2.46), presence of diabetes (OR = 1.78, 1.04-3.04), preoperative hypoalbumine-mia (OR =1.90, 1.32-2.74), anemia (OR =1.59, 1.07-2.36), and thrombocytosis (OR =1.48, 1.04-2.10) were independently associated with postoperative wound complications. A prognostic model using three variables—prior radiation therapy, diabetes, and hypoalbuminemia—provided excellent risk stratification into three tiers (6.3%, 13.7%, 21.7%). CONCLUSIONS: Preoperative radiation, prolonged operative time, low albumin, and diabetes were independently associated with postoperative wound infections. These results will help to identify patients at risk for wound complications, thus allowing for heightened surveillance and preventive measures where possible.
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Affiliation(s)
- Seth R Schwartz
- University of Washington Medical Center, Seattle, WA 98195, USA.
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Hsu JL, Su CY, Lin JW. Resection of a granular cell tumor of the larynx followed by medialization laryngoplasty with bipedicled sternohyoid muscle transposition. Otolaryngol Head Neck Surg 2016; 135:983-5. [PMID: 17141103 DOI: 10.1016/j.otohns.2005.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2004] [Accepted: 04/23/2005] [Indexed: 11/26/2022]
Affiliation(s)
- Jui-Lin Hsu
- Department of Otolaryngology, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan
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Abstract
BACKGROUND/OBJECTIVE: Awake tracheotomy is performed for patients with impending airway obstruction. Few studies to date have addressed the issues surrounding awake tracheotomy. We sought to review the indications, complications, and outcome of awake tracheotomy for urgent airway control.MATERIALS AND METHODS: We conducted a retrospective review of patients who underwent awake tracheotomy over a 4-year period from 2001 to 2004 at an urban tertiary medical center. Data were obtained from inpatient records and operative charts.RESULTS: We obtained data on 54 men and 19 women, with a mean age of 61 years. The majority of patients presented with hoarseness, dyspnea, and stridor. Twenty patients had obstruction from head and neck cancers. Nonmalignant causes included deep neck infections (n = 18), bilateral vocal cord paralysis (n = 17), trauma (n = 9), and laryngeal edema (n = 6). Other causes include laryngeal cyst, subglottic stenosis, and vocal cord granuloma. Six (8.2%) patients experienced complications, including postoperative hemorrhage, pneumothorax, and chest and wound infections. There were no long-term complications or deaths.CONCLUSION: Awake tracheotomy is efficacious and safe and has a low complication rate.SIGNIFICANCE: Awake tracheotomy should be performed for impending airway obstruction and in a timely manner before complete obstruction occurs.
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Affiliation(s)
- Heng-Wai Yuen
- Department of Otolaryngology, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore.
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Yun YS, Kim MB, Son YI. The effect of vocal hygiene education for patients with vocal polyp. Otolaryngol Head Neck Surg 2016; 137:569-75. [PMID: 17903572 DOI: 10.1016/j.otohns.2007.03.043] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2007] [Accepted: 03/29/2007] [Indexed: 10/22/2022]
Abstract
Objective The authors aimed to assess the effect of vocal hygiene education for patients suffering with vocal polyp and to discover the meaningful factors that can predict better outcomes with performing vocal hygiene. Study Design and Setting Voice evaluation and vocal hygiene education were provided to 340 consecutive patients with vocal polyp. Three months later, 175 of the 340 patients completed a follow-up evaluation. According to the change in polyp size, these patients were divided into two groups: the “improvement” and the “no improvement.” The effect of vocal hygiene was assessed. Eight parameters were compared between these two groups. Results The “improvement” group was composed of 20% of the 340 patients and 38% of the 175 patients. Multivariate analyses demonstrated that nonsmokers with a small polyp had the greatest possibility of improvement with vocal hygiene and so avoid unnecessary surgery. Conclusion Patients who do not smoke and who have a polyp that is small in size have a much better chance to improve their voice by performing vocal hygiene.
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Affiliation(s)
- Young-Sun Yun
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Korea
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Raguin T, Carvalho J, Riehm S, Takeda C, Dupret-Bories A. Method for dealing with severe aspiration using a new concept of intralaryngeal prosthesis: A case report. Head Neck 2016; 38:E2504-7. [PMID: 27099209 DOI: 10.1002/hed.24485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 02/10/2016] [Accepted: 03/17/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Deglutition disorders are frequent in patients treated for cancer of the oropharynx, and are responsible for severe aspiration and, in some cases, may require the use of enteral nutrition by gastrostomy or tracheotomy. METHODS We present the case of a patient with a medical history of infiltrating laryngeal carcinoma treated by partial laryngectomy and radiochemotherapy, presenting severe aspiration causing significant weight loss. The patient received a new intralaryngeal prosthesis to prevent aspiration with the objective of regaining safe oral nutrition and closure of the tracheotomy. RESULTS Deglutition tests after postimplantation demonstrated significantly improved airway protection and recovery deglutition, allowing the patient to return home with resumption of varied solid and a liquid diet. CONCLUSION For a patient presenting severe aspiration, the intralaryngeal prosthesis allowed a resumption of oral feeding without exclusion of the larynx or airway protection by tracheotomy. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-E2507, 2016.
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Affiliation(s)
- Thibaut Raguin
- Service ORL et Chirurgie Cervico-faciale, CHU de Strasbourg, Strasbourg Cedex, France
| | - Jean Carvalho
- Service ORL et Chirurgie Cervico-faciale, CHU de Strasbourg, Strasbourg Cedex, France
| | - Sophie Riehm
- Service de Radiologie, CHU de Strasbourg, Strasbourg Cedex, France
| | - Catherine Takeda
- Service de Gériatrie, CHU de Strasbourg, Strasbourg Cedex, France
| | - Agnès Dupret-Bories
- Service ORL et Chirurgie Cervico-faciale, CHU de Strasbourg, Strasbourg Cedex, France.
- Service d'Otorhinolaryngologie et Chirurgie Cervico-faciale, Institut Universitaire du Cancer, Toulouse, France.
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Abstract
The "cannot ventilate, cannot intubate" scenario during anesthesia induction can be lethal. We present a patient with an undiagnosed subglottic tumor who developed the "cannot ventilate, cannot intubate" situation after induction of general anesthesia, due to the presence of an undiagnosed subglottic tumor. A 93-year-old woman was brought to the operating room for repair of a femoral neck fracture. Both ventilation and intubation could not be accomplished, and the patient was awakened without complications after trials of maintaining the airway. In order to reverse muscle relaxation, sugammadex was useful to allow resumption of spontaneous breathing. A difficult airway can be caused by an undiagnosed subglottic tumor. Subglottic tumors can be misdiagnosed as asthma, because the clinical presentation can be very similar. If cricothyrotomy had been performed based on airway management algorithms, the airway may not have been controlled with a possibly fatal outcome. Ultrasound examination of the trachea may be useful to diagnose obstructive lesions in the airway.
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Affiliation(s)
- Kohji Uzawa
- From the Department of Anesthesiology (KU, JT, KW, TY), Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo; Department of Surgery (AKL), Jichi Medical University, Yakushiji, Shimotsuke-shi, Tochigi-ken; and Department of Anesthesia (TT), Higashiyamato Hospital, Nangai, Higashiyamato, Tokyo, Japan
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Moore JE, Krane N, Sataloff RT. Blood flow to a hemorrhagic vocal fold mass. Ear Nose Throat J 2016; 95:58-60. [PMID: 26930328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Affiliation(s)
- Jaime Eaglin Moore
- From the Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond (Dr. Moore); and the Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia (Dr. Krane and Dr. Sataloff)
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Koltsidopoulos P, Chaidas K, Chlopsidis P, Skoulakis C. Granular cell (Abrikossoff) tumor in the head and neck: A series of 5 cases. Ear Nose Throat J 2016; 95:36-39. [PMID: 26829685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
We evaluated a series of 5 patients-3 men and 2 women, aged 39 to 70 years (mean: 54.4)-with a granular cell tumor (GCT) of the head and neck in an effort to better define the clinical presentation, imaging characteristics, and surgical management of this type of tumor. In all cases, the diagnosis was established by pathologic analysis. There were 2 cases of laryngeal GCT and 1 case each of GCT arising in the nostril, hypopharynx, and the tongue base. The clinical findings were variable, depending on the location and extent of each lesion. Four of these patients underwent endoscopic examination, and in 2 cases computed tomography was performed. Treatment included wide surgical excision of the lesion in all cases. Otolaryngologists should be familiar with this unusual tumor. Although an accurate preoperative diagnosis is extremely difficult to make, appropriate therapeutic intervention is associated with a cure rate that is quite high.
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Affiliation(s)
- Petros Koltsidopoulos
- ENT Department, General Hospital of Volos "Achillopoulio," Polimeri 134, 38222 Volos, Greece.
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McClurg SW, Wakely PE, Chio EG. Laryngeal neuromas in a case of multiple endocrine neoplasia type 2B. Ear Nose Throat J 2015; 94:E20-E22. [PMID: 26535826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Mucosal neuromas of the larynx in the setting of multiple endocrine neoplasia type 2B (MEN-2B) are extremely rare; to the best of our knowledge, only 2 other cases have been previously reported in the world literature. We describe a new case, which occurred in a 30-year old woman who presented with dysphagia, dysphonia, and cough. On examination, she was found to have multiple laryngeal mucosal neuromas throughout the glottis and supraglottis. She underwent surgical resection of these lesions with resolution of her symptoms.
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45
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Guan L, Sun N, Sun G, Fang Q, Meng Y, Zhao X, Meng L. [Subtype analysis and clinical significance of HPV infection in laryngeal squamous cell carcinoma and precancerous lesions]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 29:1549-1552. [PMID: 26647542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the correlation of laryngeal squamous cell carcinoma (LSCC) and precancerous lesion with HPV infection subtypes and possible clinical relationship. METHOD Eighty-three cases in paraffin embedded tissues were detected with thirty seven HPV subtypes by flow-through hybridization and gene chip (HybriMax), including 31 cases of laryngeal squamous cell carcinoma, 52 cases of precancerous lesions (29 cases of vocal cord leukoplakia and 23 cases of laryngeal papilloma), and 36 cases of vocal cord polyp as normal vocal mucosa were used as control. RESULT The total positive rate of HPV was 19.4% in the group of laryngeal squamous cell carcinoma (6/31), 0 in vocal cord leukoplakia, 65.2% in laryngeal papilloma (15/23), and the control group were all negative, HPV virus subtype of HPV-positive laryngeal squamous cell carcinoma were all high-risk HPV16; and there were 6 HPV virus subtypes in laryngeal papilloma (8: HPV6,4: HPV52, 1: HPV11, 1: HPV18, 2: HPV45, 3: HPV16), individual mixing two or more subtypes infection. HPV infection of laryngeal squamous cell carcinoma and precancerous lesions has no statistically significant difference according to gender, high low-risk subtypes. CONCLUSION HPV infection related to laryngeal squamous cell carcinoma and precancerous lesions, but no significant correlation with the subtype distribution of high and low risk; HPV detection is making positive sense to clinical diagnosis of laryngeal carcinoma and precancerous lesions as well as the development of specific HPV subtype vaccine.
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46
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Rosen CA, Mau T, Remacle M, Hess M, Eckel HE, Young VN, Hantzakos A, Yung KC, Dikkers FG. Nomenclature proposal to describe vocal fold motion impairment. Eur Arch Otorhinolaryngol 2015; 273:1995-9. [PMID: 26036851 PMCID: PMC4930794 DOI: 10.1007/s00405-015-3663-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/12/2015] [Indexed: 11/27/2022]
Abstract
The terms used to describe vocal fold motion impairment are confusing and not standardized. This results in a failure to communicate accurately and to major limitations of interpreting research studies involving vocal fold impairment. We propose standard nomenclature for reporting vocal fold impairment. Overarching terms of vocal fold immobility and hypomobility are rigorously defined. This includes assessment techniques and inclusion and exclusion criteria for determining vocal fold immobility and hypomobility. In addition, criteria for use of the following terms have been outlined in detail: vocal fold paralysis, vocal fold paresis, vocal fold immobility/hypomobility associated with mechanical impairment of the crico-arytenoid joint and vocal fold immobility/hypomobility related to laryngeal malignant disease. This represents the first rigorously defined vocal fold motion impairment nomenclature system. This provides detailed definitions to the terms vocal fold paralysis and vocal fold paresis.
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Affiliation(s)
- Clark A Rosen
- Department of Otolaryngology, University of Pittsburgh Voice Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ted Mau
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marc Remacle
- Department of ORL-Head and Neck Surgery, Louvain University Hospital of Mont-Godinne, Yvoir, Belgium
| | - Markus Hess
- Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans E Eckel
- Abteilung Hals-, Nasen- u Ohrenkrankheiten, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - VyVy N Young
- Department of Otolaryngology, University of Pittsburgh Voice Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anastasios Hantzakos
- First Department of ORL-HNS of University of Athens, Hippocrateion General Hospital, Athens, Greece
| | - Katherine C Yung
- Department of Otolaryngology, University of California at San Francisco, San Francisco, CA, USA
| | - Frederik G Dikkers
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
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Cheng J. Isolated subglottic hemangiomas: A potential diagnostic challenge in the absence of a cutaneous clue. Am J Otolaryngol 2015; 36:399-401. [PMID: 25659918 DOI: 10.1016/j.amjoto.2015.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/18/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Subglottic hemangiomas may present a diagnostic challenge in the stridorous infant without a cutaneous lesion. METHODS Consecutive case series with chart review of isolated subglottic hemangiomas without cutaneous lesions. RESULTS Two patients with isolated subglottic hemangiomas without cutaneous lesions were identified. Both patients presented with stridor and were initially treated with systemic corticosteroids, racemic epinephrine, and supportive medical therapy for a presumed infectious etiology. After failure to clinically improve over an expected period of time, endoscopy was performed. Propranolol was initiated immediately after the diagnosis was made. Clinical response was noted in the first 24 hours after administration. Both children were able to be safely titrated up to the therapeutic dose (2mg/kg/day). No complications or re-admissions were encountered. CONCLUSIONS Clinical suspicion for a subglottic hemangioma in an infant with stridor may be high in cases where there is a synchronous cutaneous lesion. In infants without cutaneous involvement, diagnosis may be delayed and more challenging, given the possibility of an infectious etiology. These infants without a synchronous cutaneous lesion tend to present at an older age than infants with cutaneous lesions and may be managed successfully with propranolol.
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Affiliation(s)
- Jeffrey Cheng
- Division of Pediatric Otolaryngology, Cohen Children's Medical Center, New Hyde Park, NY, USA; Department of Otolaryngology - Head and Neck Surgery, Hofstra North Shore LIJ School of Medicine, Hempstead, NY, USA.
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Xu Y, Liu S, Yi H, Wang J, Dong P, Li X, Yin S. Human papillomavirus infection in 674 Chinese patients with laryngeal squamous cell carcinoma. PLoS One 2014; 9:e115914. [PMID: 25536405 PMCID: PMC4275260 DOI: 10.1371/journal.pone.0115914] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 11/30/2014] [Indexed: 01/02/2023] Open
Abstract
Objectives Previous reports suggest a strong association between human papillomavirus (HPV) and the etiology of laryngeal squamous cell carcinoma (LSCC). However, clinical data regarding the HPV infection rate among LSCC patients remain largely inconsistent. Methods In total, 674 LSCC patients from three major hospitals in Shanghai were enrolled in this study. We determined the patients' HPV infection status using immunohistochemistry and the GenoArray HPV genotyping assay and calculated their long-term survival rate using the Kaplan-Meier method. Results The total P16-positive rate according to immunostaining results was 7.57% (51/674). None of the P16-negative patients were HPV-positive according to the HPV genotyping test. The rate of HPV infection among patients with LSCC was 4.9% (33/674). HPV infection was more common among nonsmokers (P<0.05), nondrinkers (P<0.05), and patients with supraglottic LSCC (P<0.05). Of the 33 HPV-positive patients, 28 (84.8%) were infected with HPV-16, 2 with HPV-18, 1 with HPV-31, 1 with HPV-33 and 1 with HPV-45. The 3-year overall survival rate and progression-free survival rate were higher in HPV-positive than HPV-negative patients, but the difference was not statistically significant (76.3% vs. 70.7%, P = 0.30 and 65.1% vs. 58.3%, P = 0.37, respectively). Conclusion HPV was not a main causal factor in LSCC carcinogenesis in this Chinese population. HPV infection did not alter patients' overall survival or progression-free survival rates in this study.
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Affiliation(s)
- Yanan Xu
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Department of Head and Neck Surgery, Renji Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute of Shanghai Jiaotong University, Shanghai, China
| | - Suru Liu
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Otolaryngological Institute of Shanghai Jiaotong University, Shanghai, China
| | - Hongliang Yi
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Otolaryngological Institute of Shanghai Jiaotong University, Shanghai, China
| | - Jiadong Wang
- Department of Head and Neck Surgery, Renji Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute of Shanghai Jiaotong University, Shanghai, China
- * E-mail: (SY); (JW); (PD)
| | - Pin Dong
- Department of Otolaryngology Head and Neck Surgery, Shanghai Jiao Tong University Affiliated First People's Hospital, Shanghai, China
- Otolaryngological Institute of Shanghai Jiaotong University, Shanghai, China
- * E-mail: (SY); (JW); (PD)
| | - Xiaoyan Li
- Department of Otolaryngology Head and Neck Surgery, Children's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Shankai Yin
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Otolaryngological Institute of Shanghai Jiaotong University, Shanghai, China
- * E-mail: (SY); (JW); (PD)
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Girardi FM, Fontana CW, Kroef RG, Barra MB, Detânico FO, Herter NT. Laryngeal inflammatory myofibroblastic tumor. Ear Nose Throat J 2014; 93:E10-E12. [PMID: 25531846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Inflammatory myofibroblastic tumor seldom involves the larynx, as only about 50 to 60 cases have been described in the literature. Even though these tumors are often not aggressive, they have the potential for invasion and local recurrence. We describe the case of a 27-year-old man who was admitted to an emergency department with signs of upper airway obstruction secondary to an obstructive mass. Histology identified the mass as an inflammatory myofibroblastic tumor of the subglottis. The patient underwent an emergency tracheotomy followed by a partial laryngectomy. During 14 months of follow-up, he remained free of active disease.
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Affiliation(s)
- Fábio M Girardi
- Department of Head and Neck Surgery, Hospital Santa Rita, Complexo Hospitalar Santa Casa, Porto Alegre, Brazil.
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Wang Q, Chen H, Zhou S. Typical laryngeal carcinoid tumor with recurrence and lymph node metastasis: a case report and review of the literature. Int J Clin Exp Pathol 2014; 7:9028-9031. [PMID: 25674282 PMCID: PMC4314005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 11/26/2014] [Indexed: 06/04/2023]
Abstract
Typical carcinoid tumor of the larynx is an extremely rare lesion which arises from neuroendocrine cells scanning in the laryngeal mucosa or submucosal glands. Conventionally, it is a well-differentiated neuroendocrine carcinoma, conservative surgery represents the treatment of choice, and the patient usually has a good prognosis with rarely recurrence and metastasis. In this report, we present a case of typical laryngeal carcinoid tumor with recurrence and lymph node metastasis. The patient was a 58-year-old man, complaints of intermittent burning pain in his both ears for 2 years, and for the recent one month the pain turn to continuous accompanied with a mild discomfort in the throat, he had neither hoarseness, dysphagia, nor any otorrhea and hearing loss. The patient was scheduled to undergo a tracheotomy and then a biopsy under supporting laryngoscopy. During the operation, the frozen section diagnosis from the first and the second time both indicated that the biopsy specimens originated from musculo-epithelia, it couldn't be differed from malignant to benign. So the mass was simply removed under supporting laryngoscopy. The histopathology from paraffin sections revealed typical carcinoid of the larynx and the second procedure consisted of supraglottic laryngectomy with clear margins, the otalgia resolved and the patient had no difficulty with phonation or swallowing. After 1 year follow-up, the patient was found a mass on his right neck with symptom free, B-ultrasonography indicated several enlargement lymph nodes with some merged on both sides of the neck, the patient was scheduled to undergo a "total-laryngectomy with radical neck dissection on the left side and an elective neck dissection on the right side". The specimens were positive for cytokeratin, chromogranin A and synaptophysin, a final diagnosis of typical carcinoid was made for the recurrence lesion and the metastasis of the lymph nodes. Though the post-operative recovery was uneventful, the prognosis was not good, the patient died six months later. Here, we review the pertinent references on this subject, and discuss the main managements for typical carcinoid tumor of the larynx.
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Affiliation(s)
- Qinying Wang
- Department of Otolaryngology, First Affiliated Hospital, College of Medicine, Zhe Jiang University Hangzhou 310003, PR China
| | - Haihong Chen
- Department of Otolaryngology, First Affiliated Hospital, College of Medicine, Zhe Jiang University Hangzhou 310003, PR China
| | - Shuihong Zhou
- Department of Otolaryngology, First Affiliated Hospital, College of Medicine, Zhe Jiang University Hangzhou 310003, PR China
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