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PubMed1985

Glottic reconstruction with thyroid perichondrium and investing cervical fascia.

Various surgical procedures have been designed for glottic reconstruction following vertical partial laryngectomy. Many of these techniques require flaps or even a second stage to adequately compensate for the loss of lining or bulk that accompanies extended laryngeal resection. Thyroid perichondrium and investing cervical fascia were used in 20 cases of glottic reconstruction. Laryngeal reconstruction following vertical partial laryngectomy using readily available local tissue allows for the wide resection of tumor as well as for the preservation of laryngeal structure and function.

Aged↗
PubMedDate not supplied

Oropharyngeal granulomas and tracheal cartilage degeneration in Fischer-344 rats.

The development of tracheal cartilage degeneration and inflammation of the seromucinous glands of the oropharynx may be a factor causing early mortalities in long-term studies with Fischer-344 (F-344) rats. The presence of these lesions was investigated in groups of male and female F-344 rats killed at 6, 19, and 32 wk of age. Half of the rats killed at 19 and 32 wk of age were sham treated with water (pH 10) by daily oral gavage for a duration of 13 or 26 wk prior to autopsy in order to detect any influence on the laryngotracheal cavity due to dosing technique. A clear age-associated increase in severity and incidence of chondroid degeneration of the tracheal and laryngeal cartilage was revealed, with an onset as early as 6 wk of age. After 19 wk, a high frequency of oropharyngeal granuloma formation was found. No relationship of the lesions to the gavage technique was apparent. The F-344 rat strain may possess a predisposition for inflammatory and degenerative changes in the oropharyngeal and laryngotracheal cavity, changes that can lead to increased and unexpected mortality rates in nonclinical safety studies (7).

Age Factors↗
PubMed2000

A triad of laryngeal hemorrhages in strangulation: a report of eight cases.

The results of histological studies on larynges from eight cases of manual strangulation, all that had intracartilaginous laryngeal hemorrhages, a recently described and under-recognized lesion associated with strangulation, are reported. Formalin-fixed larynges were examined in serial section using a standardized protocol. In all cases, intracartilaginous laryngeal hemorrhages were associated with subepithelial laryngeal hemorrhages, and intralaryngeal muscular hemorrhages forming a "triad of hemorrhages." In five cases, the triad was found in the presence of laryngeal cartilage microfractures. Since cartilage microfractures can be causally related to mechanical injury to the neck, it is likely that the triad of hemorrhages has diagnostic value as an independent morphological criterion for the postmortem diagnosis of strangulation. Since a proportion of cases of strangulation lack characteristics that are self-evidently due to violent application of pressure on the neck, recognition of the triad may have important implications for the postmortem diagnosis of strangulation.

Adult↗
PubMed1984

Stridor in childhood.

The acute onset of stridor in a young child usually represents viral croup, particularly during the fall and early winter. If the clinical picture is entirely consistent with this diagnosis and gas exchange is maintained, management with cool mist at home is appropriate. Rapid deterioration is unusual in viral croup; however, if obstruction is prolonged or becomes unusually severe, racemic epinephrine aerosols, hospitalization for careful observation, a brief course of corticosteroid therapy, and, rarely, endotracheal intubation may be required. Many of the other causes of acute stridor in childhood represent true pediatric emergencies: epiglottitis, foreign body aspiration, bacterial tracheitis, allergic airway edema, and retropharyngeal abscess, all requiring management with a consultant. Chronic stridor in infancy most often represents laryngomalacia, a developmental abnormality of the laryngeal cartilage which usually resolves by the second year of life and rarely requires specific treatment. Other causes of chronic stridor in childhood include subglottic hemangioma, vocal cord paralysis, and a long list of abnormalities. In the older child with chronic stridor or in the infant whose clinical picture is unusual for laryngomalacia, airway roentgenograms, barium studies, or laryngoscopy/bronchoscopy should be obtained to establish the definitive diagnosis.

Airway Obstruction↗
PubMed1991

Chondrosarcoma of the larynx after radiation treatment for vocal cord cancer.

The case of a 57-year-old man with chondrosarcoma of the laryngeal cartilage is presented, occurring 16 years after radiation treatment for squamous cell carcinoma of the right true vocal cord. Chondrosarcoma of the larynx is an uncommon tumor. The location, grade, and time elapsed from initial treatment make it probably that this patient's chondrosarcoma is associated with his prior radiation treatment. However, it is a rare occurrence, this being the second case reported in the literature.

Adult↗
PubMedDate not supplied

Resectability issues with head and neck cancer.

Head and neck surgeons often rely on imaging to determine if a neoplasm is resectable. Many of the critical issues are outlined in the American Joint Committee on Cancer Staging Manual, wherein T4a and T4b head and neck cancers are defined as resectable and unresectable, respectively. Even within the T4a advanced resectable classification, there are critical determinants that define whether the surgical option is such that major morbidity and mortality could be expected. This review article examines the imaging literature to determine the accuracy and diagnostic criteria of different modalities for evaluating these critical T4a and T4b factors, which include the following: 1) arterial encasement, 2) prevertebral fascia involvement, 3) mediastinal infiltration, 4) tracheal and esophageal extension, 5) laryngeal cartilage penetration, 6) pre-epiglottic fat involvement, 7) dural spread, 8) bone (mandible/maxilla and skull base) infiltration, 9) perineural spread, 10) orbital involvement, and 11) brachial plexus invasion. For the most part, the studies find MR imaging with higher sensitivity but lower specificity than CT. An ever-increasing role for PET/CT is suggested. Imaging is of great value in the determination of resectability issues listed previously for head and neck cancers, with the possible exception of prevertebral fascia involvement.

Bone Neoplasms↗
PubMed2006

Laryngocele: a rare complication of surgical tracheostomy.

BACKGROUND: A laryngocele is usually a cystic dilatation of the laryngeal saccule. The etiology behind its occurrence is still unclear, but congenital and acquired factors have been implicated in its development. CASE PRESENTATION: We present a rare case of laryngocele occurring in a 77-year-old Caucasian woman. The patient presented with one month history of altered voice, no other associated symptoms were reported. The medical history of the patient included respiratory failure secondary to childhood polio at the age of ten; the airway management included a surgical tracheostomy. Flexible naso-laryngoscopy revealed a soft mass arising from the posterior pharyngeal wall obscuring the view of the posterior commissure and vocal folds. The shape of the mass altered with respiration and on performing valsalva maneuver. A plain lateral neck radiograph revealed a large air filled sac originating from the laryngeal cartilages and extending along the posterior pharyngeal wall. The patient was then treated by endoscopic laser marsupialization and reviewed annually.We discuss the complications of tracheostomy and the pathophysiology of laryngoceles and in particular the likely aetiological factors in this case. CONCLUSION: A laryngocele presenting in a female patient with tracheostomy is extremely rare and has not been to date reported in the world literature. A local mechanical condition may be the determinant factor in the pathogenesis of the disease.

Aged↗
PubMed2000

Laryngeal or hypopharyngeal squamous cell carcinoma: can follow-up CT after definitive radiation therapy be used to detect local failure earlier than clinical examination alone?

PURPOSE: To determine if follow-up computed tomography (CT) after definitive radiation therapy for laryngeal or hypopharyngeal (laryngopharyngeal) carcinoma allows the detection of local failure earlier than clinical examination alone. MATERIALS AND METHODS: Pre- and post-radiation therapy follow-up CT scans in 66 patients were reviewed retrospectively. All patients underwent definitive hyperfractionated radiation therapy and were followed up clinically for at least 2 years after its completion. Post-radiation therapy CT scans (N = 153) were evaluated for posttreatment changes with a three-point score: A score of 1 represented expected posttreatment changes; 2, focal mass with a maximal diameter of less than 1 cm and/or asymmetric obliteration of laryngeal tissue planes; or 3, focal mass with a maximal diameter equal to or greater than 1 cm or estimated tumor volume reduction of less than 50%. All patients underwent the first posttreatment CT study 1-6 months after therapy. New or progressive laryngeal cartilage changes were noted. The clinical impression of the larynx at the time of each follow-up CT scan was also recorded. RESULTS: In 12 of 29 (41%) patients with treatment failure at the primary site, follow-up CT scans were definite for local failure (score, 3) a mean of 5.5 months (median, 3.5 months; range, 1-17 months) before clinical examination results. CONCLUSION: In many patients, follow-up CT shows local failure earlier than does clinical examination alone.

Adult↗
PubMed1999

In vitro regulation of expression of cartilage-derived morphogenetic proteins by growth hormone and insulinlike growth factor 1 in the bovine cricoid chondrocyte.

OBJECTIVES: To delineate the endogenous growth factors that regulate cricoid cartilage growth at the molecular level. Specifically, to attempt to establish the presence of cartilage-derived morphogenetic proteins (CDMPs), cartilage-specific members of the bone morphogenetic protein family, in newborn bovine cricoid chondrocytes and to assess the expression of these endogenous growth factors with the addition of exogenous growth hormone or insulinlike growth factor 1 in an in vitro chondrocyte culture model. METHODS AND DESIGN: Basic science molecular biologic research methods, including high-density monolayer and explant chondrocyte cultures with extraction of messenger RNA and quantitation via Northern blot hybridization via radiolabeled complementary DNA probes. SETTING: Intramural basic science research laboratory. RESULTS: Both CDMP-1 and CDMP-2 were found in newborn cricoid chondrocytes. Addition of exogenous growth hormone did not appear to influence the expression of CDMP-1 or CDMP-2. Addition of exogenous insulinlike growth factor 1 appeared to down-regulate the expression of CDMP-1 but had no effect on the expression of CDMP-2. No major differences in CDMP level of expression were noted between high-density monolayer cultures vs explant cultures. No tissue specificity differences were noted in regulation of CDMPs between cricoid and articular chondrocytes. CONCLUSIONS: Our preliminary studies indicate the presence of endogenous morphogenetic proteins in newborn bovine cricoid chondrocytes. These novel polypeptide hormones (CDMP-1 and CDMP-2) have not been previously reported in laryngeal cartilage chondrocytes. Change in level of transcription of these morphogenetic proteins under various in vitro conditions suggests that these proteins are subject to regulation and/or play a regulatory role in cricoid chondrocyte growth and differentiation. Further experimentation is needed to confirm these findings.

Animals↗
PubMed1973

The composition of cartilage proteoglycans. An investigation using high- and low-inonic-strength extraction procedures.

1. A proteoglycan fraction (the proteoglycan subunit fraction) was prepared from extracts, with 0.15m-KCl (low-ionic-strength) and 0.5m-LaCl(3), 2.0m-CaCl(2) and 4.0m-guanidinium chloride (high-ionic-strength), of bovine nasal cartilage by equilibrium-density-gradient centrifugation, essentially as described by Hascall & Sajdera (1969). 2. The use of different centrifugation times showed that near-equilibrium conditions were reached by 48h for the fractions prepared from the high-ionic-strength extracts. The fraction isolated from the low-ionic-strength extract required a longer centrifugation time to reach equilibrium conditions. 3. The composition of the proteoglycan fractions from the various extracts was compared by analyses of their carbohydrate and amino acid contents. Difference indices were calculated from the amino acid analysis to compare the degree of compositional relationship between the protein components of the proteoglycans. 4. Small compositional differences were found between the proteoglycans isolated from the various high-ionic-strength extracts. The protein content of the fractions from the CaCl(2) extract and the guanidinium chloride extract showed the greatest difference in this respect, although their amino acid analysis was similar. 5. The proteoglycan fraction isolated from the low-ionic-strength extract shows marked differences in composition from the fractions isolated from the high-ionic-strength extracts. Its protein and glucosamine contents were lower whereas its hexuronic acid and galactosamine contents were higher than those of the latter. It also exhibits major differences in its amino acid composition. The glucosamine:galactosamine ratio of the fraction from the low-ionic-strength extract indicates that it may be an almost exclusively chondroitin sulphate-proteoglycan. Its analysis correlates closely with that of a low-molecular-weight proteoglycan isolated from pig laryngeal cartilage by Tsiganos & Muir (1969). 6. The proteoglycan fractions from both the low- and high-ionic-strength extracts migrate as a single band in zone electrophoresis carried out in a sucrose-density gradient at both pH3.0 and pH7.0, although each showed evidence of band widening during the electrophoresis. All the proteoglycan fractions migrated with the same electrophoretic mobility at pH3.0, irrespective of the differences in composition between them. 7. The differences between the proteoglycans from the low- and high-ionic-strength extracts are discussed and the view is advanced that they may be due to association between predominantly chondroitin sulphate-proteoglycans and a keratan sulphate-enriched proteoglycan species.

Amino Acids↗
PubMed2005

A peculiar site of chondroma: the epiglottis.

Chondroma of the laryngeal cartilage is an uncommon benign cartilaginous neoplasm. The commonest location is the posterior lamina of the cricoid cartilage, followed by the thyroid cartilage. The occurrence of chondroma in the epiglottis is extremely rare. Depending on the size and location of epiglottic chondroma the clinical manifestations are variable and include a lump in the neck, difficulty in swallowing fluids and dyspnea. In this study, an additional rare case of chondroma arising in the epiglottis is reported. The mass was located over the tip of the epiglottis and caused no significant clinical manifestations except for a foreign body sensation in the throat. Endoscopic excision with an adequate free margin was achieved via suspension laryngoscopy under general anesthesia with intubation. The patient was disease-free during a 1-year follow-up period. We present this case to highlight the occurrence of this rare benign lesion in the epiglottis, and stress that it should not be neglected in the differential diagnosis of an epiglottic mass. Conservative surgical excision is the initial treatment of choice and long-term follow-up is necessary.

Adult↗
PubMed1992

Does conventional tomography still have a place in glottic cancer evaluation?

Computed tomography (CT) can detect laryngeal cancer invading the pre-epiglottic, paraglottic spaces, laryngeal cartilages, and soft tissues, but in T1 and limited T2 tumours its main value is in evaluating subglottic extent. Conventional tomography in the coronal plane has been used with reasonable success to detect both subglottic and ventricular invasion and is less expensive than CT. Twenty-nine cases of glottic carcinoma of all stages were examined clinically, endoscopically and radiographically by both coronal conventional tomography and CT. The results of these imaging studies are compared in this investigation, stressing their relationship to clinical findings (and stage), especially vocal and cord mobility. Coronal conventional tomography was found to be as accurate as CT for sublottic spread in nine cases of T1 and T2A cancer with normal vocal cord mobility. Conventional tomography had a slight tendency to overestimate ventricular and false cord involvement (two out of seven patients) with T1 glottic cancer. When mobility was impaired (four cases) or absent (15 cases), CT added data which changed staging and/or treatment plan in six cases. In seven others it was suggestive of a more advanced stage.

Female↗
PubMed2002

[Organ preservation in advanced laryngeal and hypopharyngeal carcinoma by primary radiochemotherapy. Results of a multicenter phase II study].

INTRODUCTION: Regarding the promising results of international trials we conducted the first German prospective multicentre phase II trial for organ preservation with primary simultaneous chemoradiation in advanced laryngeal and hypopharyngeal cancer. PATIENTS AND METHODS: 28 of 30 recruited patients suffering from stage II and III (UICC) laryngeal and hypopharyngeal cancer were treated with primary simultaneous chemoradiation within an organ preservation program and monitored in follow-up of one year. Exclusion criteria included tumor infiltration of the laryngeal cartilage, bilateral neck nodes (N2c) and need for flap reconstruction in case of laryngectomy. The protocol included an accelerated concomitant boost chemoradiation (66 Gy) with Carboplatinum (70 mg/m2 1st and 5th week) and a restaging procedure one month after therapy. In case of residual disease, salvage laryngectomy and/or neck dissection were performed. RESULTS: After follow-up of one year 20 of 28 patients (71%) were presented with stable complete remission and functionally preserved larynx. Of these 20 patients 3 developed pulmonary metastases, 1 secondary primary carcinoma of the lung and 3 neck metastases which needed neck dissections. The other patients showed in 4 cases relapsing tumor which was indicated for laryngectomy. One patient needed tracheotomy because of persisting edema and 2 patients died due to tumor progress. One patient died after complications due to salvage surgery. CONCLUSION: The organ preservation protocol was feasible with well tolerated early toxicity. Problems of screening for recurrent disease, salvage surgery and late toxicity should be noted and pronounced in patient information. Further studies should focus on the improvement of patient selection which could be realized by induction Chemotherapy (using new components like taxan) and/or use of prediction factors such as tumor volume and hemoglobin levels.

Adult↗
PubMed2001

Dynamic tissue expansion of the larynx in a canine model.

OBJECTIVES: To test whether staged, progressive, monitored, dynamic tissue expansion is possible in the larynx and to evaluate its effectiveness in dilating and augmenting constricting cicatricial lesions. DESIGN: Animal study. SETTING: Research facility, tertiary care medical center. SUBJECTS: Thirteen dogs, 3 with laryngotracheal stenosis. INTERVENTIONS: Dogs underwent laryngeal splits, tracheostomy, and insertion of inflatable stents. In 7 normal dogs, stents were progressively inflated by air in predetermined increments during 11 days. In 3 normal dogs and 3 with laryngotracheal stenosis, stents were gradually expanded by water. Stents were kept in place for 21 days. After removal, dogs were observed for 25 days. Five died of complications of tracheostomy. MAIN OUTCOME MEASURES: Airway diameter measured by endoscopy before the induction of stenosis, before the laryngeal splitting procedure, after stent removal, and before euthanasia. RESULTS: The lumen increased, then shrank somewhat after stent removal. In 2 surviving dogs with laryngotracheal stenosis and water-expanded stents, the lumen was 82.5% larger than baseline at stent removal and 71.0% larger at euthanasia. In 2 surviving normal dogs with water-expanded stents, lumen size increased by 50.0% at stent removal, and in 1 dog surviving to day 46, it was 17.0% larger. In 5 surviving dogs with air-inflated stents, lumen size was 39.0% larger at stent removal and 8.0% larger at day 46. Histologically, fibrous tissue developed in the gaps between the splayed margins of the laryngeal cartilages. CONCLUSIONS: The larynx may be dynamically expanded. Although the maximal diameter is not maintained, final cross-sectional areas are larger.

Animals↗