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PubMedDate not supplied

Framework invasion by laryngeal carcinomas.

The accuracy of standard clinical and radiologic methods in detecting invasion of the laryngeal framework or the presence of a transglottic tumor was examined by comparing clinical and pathologic findings in a series of 50 randomly selected laryngectomies for squamous carcinoma. Forty-two of the patients had received radiation therapy as primary treatment. The presence of pain referred to the ear immediately before laryngectomy indicated invasion of the laryngeal framework or spread into the extralaryngeal soft tissues in 11 of 12 patients. Transglottic tumors were correctly identified in 10 of 14 patients from laryngeal tomograms, but seven additional tumors were incorrectly designated as transglottic. Both transglottic tumors and infraglottic extension were seriously underdiagnosed by direct laryngoscopy. Framework invasion was seen to be a feature of transglottic tumors 2 cm or more in diameter. The morphology of this process is described. Limited follow-up has already shown a pattern of early recurrence, frequently as cervical node metastases, that is significantly more common in patients with framework invasion.

Adult↗
PubMed1995

Impact of magnetic resonance imaging and computed tomography on the staging of laryngeal cancer.

This retrospective study quantitatively assessed the effects of magnetic resonance imaging (MRI) and computed tomography (CT) on the staging of laryngeal cancer. A blind comparison between CT and MRI was made in a group of previously untreated patients with squamous cell carcinomas of the larynx. From June 1992 to November 1993, 29 patients were eligible for study. Of these, 14 patients (48%) had supraglottic lesions, 11 patients (40%) had glottic lesions and 4 patients (14%) had both. No subglottic lesions were seen. The data suggest that clinical staging of laryngeal tumors is inadequate. MRI proved superior to CT for staging tumors, especially those confined to the supraglottis. Nevertheless, clinically staged T1 or T2 lesions could be adequately assessed by CT alone. Findings also indicate that MRI should be reserved for T3 or T4 clinically staged lesions. Furthermore, most nodal disease can be staged by CT.

Carcinoma, Squamous Cell↗
PubMed1987

Effect of cricopharyngeal myotomy on pharyngoesophageal function: pre- and postoperative cineradiographic findings.

The pre- and postoperative cineradiographic findings in 14 dysphagic patients who underwent cricopharyngeal myotomy were compared. The reason for the operation was Zenker's diverticulum (7 patients), lack of cricopharyngeal coordination (5 patients), or a cervical esophageal web (2 patients). After the operation the function of the epiglottis, laryngeal vestibule, and pharyngeal constrictors was unaltered (11 patients) or improved (3 patients), although 4 cases showed residual impression due to the cricopharyngeal muscle. Postoperatively, 9 patients developed defective peristalsis and 10 had impaired tonicity of the cervical esophagus. It is concluded that myotomy alters the motor function of the pharyngoesophageal segment considerably. Moreover, certain functions of the pharynx proper are changed by this procedure.

Aged↗
PubMed1997

Histopathology of laryngeal changes after long-term chondrosynthesis.

Two patients treated for laryngeal tumors at the University of Lübeck are presented. Both underwent laryngeal reconstructions with plate and screw fixation systems immediately following partial laryngectomies. Recurrent disease was found at 14 and 55 months, respectively, and was subsequently managed by total laryngectomy. The laryngectomy specimens with the plate and screws in situ were evaluated histopathologically, paying special attention to the reaction of local tissue to the implants. Findings showed that the metallic plates were fixed with screws in the bony trabeculae of the laryngeal skeleton. The histological response showed primary wound healing without evidence of sequestration or implant loosening, as often associated with excess mechanical stress. Furthermore, there were no signs of tissue necrosis or widespread chronic inflammation. In both patients, a small discrete area of chronic inflammation and soft tissue fibrosis was noted adjacent to the screw heads. This study supports our previously documented clinical experience that the use of chondrosynthetic techniques is almost complication-free and is an ideal system for performing precise anatomical reconstruction of the laryngeal skeleton.

Aged↗
PubMed2004

[Not all vocal cord failure following thyroid surgery is recurrent paresis due to damage during operation. Statement of the German Interdisciplinary Study Group on Intraoperative Neuromonitoring of Thyroid Surgery concerning recurring paresis due to intubation].

Since the phoniatrician H. Bauer described the first case of recurrent laryngeal nerve palsy most likely caused by intubation some 45 years ago, several case reports have been published. However, systematic analyses regarding the frequency of recurrent laryngeal nerve palsies due to intubation are scarce, and none of them has used the proper methods to demonstrate clearly that such a mechanism exists. Currently available data justify the assumption that not every recurrent laryngeal nerve palsy following thyroid surgery is due to the operation itself and that the damage caused by intubation, however, may only account for a minority of these cases. The differential diagnosis of postoperative recurrent laryngeal nerve palsy requires the use of specific tools which go beyond simple laryngoscopy and include stroboscopy as well as intra- and extralaryngeal electromyography. A partial palsy of recurrent laryngeal nerve due to intubation would be associated with severe dysphonia or aphonia, not with dyspnea because of the typical intermediate position of the paralyzed vocal folds with a normal electromyographic function of the cricothyroid muscle. The use of these methods to identify the nature of postoperative recurrent laryngeal nerve palsy is recommended in cases of regular intraoperative neuromonitoring but postoperatively impaired function of the vocal cords.

Diagnosis, Differential↗
PubMed2003

[Therapeutic and histological features of basaloid squamous cell carcinoma].

BACKGROUND AND OBJECTIVE: Basaloid squamous cell carcinoma s a rare, highly malignant carcinoma variant typically situated in the tongue base, supraglottis and pyriform sinus. It is usually only diagnosed at a very advanced stage due to its tendency towards submucosal growth, deep infiltration and early local and distant metastases. PATIENTS/METHODS: The case described involves a 39-year-old man with the clinical and histopathological findings typical for this neoplasm. RESULTS: In contrast to simple squamous cell carcinomas, the basaloid variant with its very poor prognosis calls for therapeutic decisions that give particular consideration to quality of life. It should be stressed that highly invasive surgery is justified only in exceptional cases because of the high local recurrence rate and early distant metastases. CONCLUSIONS: The case presented shows that radio- and chemotherapeutic approaches are just as important as surgery.

Adult↗
PubMed2006

Staging of laryngeal and hypopharyngeal cancer: value of imaging studies.

Imaging methods assist in the pre-treatment planning of laryngeal and hypopharyngeal neoplasms, by better defining the local extension of infiltrating tumours and by detecting subclinical neck adenopathies. Imaging has also an important role in excluding or detecting distant metastasis. Furthermore, there is evidence that several imaging-derived parameters can be used as predictors of locoregional control after radiotherapy, and this independently from the TN classification. Such prognostic information is helpful in determining the relative value of surgery and radiation therapy, in selecting patients who may benefit from adjuvant treatment, and in identifying patients at high risk for recurrence to be followed up more closely.

Carcinoma, Squamous Cell↗
PubMed1992

Suicidal hanging in Cardiff--a 15-year retrospective study.

A retrospective study of 84 cases of suicidal hanging was undertaken in which petechial haemorrhages or congestion were seen in 27%, soft tissue haemorrhage in 29% and fracture of the hyoid or laryngeal cartilages in 36%. Fractures were found to be related to increasing age and were not found when a soft ligature had been employed. Petechial haemorrhages and congestion were related to the completeness of suspension. Apart from the lack of fractures in the soft ligature group any of these findings, either singly or in combination, was found to occur without regard to age, suspension type or ligature type. No evidence was found of clustering or seasonality. The findings are compared to other series and discussed with regard to the mechanisms of causation.

Adult↗
PubMed2006

Pulmonary arterial pressure in infants with laryngomalacia.

OBJECTIVE: Persistent upper airway obstruction may lead to increased pulmonary arterial pressure in childhood. Laryngomalacia is one of the most common causes of transient upper airway obstruction by laryngeal blockage in infants. The aim of the study is to evaluate the pulmonary arterial pressures in infants with laryngomalacia during infancy period. METHODS: Fifteen infants with laryngomalacia and 30 healthy controls were enrolled into this study. The pulmonary arterial pressures were measured by using Doppler echocardiography. Infants were also evaluated by clinical investigations, telecardiography and electrocardiography. RESULTS: Our results showed that infants with laryngomalacia may have significantly higher pulmonary arterial pressure than healthy subjects. Pressures of patient group were significantly decreased at the end of infancy period. CONCLUSIONS: Increased pulmonary arterial pressure levels due to laryngomalacia are reversible by during developmental process. Therefore, in symptomatic period, evaluation of infants with laryngomalacia by using Doppler echocardiography may be useful for monitoring pulmonary arterial pressure and following up the clinical outcome.

Airway Obstruction↗
PubMed2004

Differential expression of myosin heavy chain isoforms between abductor and adductor muscles in the human larynx.

OBJECTIVE: This study examines the differential expression of myosin heavy chain (MyHC) components in human laryngeal muscle groups. STUDY DESIGN: A battery of monospecific monoclonal antibodies in Western blots was used to determine expression of IIX, extraocular-specific (EOM), and IIB MyHCs for the thyroarytenoid (TA), vocalis (VOC), lateral cricoarytenoid (LCA), cricothyroid (CT), and posterior cricoarytenoid (PCA) muscles obtained from fresh cadaver specimens. RESULTS: Fast IIX MyHC was only expressed in the TA, VOC, and LCA muscles. Fast IIA and slow MyHCs were expressed in all laryngeal muscles including the CT and PCA. The CT with mixed phonatory and respiratory function and the PCA with respiratory function did not express IIX MyHC. The 2 MyHC isoforms associated with the highest speeds of contraction in rat laryngeal muscle, namely, the EOM MyHC and IIB MyHC, were not detected in human laryngeal muscles. Novel MyHC bands were not detected in SDS-PAGE gels or Western blots using a broad specificity MyHC antibody. CONCLUSION: The profile of MyHC expression in human laryngeal muscles differs from that observed in human extraocular and masticator muscles, and other mammalian species. Our data demonstrate that IIX MyHC expression is associated primarily with muscles affecting glottic closure and is absent in CT and PCA. SIGNIFICANCE: A higher percentage of IIX MyHC is expected to impart a high speed of shortening to the TA and LCA muscles. The absence of IIX MyHC in muscles with respiratory (PCA) and mixed respiratory/phonatory function (CT) further supports the inference that the physiologic difference between laryngeal muscles is reflected in the molecular composition of contractile protein.

Aged↗
PubMed1988

Computed tomography in children with esophageal and airway trauma.

Computed tomography (CT) was used in five children, four with esophageal and one with airway trauma. The examination contributed valuable information that aided in planning and evaluating therapy: (1) it assessed mediastinal and pleural cavity involvement prior to surgery or drainage; (2) it evaluated the efficacy of drainage; (3) it gave excellent information about the position of chest tubes; and (4) it demonstrated unsuspected pneumothoraces, pleural effusion, pulmonary infiltrates, and lung perforation by a chest tube. In the postoperative assessment of laryngotracheal fracture, neck radiographs were useless since the airways were obliterated by hematomas and edema. In this situation, CT showed the position and state of the laryngeal cartilages. However, CT findings were not pathognomonic for esophageal tears or airway fractures. The primary diagnosis was still made by conventional radiography. Esophageal tears were accurately demonstrated by gastrografin swallow and the tracheolaryngeal fracture was diagnosed by a lateral neck radiograph--the state of the child permitting no lengthy workup. CT and conventional radiography with contrast studies play a complementary role in esophageal and airway trauma in children.

Child↗
PubMed1987

Immunochemical studies on the synthesis and secretion of link protein and aggregating proteoglycan by chondrocytes.

Chondrocytes from pig laryngeal cartilage were maintained in culture, and the biosynthesis and secretion of link protein and proteoglycan were studied using immunochemical, biochemical and immunolocalisation techniques. In the presence of monensin there was a dose-dependent inhibition of link protein secretion which was very similar to that of aggregating proteoglycan, and suggested that they followed the same intracellular pathway during biosynthesis. In the presence of cycloheximide there was a similar dose-dependent inhibition of the secretion of both link protein and proteoglycan. Kinetics of secretion following inhibition of synthesis by cycloheximide showed that both proteins had similar intracellular pool sizes. Analysis of protein core and glycosaminoglycan biosynthesis showed that the time for synthesis and glycosylation of proteoglycan was 22 minutes, and this was quickly followed (within 6 minutes) by secretion. Intracellular electron microscopic immunolocalisation using protein A-gold showed link protein to be present in the Golgi cisternae and vesicles, and double-labelling experiments showed link protein only to be detected in vesicles that also labelled for proteoglycan protein core. When chondrocytes were maintained in monolayer culture for 10 days the rate of biosynthesis and secretion of proteoglycan increased although that of link protein remained constant. The control of their biosynthesis was thus shown to be independent. Within 4 hours of secretion a high proportion of link protein was incorporated into proteoglycan aggregates.

Animals↗