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PubMed1990

Effects of nasal CPAP on supraglottic and total pulmonary resistance in preterm infants.

The effects of continuous positive airway pressure (CPAP) on supraglottic and total pulmonary resistance were determined in 10 healthy premature infants (postconceptional age 34 +/- 2 wk, weight at study 1,628 +/- 250 g). Nasal airflow was measured with a mask pneumotachograph, and pressures in the esophagus and oropharynx were measured with a 5-Fr Millar or fluid-filled catheter. Nasal CPAP between 0 and 5 cmH2O correlated well with oropharyngeal pressure (r = 0.94). Total supraglottic resistance, total pulmonary resistance, and supraglottic resistance in inspiration and expiration were measured on increasing CPAP. Total supraglottic resistance decreased from 46 +/- 29 to 17 +/- 16 cmH2O.l-1.s (P less than 0.005) between 0 and 5 cmH2O CPAP, and a delay in return of resistance to control values was seen as CPAP was reciprocally decreased to 0. CPAP produced a decrease in supraglottic resistance in both inspiration and expiration, from 41 +/- 26 to 14 +/- 9 and from 33 +/- 17 to 10 +/- 6 cmH2O.l-1.s, respectively (P less than 0.01). Total pulmonary resistance also decreased from 161 +/- 40 to 95 +/- 24 cmH2O.l-1.s (P less than 0.01) between 0 and 5 cmH2O CPAP. The decrease in total supraglottic resistance in these infants accounted for 60% of the change in total pulmonary resistance, which occurred on CPAP of 5 cmH2O. We speculate that CPAP may decrease supraglottic resistance directly through mechanical splinting of the airway. This effect of CPAP may be the primary mechanism by which this form of therapy reduces apnea with an obstructive component in premature infants.

Airway Resistance↗

PubMed1993

Comparison of early glottic and supraglottic carcinoma treated with conventional fractionation of radiotherapy.

There were a few reports to compare the treatment results of glottic and supraglottic carcinoma. We investigated the difference of glottic and supraglottic carcinoma. From 1967 through 1985, 338 cases with early glottic (T1: 210, T2: 52) and supraglottic carcinoma (T1: 34, T2: 42) were treated with the conventional fractionation of radiation and evaluated the tumor response during radiation at the Department of Radiology, Osaka University Hospital. The ten-year actuarial survival rates of T1, T2 glottic and T1 and T2 supraglottic carcinoma were 63%, 64%, 58% and 46%, the corresponding ten-year cause-specific survival rates 92%, 89%, 88% and 78%, and the corresponding ten-year local control rates 76%, 67%, 69% and 59%, respectively. Tumor clearance rates of T1 and T2 glottic and T1 and T2 supraglottic carcinoma at 40 Gy were 68%, 40%, 35% and 24%, respectively. The local control rate of the tumor which disappeared at 40 Gy was 84%, that persisted at 40 Gy and disappeared at 60 Gy 69%, and that persisted at 60 Gy 33%. The local control rate and the tumor clearance rate of T1 glottic carcinoma were the highest among early laryngeal carcinoma, and those of T2 glottic carcinoma were the same as those of T1 supraglottic cases. The local control rate, the cause-specific survival rate, and the actuarial survival rate of T2 supraglottic were significantly lower than other cases.

Actuarial Analysis↗

PubMed1995

Unilateral supraglottitis in adults: fact or fiction.

Supraglottitis and epiglottitis have been described for many years by various authors. Haemophilus influenzae type b is the primary cause of childhood epiglottitis, which classically appears between the ages of 2 and 4 years. Onset is usually acute and the presentation can be dramatic with drooling, high temperatures, and stridor. Compared to childhood supraglottitis, adult supraglottitis usually pursues a more indolent course with no significant airway compromise and no identifiable pathogen. Rarely, adult supraglottitis can resemble its childhood counterpart with acute respiratory compromise secondary to H. influenzae infection. Although most incidences of adult supraglottitis are infectious in origin and involve the entire supraglottitis and epiglottis, we present two cases of unilateral supraglottitis caused by inhalation of a hot wire screen used as a filter for smoking crack cocaine.

Administration, Inhalation↗

PubMed1988

Conservation surgery for T2 and T3 carcinomas of the supraglottic larynx.

The treatment of choice for supraglottic carcinomas of intermediate size (stages T2 and T3) remains controversial. Between 1974 and 1983 in our institution, 139 patients with supraglottic carcinoma of intermediate size were judged retrospectively to have been technically amenable to conservation surgery. Primary disease control at three years was achieved in 100% of the patients treated by supraglottic laryngectomy, 91% (34 patients) of those treated by total laryngectomy, and 69% (81 patients) of those treated by radiotherapy. Of the latter group, 62% were salvaged by total laryngectomy yielding a net three-year local control of 85%. Determinate five-year survival rates were 89% for supraglottic laryngectomy, 78% for total laryngectomy, and 70% for radiotherapy. Significant problems with aspiration occurred in four patients (16%) who were treated by conservation surgery, and two patients (8%) required a permanent tracheostomy. The results of this study show that supraglottic laryngectomy with postoperative radiotherapy as indicated is a highly effective method for the local control of supraglottic carcinoma of intermediate size that is amenable to conservation surgery.

Adult↗

PubMed2005

Extended and standard supraglottic laryngectomies: a review of 110 patients.

The purpose of this study was to compare functional and oncological results of extended and standard supraglottic laryngectomies. One hundred ten patients with supraglottic carcinoma were treated. A standard supraglottic laryngectomy (SSL), a laterally extended supraglottic laryngectomy (LESL) and an anteriorly extended supraglottic laryngectomy (AESL) were performed on 32, 47 and 31 patients, respectively. Indications for postoperative radiotherapy included positive surgical margins (23% of patients) and/or node metastasis (63% of patients). Local recurrence occurred in 13% of SSL, 15% of LESL and 17% of AESL patients. Pulmonary complications due to aspiration were observed in 6% of SSL, 15% of LESL and 19% of AESL. The overall 5-year cure rates were 63% for SSL, 45% for LESL and 47% for the AESL procedures. Extended supraglottic laryngectomies provided as good a local tumor control as SSL. Extension to the hypopharynx (LESL) and to the vallecula (AESL) showed more frequent pulmonary complications and reduced cure rates.

Adult↗

PubMed1999

Upper neck (level II) dissection for N0 neck supraglottic carcinoma.

OBJECTIVES: Elective neck dissection for the N0 neck in head and neck surgery is still controversial. This prospective nonrandomized study of N0 supraglottic carcinoma was designed to find an appropriate method of neck management. STUDY DESIGN: Anatomical studies show that the first echelon of lymphatic drainage from the supraglottic larynx is toward the upper jugular nodes (level II). An upper neck dissection (UND) was applied and all the lymph nodes were sent for frozen section. If the subclinical metastasis was found, a modified neck dissection was performed. If the nodes harbored no foci of cancer, the patients were observed after surgery on the supraglottic lesions. METHODS: Patient records of 142 patients with supraglottic laryngeal cancer (T1-4N0M0) were reviewed, with special attention paid to neck recurrences and survival rates. The cases were treated between 1976 and 1990 and all were observed for at least 5 years after the operation or until the time of death. RESULTS: The UND specimens of 142 patients were negative for metastasis. The 5-year survival rate for this group after surgery was 80.8%, according to the life table analysis. Fifteen of the 142 patients (10.6%) had neck recurrences during the period of observation within 5 years. The recurrence rate of this series with limited dissection on the neck was comparable with those reported in the literature after neck dissection, either radical or modified. CONCLUSIONS: There is no need for a comprehensive neck dissection for N0 supraglottic laryngeal cancer. A selective neck dissection such as UND (level II) or a supraomohyoid neck dissection (sparing the submandibular region) of level II and III will serve the purpose of radical neck treatment for the supraglottic cancer.

Adult↗

PubMed2004

Expression of matrix metalloproteinases in supraglottic carcinoma and its clinical implication for estimating lymph node metastases.

OBJECTIVE: Twenty to 30% of clinically node-negative patients with squamous cell carcinoma (SCC) of supraglottic larynx were pathologically confirmed with occult lymph node metastasis after operation. Therefore, preoperative judgment on the neck node metastasis should be very important for making an appropriate surgical plan. The purpose of this study is to explore the role of matrix metalloprotineases (MMPs) in the metastatic potential of supraglottic carcinoma in this regard. STUDY DESIGN: Examination of MMPs expression in supraglottic carcinoma and establishment of the mathematic model for diagnosis of occult lymph node metastases in a prospective manner. METHODS: Thirty-two patients with supraglottic SCC underwent supraglottic horizontal partial laryngectomy and neck dissection, and the samples of primary cancer and the corresponding adjacent non-neoplastic tissues were evaluated for both mRNA and protein expression of MMP-1, MMP-2, MMP-7, MMP-8, MMP-9, and MMP-10 using reverse transcriptase polymerase chain reaction (RT-PCR) and immunohistochemistry. In addition, cervical lymph nodes were examined by routine histopathology to determine whether there was any evidences of node metastasis. RT-PCR and immunohistochemical data were analyzed by multivariate logistic regression, and then two mathematical models were established according to the multivariate logistic regression analysis. RESULTS: Among the six kinds of MMPs, both mRNA and protein expression of MMP-2, MMP-7, and MMP-9 were found up-regulated in more than 63% of the tumor tissues as compared with the adjacent non-neoplastic tissues, and this was significantly correlated with lymph node metastasis (all P < .05). Twenty patients, including seven cases with N0, were pathologically confirmed as having cervical lymph node metastasis. Using RT-PCR and immunohistochemical data of MMP-2, MMP-7, and MMP-9, two mathematic models were tested, and their diagnostic efficiencies for lymph node metastasis were 84% and 88%, respectively. CONCLUSION: Expressions of MMP-2, MMP-7, and MMP-9 are up-regulated in supraglottic carcinoma tissues, suggesting that MMPs may be useful in the detection of occult lymph node metastasis but that more research is needed.

Adult↗

PubMed1996

Complications of supraglottic laryngectomy for carcinomas of the supraglottis and the base of the tongue.

The medical records of patients with either a supraglottic carcinoma (n = 193) or a base of tongue carcinoma (n = 56) who underwent a supraglottic laryngectomy were studied. Because of aspiration total laryngectomy was required in 9.8% and 21.4% of patients with supraglottic and base of tongue carcinomas, respectively, being related to locally advanced stage of disease in the base of tongue and to an age older than 65 years in the case of supraglottic carcinomas. The non-decannulation rates were 23.8% and 50% in supraglottic and base of tongue tumours respectively. Post-operative radiotherapy did not influence the decannulation rate, but advanced local disease and age did. Post-operative mortality in the first month after the operation was 2.6% in supraglottic tumours and 3.6% in base of tongue tumours.

Adult↗

PubMed1995

Reconsidering a paradigm: the spread of supraglottic carcinoma to the glottis.

This study was performed to evaluate the spread of supraglottic carcinoma to the glottic level. Whole organ sections of total laryngectomy specimens from 37 patients with previously untreated supraglottic carcinomas were reviewed retrospectively. Of the 37 specimens, 20 (54%) were noted to have extension of cancer to the glottic level. A significant relationship was noted between glottic extension and abnormal cord motion (P = .0002). A statistically significant trend was noted for the relationship between inferior extension along the supraglottic mucosa and glottic level extension (P < .0001). Contrary to the prevailing model of the spread of supraglottic carcinoma, in which there is a distinct barrier to spread at the ventricle, this analysis of selected supraglottic carcinomas revealed a continuum of spread from the supraglottic to the glottis.

Chi-Square Distribution↗

PubMed1999

Comparative estimation of cure rates for supraglottic and glottic cancer in radiotherapy.

There are some clinical evidences, that the same types of tumors originated from neighboring anatomical structures can significantly differ in their response to radiation therapy. Squamous cell cancer of supraglottis and glottis could be good examples of this phenomenon. The purpose of the study was to compare the radiocurability of cancers localized in the upper and medium level of the larynx. From 1985 to the end of 1989, 544 patients with squamous cell cancer of the larynx were treated by radiotherapy alone. There were 388 patients with supraglottic cancer and 156 patients with glottic cancer. The total dose was in the range of 59-74 Gy. The end-point criteria were overall (OS) and disease-free survival (DFS). Generally, 5-year overall and disease-free survival rates were significantly more favorable for glottic cancer patients than for supraglottic cancer (67 and 63% vs. 40 and 36%, respectively). Significant differences in both disease-free and overall survival between supraglottic and glottic cancer in aspect of several analyzed clinical prognostic factors were found for: male sex, age, pattern of tumor growth, clinical performance status, radiation total dose lower than 70 Gy, fraction doses and overall treatment time. In all these prognostic categories 5-year survival rates were lower for supraglottic cancer patients. This tendency disappeared when the treatment results were compared in aspect of tumor stage (T). Tumor cure doses for 50% probability of local control (TCD50) in supraglottic cancer were estimated as: 61 Gy (T(1+2)) and 66 Gy (T3). In glottic cancer the lower TCD50 values of 54.5 Gy (T(1+2)) and 61 Gy (T3) were found in comparable treatment time. The comparative estimation of cure rates (i.e. OS and DFS) of laryngeal cancer treated by radiation alone showed that in aspect of almost all analyzed prognostic factors the greater risk of treatment failure was significantly associated with supraglottic origin.

Analysis of Variance↗

PubMed2003

Endoscopic CO2 laser treatment of supraglottic carcinoma.

Aim of the study was to evaluate whether laser endoscopic microsurgery is a reliable and appropriate approach to treatment of laryngeal supraglottic cancer. A retrospective study was made of 12 patients (11 M/1 F; mean age 62.5 years) treated from December 1995 to October 2001 in the Department of Surgical Sciences and Organ Transplantations, Section of Otorhinolaryngology, University of Cagliari, Italy. Surgical steps and oncologic results are reported. These 12 patients with supraglottic cancer underwent transoral laser surgery (TNM classification: T1, 3 patients; T2, 9 patients; N-, 9 patients; N+, 3 patients; M-, 12 patients). On the basis of the different subsites removed, the following resections were performed: 1 limited excisional biopsy (false chord), 3 wide excisional biopsies (2 or 3 subsites), 2 simple epiglottectomies, 1 extended epiglottectomy, 3 horizontal supraglottic laryngectomies, and 2 horizontal supraglottic laryngectomies that were extended to the anterior commissure and to one arytenoid, respectively. Five patients underwent functional neck dissection, and one patient underwent post-operative radiotherapy at sites of tumour and lymph nodes. Temporary tracheotomy was carried out in 10 patients. Mean follow-up was 33.3 months. No local recurrences were noted. Local control was thus 100%. Aspiration was the main post-operative problem, but there were no cases of aspiration-associated pneumonia. Moreover, no patient needed laryngectomy or a permanent tracheotomy for aspiration. In conclusion, although our experience with supraglottic cancers treated by endoscopy is still too limited to confirm the definitive oncologic validity of this type of surgery, in our hands, it seems to be a reasonable tool in selected cases and a safe, time- and cost-effective alternative to traditional surgery or radiotherapy for selected supraglottic carcinomas.

Aged↗

PubMed2004

[Patterns and prognostic factors of cervical lymph node metastasis in supraglottic laryngeal carcinoma].

OBJECTIVE: To investigate the risk factors in the prediction of cervical lymph node metastases and the cervical lymph node prognostic factors in supraglottic laryngeal carcinoma. METHOD: A retrospective study was carried out to review the histopathological data from 55 supraglottic laryngeal carcinoma patients. The relationship between histopathological parameters and cervical lymph node metastases were evaluated by means of a univariate chi2 test and multivariate stepwise logistic regression model. And the Cox regression model was used to define possible pathological parameters of cervical lymph node affecting survival including N staging, presence of cervical lymph node metastases and extracapsular nodal spread, size and number of positive neck nodes, and levels of positive neck nodes. RESULT: In a univariate analysis, it was confirmed that the following variables correlated to cervical lymph node metastases, i.e., depth of primary tumor infiltration, size and histological grade of primary tumor. In a multivariate analysis, the most significant risk factors for cervical lymph node metastases were the size and histological grade of primary tumor. The overall 5-year survival rate of patients with supraglottic laryngeal carcinoma was 52.7%. In a Cox regression analysis, N staging, size of positive neck nodes, presence of cervical lymph node metastasis and extracapsular nodal spread were found to be related to the prognosis of supraglottic laryngeal carcinoma. CONCLUSION: Cervical lymph node metastasis is one of the most significant prognostic factors of supraglottic laryngeal carcinoma. The identification of patients at risk for cervical lymph node metastasis and the management of the neck by coping with pathological factors of neck node affecting survival are crucial steps to improve the effect of supraglottic laryngeal carcinoma treatment.

Adult↗

PubMed1981

Second primary respiratory tract malignant neoplasms in supraglottic carcinoma.

In this study, a second respiratory tract malignant neoplasm developed in 20 of 163 cases of supraglottic carcinoma either at the time of diagnosis or after diagnosis. Using an actuarial method of calculation, 19% of the survivors will experience a second respiratory tract malignant neoplasm within five years after the diagnosis of supraglottic carcinoma. This is three times the incidence in patients who survive glottic carcinoma and 14 times the incidence in the normal population. A third of this group of patients with supraglottic carcinoma are alive and well at five years, a third died of supraglottic cancer, and a third died of intercurrent disease. The death rate from intercurrent disease is twice that seen in the general population, and this difference is due almost entirely to second respiratory tract tumors. Even if the cure rate of patients with primary supraglottic carcinoma was 100%, only half of these patients would actually be alive at five years, owing to deaths from intercurrent disease. More emphasis needs to be placed on the reduction of the mortality from second respiratory tract tumors with the use of screening or preventive methods.

Glottis↗

PubMed1994

The impact of bilateral neck dissection on pattern of recurrence and survival in supraglottic carcinoma.

OBJECTIVE: The findings of an initial evaluation of 202 patients treated for squamous cell carcinoma of the supraglottic larynx have been previously reported. Recurrent disease was observed at the primary site in four patients (2%), in the regional lymphatics in 39 patients (20%), and at distant sites in 24 patients (12%). Critical analysis of patients who demonstrated recurrent disease in the cervical lymphatics indicated that 38 of 39 recurrences developed in nonsurgically treated necks irrespective of the use of postoperative radiation therapy. Accordingly, all patients with supraglottic carcinoma have been treated with routine bilateral neck dissection since that time. We have reviewed our data to determine if bilateral neck dissections deter recurrence and improves survival. DESIGN: A retrospective review of the clinical course of 76 patients undergoing excision of supraglottic squamous carcinoma combined with bilateral neck dissection between 1980 and 1990 was performed to determine survival and recurrence rates. Surgery alone was used to treat 32 patients, while 44 patients were treated with surgery plus adjunctive therapy. SETTING: Department of Otolaryngology--Head and Neck Surgery, The Eye and Ear Institute, University of Pittsburgh (Pa) School of Medicine. RESULTS: Distant metastatic spread was the most frequent site of failure, occurring in nine (11.8%) of 76 patients. Local recurrence was experienced by two patients (1%). The incidence of cervical recurrence (seven patients, 9.2%) following treatment for squamous cell carcinoma of the supraglottic larynx has been reduced from 20% to 9% through the use of bilateral neck dissection. The 2-year survival rate increased from 72% to 76%. CONCLUSION: Routine bilateral neck dissection is beneficial in the surgical management of squamous cell carcinoma of the supraglottic larynx.

Adult↗

PubMedDate not supplied

Radiotherapy for squamous cell carcinoma of the supraglottic larynx: an alternative to surgery.

BACKGROUND: The purpose of this article is to present the results of radiotherapy with or without neck dissection for squamous cell carcinoma of the supraglottic larynx at the University of Florida and to compare these data with those obtained after conservation surgery. METHODS: Continuous-course radiotherapy alone or combined with a planned neck dissection was used to treat 209 patients with 211 supraglottic carcinomas between 1964 and 1992; all patients had follow-up for > or = 2 years. RESULTS: The 5-year rates of local control after radiotherapy were as follows: T1, 100%; T2, 83%; T3, 68%; and T4, 56%. Tumor volume, as calculated on pretreatment computed tomography (CT) scan, and vocal cord mobility influenced the likelihood of local control. CONCLUSIONS: Based on our data and the literature, early or moderately advanced supraglottic carcinomas may be treated successfully with either supraglottic laryngectomy or radiotherapy. Supraglottic laryngectomy probably produces a higher initial local control rate but, based on anatomic and coexisting medical constraints, is suitable for a smaller subset of patients and has a higher risk of complications compared with radiotherapy.

Carcinoma, Squamous Cell↗

PubMed2002

Carcinoma of the supraglottic larynx: treatment results with radiotherapy alone or with planned neck dissection.

PURPOSE: To present the results of radiotherapy with or without neck dissection for squamous cell carcinoma of the supraglottic larynx treated at the University of Florida and to compare these data with those obtained after conservation surgery. METHODS AND MATERIALS: Continuous-course radiotherapy alone or combined with a planned neck dissection was used to treat 274 patients with squamous cell carcinoma of the supraglottic larynx between 1964 and 1998. All patients had follow-up for a minimum of 2 years, and 250 (91%) had follow-up for 5 years or more. RESULTS: At 5 years, the actuarial probability of local control after radiotherapy according to T stage was as follows: T1, 100%; T2, 86%; T3, 62%; and T4, 62%. The probability of cause-specific survival at 5 years by AJCC stage was as follows: stage I, 100%; II, 93%; III, 81% IVA, 50%; and IVB, 13%. The risk of severe late complications was 4%. Of 57 patients undergoing planned postradiotherapy neck dissection, 7% experienced a severe complication. CONCLUSIONS: On the basis of our data and the literature, early or moderately advanced supraglottic carcinomas may be treated successfully with either supraglottic laryngectomy or radiotherapy. Supraglottic laryngectomy probably produces a higher initial local control rate but, based on anatomic and coexisting medical constraints, is suitable for a smaller subset of patients and has a higher risk of complications compared with radiotherapy.

Carcinoma, Squamous Cell↗

PubMed1999

Endoscopic CO(2) laser therapy of selected cases of supraglottic marginal tumors.

Endoscopic CO(2) laser intervention can be used as conservation surgery for supraglottic laryngeal carcinomas in carefully selected patients. We analyzed retrospectively our experience in managing patients with early supraglottic carcinomas operated on at the Clinic of Otorhinolaryngology, Szeged, Hungary, during the 10-year period between 1987 and 1997. Conservation surgery was the treatment of choice in 187 patients, but only 23 (12%) were selected for endoscopic CO(2) laser surgery. Laser surgery was indicated predominantly for T1 cancer of the epiglottis (n = 15), but was also performed for T2 cancers (n = 8). Of the 23 supraglottic tumors treated, 16 had no signs of recurrence to date (1.5 to 9 years after surgery) a local control rate of 70%. Six patients with recurrences underwent salvage therapies that included repeated laser excisions (n = 3), radiotherapy (to 60 Gy), horizontal supraglottic laryngectomy and total laryngectomy. One patient was not resectable because of multiple metastases. Our experience with endolaryngeal CO(2) laser excision indicates that it is a reasonable method in selected cases of supraglottic tumors, but one-third of the patients required salvage treatment.

Carbon Dioxide↗

PubMed1983

Supraglottic laryngeal carcinoma: an analysis of dose-time-volume factors in 410 patients.

Four hundred and ten patients with supraglottic laryngeal carcinoma treated with moderate dose radical radiotherapy with surgery for salvage (RRSS) were analyzed in detail to determine optimal dose-time-volume parameters to be used in the treatment of each stage of supraglottic carcinoma. In the RRSS group 41% are alive and well at 5 years, 38% died of their tumor and 21% of intercurrent disease. Presence or absence of nodal disease has a major impact on survival. Local control is approximately 70% in T1, T2N0 patients and approximately 50% in T3 and T4N0 patients. Seventeen percent of T1 and T2N0 patients failed in the initially negative neck. Ten major complications (2.4%) have been seen. Local control by irradiation was not influenced by dose or field size. Regional control in the initially negative neck was markedly increased with the use of larger irradiation field sizes. Field sizes of less than 7 X 7 cm resulted in an 18% neck failure rate as compared to 3% with larger field sizes (p = 0.00005). This particularly applied to early stage disease. As a result of the use of larger irradiation field sizes giving reduced neck failure rates, improvement in survival has been seen in early stage supraglottic patients. The results are compared with published results. There is no statistically significant dose response curve in any stage of supraglottic cancer over the dose range 1650-2300 ret. Optimal treatment factors for supraglottic cancer are discussed.

Carcinoma, Squamous Cell↗