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PubMed1975

Supraglottic cancer.

Supraglottic cancer, because of the embryological development of the larynx, and of the arrangement of its lymphatic network, tends to remain limited within the vestibule of the larynx and the pre-epiglottic space also in its advanced stages of evolution. The cancer spread may superiorly involve the epilarynx, the vallecula, the base of the tongue, and the pyriform fossa; however, inferiorly, the invasion of the glottis is quite exceptional (1 percent of cases); therefore, supraglottic laryngectomy is the operation of choice. The lower the location of cancer in the vestibule, the safer the indication. The higher location generally requires an extension of surgical excision toward the tongue, arytenoids and hypopharnx. In view of the high percentage of lymph node metastases, supraglottic laryngectomy should be associated with neck dissection, mainly bilateral, also in cases with no evidence of enlarged lymph nodes. Supraglottic laryngectomy has been performed in 240 cases in the course of the last 14 years and the five-year cure rate has been 79 percent. Five postoperative deaths have been recorded. Rehabilitation time for the breathing and swallowing function has been three weeks as an average. Complications, such as fistula or infection have been exceedingly rare: uneventful recovery followed in all cases.

Glottis↗
PubMed1976

Tuberculosis of the larynx.

Tuberculosis of the larynx, once a common disease, has become quite rare with the advent of anti-tuberculous chemotherapy. In the pre-antibiotic era two modes of laryngeal infection were recognized; bronchogenic and hematogenous. The literature is briefly reviewed. Thirteen patients in the past 15 years in whom tuberculous laryngitis was diagnosed upon indirect laryngoscopy by members of the University of Michigan Department of Otorhinolaryngology are presented. Bronchogenic infection was present in 11, and in two patients the disease was consistent with hematogenous spread. Tissue biopsy from a case of bronchogenic contamination demonstrated epithelioid tubercles, while numerous subepithelial acid-fast bacilli without typical tuberculous histological change were present in a case of hematogenous laryngeal infection. A case of cicatricial laryngeal stenosis was successfully treated surgically by laryngofissure, excision of fibrosis with arytenoidectomy, and free mucous membrane grafting. Finally, the initial subtle presentation of many of our patients emphasizes the importance of a consideration of tuberculosis in the differential diagnosis of chronic laryngitis.

Adult↗
PubMed1977

Two hundred laryngeal cancers: patterns of growth and spread as seen in serial section.

Whole organ serial section studies of specimens removed by partial or total laryngectomy have yielded information which the surgeon ordinarily needs in determining the suitability of the laryngeal cancer for conservation surgery. This information includes the degree to which the surface presentation of a growth reveals its margins, and the likelihood of invasion of the laryngeal framework and overlying soft tissues. The present studies indicate that in assessing these features of a growth before treatment, the surgeon can be guided by: 1. location; 2. fixation, and 3. size of the growth. These features are presented together under each location.

Glottis↗
PubMed1980

Laryngeal rheumatoid arthritis.

The classic sequence of pathologic changes associated with rheumatoid arthritis as they affect the cricothyroid and cricoarytenoid joints of five larynges is described. Although several previous reports have drawn attention to the presence of rheumatoid arthritis in the larnx, the current study emphasizes that the small joints of the larynx may be involved by the full spectrum of pathologic changes and that both cricothyroid and cricoarytenoid joints are equally prone to the various stages of inflammation, joint destruction and ankylosis that characterize the disease elsewhere. Rheumatoid nodules were seen in two cases and granulomatous areas surrounding cricothyroid joints were noted in two others.

Arthritis, Rheumatoid↗
PubMed1989

Glottal closure in the hemiparalyzed canine larynx.

Although compensation of voice with unilateral recurrent laryngeal nerve paralysis is commonly held to be the result of the unaffected vocal fold crossing past midline, or overcrossing, this mechanism of compensation has rarely been documented accurately. Beagle dogs were used to create a model of another proposed mechanism of compensation, known as midline drift. Six animals underwent sectioning of the left recurrent laryngeal nerve. One week later, three of the dogs underwent removal of the left posterior and lateral cricoarytenoid muscles. The effects of these procedures were studied by subjective assessment, direct laryngoscopy, and sound spectrographic analysis. Results indicate that glottal closure was improved after the second surgical procedure. The clinical implications of the results are discussed and compared with other manners of compensation hypothesized in the literature.

Animals↗
PubMed1991

The association of laryngoceles with squamous cell carcinoma of the larynx.

The clinical diagnosis of laryngoceles simultaneously occurring with squamous cell carcinoma of the larynx is infrequent; however, when specimens from patients with laryngeal cancer have been examined closely, the two entities have been associated in 4.9% to 28.8% of cases. Despite this apparent relationship, the literature has failed to address the potential impact of a concurrent laryngocele on surgical decision making. Also, the wide variation in the reported rates of simultaneous occurrence of these two entities is unexplained. We performed whole-organ histopathologic analysis on a laryngeal specimen with bilateral external laryngoceles associated with squamous cell carcinoma and correlated this to computed tomography findings. Based on this information and other reports concerning the pattern of spread of carcinoma within laryngoceles, it appears that supraglottic laryngectomy is oncologically sound in the presence of a laryngocele as long as the usual criteria for this procedure are met.

Aged↗
PubMed1992

Laryngeal chondrosarcomas: a clinicopathologic study of 11 cases, including two "dedifferentiated" chondrosarcomas.

Laryngeal chondrosarcomas are uncommon, and those that contain a distinct, nonchondroid, high-grade spindle cell sarcoma (the so-called "dedifferentiated" chondrosarcoma or chondrosarcoma with additional malignant mesenchymal component [CAMMC]) are extremely rare. Laryngeal CAMMC merit special attention, as CAMMC in other sites portends a poor prognosis. Eleven patients with laryngeal chondrosarcomas are reported on; 2 of these patients had CAMMC. On follow-up, 3 of the 11 patients had recurrences. The first had recurrence 4 and 11 years after tumor enucleation; that patient died disease free 2 years after salvage total laryngectomy. The second had recurrence 2 years after partial laryngectomy and was lost to follow-up after salvage total laryngectomy. The last patient recurred 13 years after partial laryngectomy and underwent salvage total laryngectomy; that patient was one of the two who developed CAMMC, and he also developed stomal recurrence of the "dedifferentiated" component 3 years after total laryngectomy. The other 8 patients are disease free after partial laryngectomy (6) or total laryngectomy (2) 10 months to 12 years later (mean: 51 months). This includes the 1 other patient with CAMMC, who is disease free 60 months after total laryngectomy. Laryngeal CAMMC has been shown, in at least one of the two patients, to be associated with a poor outcome. Patients with recurrent laryngeal chondrosarcomas do not have a poorer outcome after salvage total laryngectomy. The authors advocate partial laryngectomy if technically feasible.

Adult↗
PubMedDate not supplied

Late complications after irradiation treatment for cervical adenitis in childhood. A 60-year follow-up study.

Irradiation against benign cervical adenitis in children was formerly a widely used form of treatment which has caused a great number of late complications, mostly various benign and malignant tumours in the head and neck area, especially in the thyroid gland. In a follow-up study on 63 individuals irradiated at Karlstad Hospital between 1917 and 1929 we found, in addition to these changes, two hitherto not reported complications. Laryngeal stenoses occurred in 27 cases, 17 of which so severe that they eventually required permanent tracheostomies and 11 had fibrous strictures of the upper esophagus, repeated dilatations have been necessary in many of these cases. These complications were mostly seen in those who had been irradiated at an early age, the laryngeal stenoses appear to be caused by a general retardation or inhibition of the normal growth of the laryngeal cartilages resulting in a microlarynx. One possible explanation for these previously not reported sequelae might be the exceptionally high irradiation doses these persons were exposed to up to 60 years ago.

Aged↗
PubMedDate not supplied

Laryngeal obstruction assessed by computed tomography.

The aim of this study was to find out if laryngeal obstruction could be assessed by measuring the glottic area using computed tomography (CT). Results from model studies were compared with those from twelve patients with laryngeal diseases. Determination of the orolaryngeal airway resistance (Rol) was used as a reference method. The correlation between airway resistance and area in both the model and among the patients was consistent, with a curvilinear relationship. The results indicate that it is possible to measure the area of a short obstruction by CT and that this area determines the degree of obstruction.

Aged↗