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PubMed1990

Histological types of laryngotracheal tumors induced in Syrian golden hamsters by nitrosomorpholine and nitrosopiperidine.

The chronic oral administration of nitrosomorpholine (NM) and nitrosopiperidine (NP) to 360 adult Syrian golden hamsters of both sexes resulted in the induction of a high incidence of laryngo-tracheal tumors, which in the group treated with 0.01% solution of NM affected up to 80% of the males. A total of 232 different laryngo-tracheal tumors were found. 36 of these were located within the supraglottic and glottic larynx, 62 were within the subglottic and glottic larynx, and 134 arose within the trachea. Among the laryngeal supraglottic and glottic tumors there were 18 squamous cell carcinomas, 16 squamous cell papillomas and only 2 mixed cell mucoepidermoid papillomas. All the subglottic laryngeal tumors and tracheal tumors were mixed cell mucoepidermoid papillomas. In this study, the squamous cell carcinomas observed within the larynx of hamsters bear morphological and biological similarities to their tumor counterpart found in the larynx of adult man. The laryngeal squamous papillomas observed in this experiment are not similar to the squamous papillomas occurring in man during infancy and childhood. The mixed cell mucoepidermoid papillomas of the hamster trachea and subglottis are a peculiar neoplasm of this species, which morphologically and biologically differs from the cases of tracheal papillomatosis described in man, as well as from the mucoepidermoid tumors of major and minor salivary gland origin also seen in this latter species.

Administration, Oral↗

PubMed2001

Leaf position optimization for step-and-shoot IMRT.

PURPOSE: To describe the theoretical basis, the algorithm, and implementation of a tool that optimizes segment shapes and weights for step-and-shoot intensity-modulated radiation therapy delivered by multileaf collimators. METHODS AND MATERIALS: The tool, called SOWAT (Segment Outline and Weight Adapting Tool) is applied to a set of segments, segment weights, and corresponding dose distribution, computed by an external dose computation engine. SOWAT evaluates the effects of changing the position of each collimating leaf of each segment on an objective function, as follows. Changing a leaf position causes a change in the segment-specific dose matrix, which is calculated by a fast dose computation algorithm. A weighted sum of all segment-specific dose matrices provides the dose distribution and allows computation of the value of the objective function. Only leaf position changes that comply with the multileaf collimator constraints are evaluated. Leaf position changes that tend to decrease the value of the objective function are retained. After several possible positions have been evaluated for all collimating leaves of all segments, an external dose engine recomputes the dose distribution, based on the adapted leaf positions and weights. The plan is evaluated. If the plan is accepted, a segment sequencer is used to make the prescription files for the treatment machine. Otherwise, the user can restart SOWAT using the new set of segments, segment weights, and corresponding dose distribution. The implementation was illustrated using two example cases. The first example is a T1N0M0 supraglottic cancer case that was distributed as a multicenter planning exercise by investigators from Rotterdam, The Netherlands. The exercise involved a two-phase plan. Phase 1 involved the delivery of 46 Gy to a concave-shaped planning target volume (PTV) consisting of the primary tumor volume and the elective lymph nodal regions II-IV on both sides of the neck. Phase 2 involved a boost of 24 Gy to the primary tumor region only. SOWAT was applied to the Phase 1 plan. Parotid sparing was a planning goal. The second implementation example is an ethmoid sinus cancer case, planned with the intent of bilateral visus sparing. The median PTV prescription dose was 70 Gy with a maximum dose constraint to the optic pathway structures of 60 Gy. RESULTS: The initial set of segments, segment weights, and corresponding dose distribution were obtained, respectively, by an anatomy-based segmentation tool, a segment weight optimization tool, and a differential scatter-air ratio dose computation algorithm as external dose engine. For the supraglottic case, this resulted in a plan that proved to be comparable to the plans obtained at the other institutes by forward or inverse planning techniques. After using SOWAT, the minimum PTV dose and PTV dose homogeneity increased; the maximum dose to the spinal cord decreased from 38 Gy to 32 Gy. The left parotid mean dose decreased from 22 Gy to 19 Gy and the right parotid mean dose from 20 to 18 Gy. For the ethmoid sinus case, the target homogeneity increased by leaf position optimization, together with a better sparing of the optical tracts. CONCLUSIONS: By using SOWAT, the plans improved with respect to all plan evaluation end points. Compliance with the multileaf collimator constraints is guaranteed. The treatment delivery time remains almost unchanged, because no additional segments are created.

Humans↗

PubMed1998

T4 laryngeal carcinoma: radiotherapy alone with surgery reserved for salvage.

PURPOSE: To review the results of primary radiation therapy for patients with T4 squamous cell carcinoma of the larynx. METHODS AND MATERIALS: Between October 1964 and October 1994, 43 patients with T4 invasive squamous cell carcinoma of the larynx received radiotherapy with curative intent in the University of Florida Department of Radiation Oncology. All patients had a minimum of 2 years follow-up. There were 26 primary cancers of the supraglottic larynx, 11 of the glottic larynx, and 6 of the subglottic larynx. RESULTS: The 5-year actuarial rate of local control was 52%. By direct calculation, local control was achieved in 8 (38%) of 21 supraglottic carcinomas, 8 (89%) of 9 glottic tumors, and 2 of 6 subglottic tumors. Local control of nonbulky lesions was achieved in 67%, and 38% of bulky lesions were locally controlled. Only 3 (17%) of 18 local recurrences were successfully salvaged by subsequent surgery. There were 2 (5%) severe complications of irradiation. CONCLUSION: From our series, as well as a review of the literature, local control by primary irradiation has been achieved in approximately 50% of patients with T4 laryngeal cancer. Selection factors for choosing irradiation have not been well described: the present series contains a small amount of information suggesting that tumor volume may be a reliable predictor of control, but further substantiation is required.

Adult↗

PubMed1985

Aspects on laryngeal cancer based on whole organ sections.

Whole organ sectioning of laryngectomy specimens has been applied since quite a few years to increase our knowledge of the histopathological behavior of laryngeal carcinoma. The laboratory techniques have been successively refined with shortening of the processing time and with improved histological results. The larynx may be cut in the coronal, sagittal or in the transverse plane, which has become more actual for comparison between computed tomograms and histopathological findings. The growth and spread of laryngeal cancer is determined by the site of origin. Glottic carcinomas often invade the thyroid cartilage in the anterior commissure area and extend outside the larynx through cartilage or by extending subglottically and then through the crico-thyroid membrane. More extensive glottic carcinomas with supra- and/or subglottic extension may spread laterally through the crico-thyroid space. This way of spread is very characteristic for tumors surrounding the laryngeal ventricle--"transglottic carcinomas." Supraglottic carcinomas show a high tendency to invade the pre-epiglottic space. Despite an advanced size they tend to be confined to the supraglottic region, but may especially when ulcerated extend down to the glottic region in the anterior midline. Primary subglottic carcinomas are rare but tend to be advanced when diagnosed, having a circumferential growth with extension up into the vocal cord muscles. They may invade the laryngeal framework and spread outside the larynx through the crico-thyroid membrane. By using the whole organ sectioning technique we have gained further knowledge of the strength and weaknesses of our clinical and radiological diagnostic methods and we have a possibility to compare the radiographic findings with the histopathological sections.(ABSTRACT TRUNCATED AT 250 WORDS)

Glottis↗

PubMed1997

The significance of arytenoid edema following radiotherapy of laryngeal carcinoma with respect to residual and recurrent tumour.

We sometimes experience patients with persistent or progressive arytenoid edema, among which residual or recurrent cancer is often accompanied. Because it is difficult to distinguish tumour rest or recurrence from normal tissue sequelae in the early period after irradiation, it is important to know both the contributing factors for arytenoid edema, and the incidence of residual or recurrent tumours in patients with postirradiation laryngeal edema. We therefore reviewed the charts of 67 patients with early laryngeal carcinoma who had received a curative dose of irradiation in the last 5 years. Fourteen patients (20.9%) had moderate or severe laryngeal edema persisting for or developing at more than 3 months after completion of a course of definitive radiotherapy. The incidence was highest in supraglottic T2 disease, followed by glottic T2 tumour. Of the 14 patients with edema, six (42.9%) had persistent or recurrent disease. The primary disease was uncontrolled in 18 patients, 17 of whom received successful salvage surgery. In patients without residual tumours, the edema was usually moderate and resolved within a year, although four patients had chronic edema lasting more than a year after treatment. All four had supraglottic T2 lesions and received 70 Gy of X-ray. We also reviewed, for sake of comparison, the records of 38 patients treated with radiotherapy at doses of more than 40 Gy between 1975 and 1980, when endoscopic microsurgery for laryngeal cancer was introduced as a primary part of treatment. The incidence of persistent or late developed edema over the period, though not significant, was 36.8%: nearly twice that of the last 5 years. Microscopic endolaryngeal surgical procedures seem to have been a causal factor for edema in this period.

Adult↗

PubMed1996

Laryngeal carcinoma in females.

Between 1950 and 1992, 96 women with squamous cell carcinoma of the larynx were diagnosed and treated in the Department of Otolaryngology and Oncology at Beilinson Medical Center, Israel, and Long Island College Hospital, Brooklyn, New York. Fifty-seven female patients (59%) had glottic carcinoma, 72% of them in stage I. Thirty-eight had supraglottic carcinoma, 68% of them in stages II and III. One patient had stage I subglottic carcinoma. Treatment varied between radiotherapy, surgery, or combined surgery with radiation and/or chemotherapy. The 5-year survival rate was 87%. Although most of the patients had glottic carcinoma in stage I, there was also a high percentage with supraglottic carcinoma, most in advanced stages and with metastases to other regions. The prognosis is not different from that in men. Smoking is an important factor in glottic carcinoma, but not as important as in males.

Carcinoma, Squamous Cell↗

PubMed2001

Vocal tract resonance analysis of aging voice using long-term average spectra.

This study is the first to use long-term average spectra (LTAS) to investigate resonance characteristics of dynamic speech in young adulthood and old age. A total of 80 speakers participated, divided equally by age group and gender. All elderly speakers were healthy, active members of the community. Measurement of the first three spectral peaks in LTAS from the first paragraph of the Rainbow Passage revealed significant lowering of peak 1 from young adulthood to old age in both men and women. Peaks 2 and 3 also lowered significantly across the adult lifespan in women and showed a tendency to lower in men. These acoustic findings are consistent with anatomic data suggesting that aging results in lengthening of the supraglottic vocal tract. Findings that women demonstrate more substantial lowering of spectral peaks with aging than men suggest that women may undergo more pronounced age-related lengthening of the supraglottic vocal tract. Alternatively, it is possible that elderly men systematically alter tongue position during vowel articulation while elderly women are less inclined to do so. Taken in conjunction with previous research, these findings suggest a "mixed model" of vocal tract resonance changes with aging in which an interaction exists between gender, the resonance effects of laryngeal lowering, and vowel articulatory patterns.

Adult↗

PubMed1998

T3-4 squamous cell carcinoma of the larynx treated with radiation therapy alone.

This article reviews the results of radiation therapy alone for T3-4 squamous cell carcinoma of the larynx. Local control after radiation therapy is approximately 65% for patients with T3 glottic and supraglottic carcinoma. The likelihood of local control is inversely related to tumor volume and, for those with glottic cancers, is adversely influenced by cartilage sclerosis on pretreatment computed tomography of the larynx. Local control after radiotherapy is approximately 60% for T4 glottic cancers and 50% for T4 supraglottic carcinomas. The probability of severe complications is related to primary site and T-stage.

Carcinoma, Squamous Cell↗

PubMed1992

Complications of treatment of recurrent laryngeal papillomatosis with the carbon dioxide laser in children.

A retrospective study of the complications of treatment with the carbon dioxide (CO2) laser of 17 patients diagnosed to be suffering from recurrent laryngeal papillomatosis is presented. No immediate complications occurred except one case of laryngospasm and failure to intubate during anaesthesia leading to hypoxic encephalopathy. Three patients were completely free from disease and complications. Another patient was free from laryngeal lesions but developed a papilloma in the right tonsillar pillar. Five other patients showed one or more multiple sites of involvement in addition to the larynx. Laryngeal scarring developed in ten patients. Six patients (35.29 per cent) developed scarring as anterior glottic webs while in two scarring (11.7 per cent) occurred as posterior glottic webs. One developed scarring in the supraglottic region. The remaining one had scarring in both the glottic and supraglottic regions. One patient developed tracheal scarring necessitating laryngo-tracheal separation. Two patients were psychologically disturbed during treatment requiring psychiatric consultation and therapy.

Child↗

PubMed1997

Different glycoconjugates in the submucosal glands of the supraglottis and subglottis. Lectin histochemistry study in the hamster.

A lectin histochemistry study was performed in the supraglottic and subglottic regions of 10 hamsters. The submucosal glands were observed by light microscopy. The supraglottic submucosal glands presented numerous mucous tubules but on the other hand, the subglottic submucosal glands had serous tubules which finished at the distal portion in serous acini. The results suggest that the distribution of fucosylated-mucin and serum-type glycoproteins between the supra- and subglottic submucosal glands suggest a different viscosity and function of the mucus.

Animals↗

PubMed2006

Acute epiglottitis in adults: a recent experience with 10 cases.

OBJECTIVES: Our objective was to examine the presentation, clinical course and management of acute epiglottitis in a recent series of adult patients. METHOD: All consecutive adults with acute epiglottitis or supraglottitis admitted to a tertiary referral centre over a recent six-month period were included in this retrospective study. The diagnosis of epiglottitis or supraglottitis was established by flexible nasolaryngoscopy. RESULTS: Ten patients were included. Two patients had concurrent acute tonsillitis and one had a peritonsillar abscess. Blood cultures were negative in all cases. Pathogens were isolated by throat swabs only in the two patients with acute tonsillitis. Two patients underwent intubation for management of airway obstruction. A combination of cefotaxime and metronidazole was the most common antibiotic regimen used. CONCLUSION: The rising incidence of acute epiglottitis in the adult population mandates vigilance on the part of the otolaryngologist. Selective airway intervention is recommended for patients with airway obstruction of more than 50 per cent.

Acute Disease↗

PubMed2006

Relationship between tumour-node-metastasis stage of laryngeal squamous cell carcinoma and duration of symptoms.

OBJECTIVE: To evaluate the relationship between disease stage and duration of symptoms for squamous cell carcinoma of the larynx. METHOD: We evaluated retrospectively data from 102 laryngeal squamous cell carcinoma patients seen in the otorhinolaryngology department of the Gazi University School of Medicine between December 1996 and June 2004. Inclusion criteria were a histologic diagnosis of laryngeal squamous cell carcinoma, no previous medical, surgical or radiological treatment for carcinoma, and the absence of any other primary tumours or distant metastatic disease. RESULTS: There was no relationship between duration of symptoms and stage of the disease, both for glottic and supraglottic tumours. When glottic and supraglottic tumours were compared, no significant difference in symptom duration could be found. CONCLUSION: There is no correlation between symptom duration and the stage of the disease for squamous cell carcinoma of the larynx. Therefore, symptom duration does not reflect the stage of the tumour.

Adult↗

PubMed1983

The influence of stress, position, and utterance length on the pressure characteristics of English /p/ and /b/.

This study examines pressure characteristics of /p/ and /b/ as a function of position with regard to stress and position within the utterance. Eight female talkers produced utterances which varied in length from one to five disyllables ([pápe] or [bábe]). Results demonstrate the importance of utterance position for the magnitude of supraglottal pressure in stops. Except in voiceless stops found in the first words of utterances, pressure was greater in the prestressed than in the poststressed position. The pressure difference distinguishing /p/ and /b/ was reduced considerably when these stops occurred in absolute utterance-initial position. A post hoc analysis revealed that pressure increased much more slowly in initial than in noninitial stops and that /p/ and /b/ were not distinguished by the rate at which supraglottal pressure increased when these stops occurred in utterance-initial position. Finally, it was found that the pressure of stops in the first words of utterances increased as a function of utterance length, suggesting preplanning for sentence production at the respiratory level.

Adult↗

PubMed1989

Laryngeal configuration and constriction during two types of whispering.

Laryngeal functioning during the production of whispered speech is not well understood. The efficacy of whispering as a means of voice rest is a common clinical concern that is unresolved. This investigation examined vocal-fold configuration, glottal size, and airway constriction by supraglottal structures during whispering. Ten normally speaking adults produced consonant-vowel syllables with three different vowels while whispering in low-effort and high-effort manners. The larynx was visualized through fiberoptic endonasolaryngoscopy, and the views were recorded on videotape. Analysis and descriptions of the data revealed that low-effort and high-effort whispering were differentiated to a small extent by vocal-fold adjustments and to a somewhat larger degree by supraglottal constriction. However, for each dependent variable, individual subject differences tended to be considerably larger than any systematic effects due to whisper type or vowel.

Adult↗

PubMed1995

Glottal area and vibratory patterns studied with simultaneous stroboscopy, flow glottography, and electroglottography.

The purpose of the present study was to examine the relationship between variations in glottal area and vibratory patterns during phonation studied with stroboscopy and glottographic methods. Two normal speaking male and three female subjects were examined by means of simultaneous stroboscopy, flow glottography, and electroglottography. Estimations were made of the glottal area from pressure and flow data using the formula described by van den Berg. Significant correlations were found for the male phonations between estimations and measurements of the minimum glottal area (glottal insufficiency). Estimations of the peak glottal area were also significantly correlated to measured peak glottal area for values below 25 mm2. The estimated minimum area tended to be higher, whereas the estimated peak area values were lower than the corresponding glottal area measurements. This might be explained by variations in glottal and supraglottal geometry for different modes of phonation and by sub- and supraglottal acoustic interaction. Several glottographic parameters for the male phonations were highly correlated with the measurements of glottal insufficiency and also differed significantly between normal, pressed, and breathy hypofunctional modes of phonation. The presence of a hump in the first part of the closed phase for the flow glottogram seems to indicate that a clearly visible mucosal wave is present during vocal fold vibration.

Electric Stimulation↗

PubMed2000

[Malignant lymphoma of the larynx: a case report and review of the literature].

BACKGROUND: Malignant lymphoma of the larynx are rare tumors and represent less than 1% of primary malignant laryngeal tumors. CASE REPORT: In this case report we present a case of a diffuse large B-cell lymphoma of the larynx. Clinical presentation, diagnostic approach, staging and differential diagnosis as well as therapy and prognosis are discussed in relation to the available literature. CONCLUSIONS: Lymphomas primary to the larynx are non-Hodgkin-lymphomas and are predominantly located in the supraglottic larynx. The presenting symptoms and signs include dysphagia, dysphonia, dyspnea which on occasion can be severe, and enlarged cervical lymphoma. B-symptoms are mostly not present. Indirect laryngoscopy reveals a globoid submucosal faintly pink tumor mass. The diagnosis rests on histological examination of a biopsy specimen. Benign tumors, squamous cell carcinoma and other lymphoproliferative diseases have to be excluded from the differential diagnosis. Extensive tumor staging is necessary before radiotherapy or chemotherapy. Surgery is not indicated, even in localized disease. Prognosis is good in the most often localized laryngeal non-Hodgkin-lymphomas (stage IE and IIE) and generalization is rare. Hence, supraglottic submucosal laryngeal tumors can represent non-Hodgkin-lymphomas. Biopsy and subsequent histological examination are essential for correct diagnosis.

Aged↗

PubMed2004

[Postoperative bleeding after laser surgery in head and neck tumors].

BACKGROUND: There are different reports in the literature how often postoperative hemorrhage occurs after laser resection of head-and-neck tumours. This retrospective study investigates the frequency of postoperative hemorrhage after laser surgery of head and neck tumours. Time and extent of bleeding have been considered as well as the localization of the primary tumour and possible general risk factors. METHODS AND PATIENTS: Between 1998 and 2001, microscopic laser surgery was performed in 223 patients with previously untreated squamous cell carcinomas of the oral cavity, oropharynx, supraglottic and glottic region and the hypopharynx. In case of ultrasonographic or palpable evidence of cervical lymphadenopathy surgery included subsequent neck dissection. The mean age of the patients was 59.2 year. RESULTS: Postoperative bleeding occurred in 14 out of 223 patients (6 %). It was 9 % for oral carcinoma, patients 10 % for oropharyngeal carcinoma, 5 % for supraglottic carcinoma and none for glottic and hypopharyngeal carcinoma. 5 patients were treated conservatively, 4 patients were controlled bei cautery and ligation, 1 patient was treated with ligation of the lingual artery and in 2 cases ligation of the external carotid artery was performed. 1 patient had a fatal hemorrhage. CONCLUSIONS: Laser-surgical resection of head and neck carcinomas does not lead to a higher incidence of bleeding complications compared to ordinary surgery.

Adult↗

PubMed1993

[Topographical and clinico-oncologic analysis of locoregional recurrence after transoral laser surgery for laryngeal cancer].

204 patients with carcinoma in situ or infiltrating carcinoma of the larynx were treated with transoral laser partial laryngectomies and, in selected cases, staged neck dissections and postoperative radiotherapy. 169 tumours were glottic, 28 supraglottic and 7 subglottic in origin. Up to now, 21 local and regional recurrences were diagnosed. 16 patients presented with recurrent tumour in the larynx, 3 in the larynx and in the cervical lymph nodes, and two in the neck only with no recurrence at the site of the primary. Out of 19 recurrences in the larynx, 10 were found at the anterior commissure, 5 in the transglottic space, 1 in the arytenoid region and two in the supraglottis. The vast majority of all recurrences were discovered during the first two years after primary treatment. 14 patients were treated with total laryngectomy, two with a second transoral laser resection, one with supraglottic laryngectomy, one with subtotal laryngectomy and two with neck dissections. One patient refused further treatment. 5 patients have so far died due to uncontrollable tumour spread. The analysis of local recurrences demonstrates, that deeply infiltrating tumours at the anterior commissure cannot be steadily removed by transoral laser surgery. Future development of transoral procedures must either focus on complete transoral resection of the anterior part of the thyroid cartilage or at least achieve thermal sterilisation of this area.

Carcinoma in Situ↗