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PubMed1991

[Transglottic carcinoma: a histopathological study of 64 cases].

Sixty-four cases of the transglottic carcinoma treated with surgical operations at our hospital were reviewed. The anatomical sites and the serial sections of the tumour specimens were observed. It indicated that 42 cases were proved to be supraglottic carcinomas; 7 glottic; 5 subglottic. Ten cases had no definite primary sites. There was no T1 lesion and only one pT2 lesion. 98.4% of the specimens showed pT3-pT4. 75% specimens lesions greater than or equal to 2 cm. Thus we suggest that the so called transglottic carcinoma should be regarded as an advanced lesion of the laryngeal cancers. The advanced cancers can spread into the paraglottic space and invade the laryngeal frame-works as a special pathological features. The paper also discussed the primary site of the transglottic lesion. We think that it is reasonable to classify the laryngeal cancers into supraglottic, glottic and subglottic categories. The idea to classify tumours that originate in the ventricle into an independent type, i.e. transglottic carcinoma, will wait for further discussions.

Adult↗

PubMed1991

[Radiotherapy of laryngeal carcinoma (T1a/b excluding glottic cancer). Critical review of the literature and personal experience].

The authors reviewed the literature on definitive radiation therapy of supraglottic and glottic cancers (T1 a/b glottic excluded). The results are here presented, in terms of local control and survival, of radiotherapy alone and combined with surgery. Voice quality and complications are discussed, as related to results and therapeutic choice. Methods to improve local control (radio-chemotherapy combinations, chemical modifiers, hyperthermia, multiple day fractionation) are analyzed. Prognostic factors and their influence on treatment choice are discussed. The authors report their results with definitive radiotherapy in patients primarily excluded from surgery (18 T2-3 glottic carcinomas and 119 T1-2-3-4 N0-1-2-3 supraglottic carcinomas). Local control was 61% and 38%, respectively; NED survival at 5 years is 45% and 35%. Complication rate is low (5.8%). In conclusion, the authors try to evaluate the comparative adequacy of surgery (especially conservative) and radiation therapy according to the risk/benefit ratio of disease control.

Combined Modality Therapy↗

PubMedDate not supplied

[Three-quarter laryngectomy. Our experience: indications, surgical technique, results].

Three-quarter laryngectomy is regarded as a supraglottic laryngectomy which has been extended on one side to the glottic plane. Indications are those for supraglottic laryngectomy at the vestibular level and of cordectomy extended to the arytenoid at the glottic level (undamaged lower paraglottic space, preserved motility). Surgical technique includes total removal of the laryngeal vestibule together with the hyoid bone, pre-epiglottic space and one supracricoid hemilarynx (vocal cord, arytenoid, medial wall of the entrance of the pyriform fossa) through an internal, subperichondrial approach. Reconstruction of a new cord on the hemilaryngectomy side is through a triangular strip of the exterior thyroid perichondrium. From 1975 to 1989 44 patients underwent a three-quarter laryngectomy in the authors' department. Functional results were positive in all cases. The oncological results were as follows: 6 recurrences (3 local, 2 locoregional lymph node recurrences and 1 distant metastasis) and 4 primary secondary tumors. 9 patients expired (6 of T, 2 of secondary tumor, 1 of other causes). The actuarial 5-year survival rate for the tumor was 79%.

Adult↗

PubMedDate not supplied

[Latero-cervical metastasis of N0 laryngeal cancer].

The authors report a pathological study of functional neck dissection performed on 145 N0 laryngeal carcinoma patients from 1982 to 1988. The incidence of occult latero-cervical metastases in N0 was evaluated in relation to site and extension of the primitive tumor. A total of 108 supraglottic, 25 glottic and 12 transglottic tumors were observed. Among the cases treated the incidence of occult metastases was 28.3% while capsular rupture accounted for 3.4%. Diagnostic error, calculated on the number of neck dissections, was 20.2%. A greater incidence of occult metastases was found in supraglottic tumors (29.6%) than in either glottic (24%) or transglottic (25%) tumors. Furthermore, incidence of occult metastases proved proportional to the extension of the primitive tumor. There was a single metastases in 35 cases while only 6 cases proved multiple. Some final considerations are given on the importance of performing precautionary functional neck dissection in N0 laryngeal cancer.

Adult↗

PubMed1990

[Neonatal respiratory distress due to congenital laryngeal cyst].

Severe, progressive, neonatal respiratory distress in a 27-month-old girl which required endotracheal intubation, was due to a congenital supraglottic saccular cyst, a rare cause. Aryepiglottic fold bulging and medial displacement of the left side of the larynx, resulting in considerable narrowing of the air-way, were prominent direct laryngoscopic findings. Transoral needle aspiration temporarily improved the infant's condition, but recurrences required repeated endotracheal intubation and needle aspiration. CT imaging demonstrated an intralaryngeal, supraglottic saccular cyst. At 2 months of age the cyst was successfully excised via a paramedian thyrotomy, and tracheotomy avoided. We suggest surgical excision of congenital saccular laryngeal cysts in infants who do not respond to repeated needle aspiration, as effective definitive treatment.

Cysts↗

PubMed1990

Vocal function following vertical hemilaryngectomy: a preliminary investigation.

Seven consecutive male patients who received a vertical hemilaryngectomy were examined for vocal function employing video-stroboscopic, aerodynamic and acoustic measurement techniques. The results of this preliminary investigation suggest that with the group of patients studied, vocal quality was rated as "rough", "breathy" and "constricted". While large variability was noted between individuals, the general tendencies for the group included: (a) incomplete glottic closure; (b) supraglottic structures (ventricular folds, arytenoids) fulfilled or aided vibratory action of the remaining fold; (c) high average transglottal airflow; (d) reduced maximum phonation time; (e) high and more variable vocal frequency positioned near the top of the frequency range; (f) a lower, more variable, and restricted vocal intensity range, and (g) a reduced vocal fold diadochokinetic (vocal fold opening and closing action) rate. We are currently attempting to determine factors related to individual patient strategies for using either glottic or supraglottic valving during phonation.

Carcinoma, Squamous Cell↗

PubMed1989

[Results of treatment of 584 laryngeal cancers at the Ear-Nose-Throat Clinic of Marburg University].

The results in the management of 460 vocal cord carcinomas and 124 supraglottic carcinomas are reported. Of the vocal cord carcinomas, 63.3% were diagnosed in the early Tis and T1 stage. Seventy-six tumors were resected endoscopically, 128 by laryngofissure and chordectomy. Not one of these patients has lost his life, larynx or voice. In bilateral tumors of the T1b category, 2 patients developed local recurrences and lost their larynx. Sixty-two carcinomas of the Tis, T1a and T1b categories were irradiated primarily. Two of these patients died and 14 underwent laryngectomy for local recurrence. In T2 carcinomas a 5-year cure rate of 87.5% was achieved by vertical partial resection. The 5-year cure rate after laryngectomy or laryngectomy with neck dissection for T2N0 and T2N+ carcinoma was 86.2% and 75.0% respectively. Most treatment failures were due to late metastases which could not be controlled. In T3 carcinomas with a 5-year cure rate of 71.4% (N0) and 70.0% (N+) respectively, treatment failures were also mainly seen in patients with N0 necks where we did not carry out a prophylactic neck dissection. Five-year survival rates for primary surgery in supraglottic T1-T4 carcinomas were 100%, 82.4%, 84% and 58.3%. The widely hel opinion that laryngeal carcinoma should only be subjected to surgery for irradiation failure can no longer be sustained. More patients lose their larynx or their life after irradiation of small carcinomas than after primary surgery. Furthermore, too many patients have to undergo two major cancer treatments (irradiation and salvage surgery). In larger carcinomas radiotherapy produces a lower survival rate and too many patients require two stressful cancer therapies. The number of retained larynges is not substantially higher than with primary surgery. Primary irradiation for selected cases should be part of every therapy concept that aims at an adequate and individual treatment of every patient.

Carcinoma in Situ↗

PubMed1989

[Results following total laryngectomy at the Budapest Clinic of Head-Neck surgery].

The data on 356 laryngectomies during a 12-year period were analysed retrospectively. The operations were divided into three groups: group I, laryngectomy alone; group II, laryngectomy and secondary neck dissection; group III, one-stage laryngectomy and radical neck dissection. Most patients had advanced disease (stage III and IV: 54.5% and 23.9%, respectively). Supraglottic and glotto-supraglottic tumours were commonest (39.6% and 36.8%, respectively). The results of palpation, fine-needle biopsy and histology of the lymph nodes are compared. The mean survival time for the three groups was 53.4, 42.7 and 29.8 months, respectively, and the 5-year survival rates were 61.9%, 32.0% and 30.8%, respectively.

Carcinoma, Squamous Cell↗

PubMed1985

[Reconstructive sub-total laryngectomy according to Labayle. Clinical experience on 21 cases].

In this paper the authors report the functional and oncological results regarding 21 patients suffering from laryngeal carcinoma, who underwent surgery at the University of Parma's ORL Clinic - between 1975 and 1984 - for sub-total reconstructive laryngectomy using the Labayle method. This process provides for not just the radical removal of the laryngeal tumor, but also for restoring basic functions such as respiration, phonation and swallowing. To this end, during the destructive phase, the cricoid cartilage (partially or wholly) and one or both of the arytenoids are retained. The application of this method is situated somewhere between the classic total laryngectomy and the conservative supraglottic, at times finding itself in natural opposition to the expanded supraglottic the lateral-front, the hemilaryngectomy, the crico-ioidopesia and the Serafini-type total laryngectomy. Since it doesn't concern a total laryngectomy in the strict sense of the word, the operation presents general counterindications that are relative - and which exist for that matter in all laryngeal surgery, functional or reconstructive - and local counterindications that are absolute. In addition to the, elective indications are dictated critically. The surgical act, illustrated in detail, consists in a period of approach or preparation, a period of destruction and a period of reconstruction. The results obtained from the series of cases followed are wholly satisfactory from both the functional and oncological point of view: the parameters evaluated - respiration, phonation and swallowing - were totally restored in the majority of cases. Swallowing in just two patients was insufficient, as was respiration in one. Concerning the oncological results, if we exclude 4 cases of the 21 considered which do not have a follow-up of more than three years, there have been no clinical signs of a recurrence of the tumoral disease in the remaining 17, of which 15 have been under observation for more than 5 years. The survival rate, up to the first months of 1985, is 70.5%.

Adult↗

PubMed1988

The use of carbon dioxide laser in dealing with fibrous strictures of the larynx and trachea.

The carbon dioxide laser has proved valuable in treating patients with severe scarring of the pharynx and supraglottic larynx. There is minimal re-scarring, and an open operation may be avoided. In conjunction with an open procedure, the laser provides a good method of controlling granulation tissue. Two cases of complete pharyngeal stenosis, resulting from caustic ingestion, are described. In one case, repair was achieved by supraglottic laryngectomy and gastro-hypopharyngeal transposition which temporarily obscured the larynx completely. The laser was used to re-open the laryngeal airway, following which the patient had normal eating, breathing and speaking.

Adolescent↗

PubMed1987

[Functional surgery in cancer of the laryngeal vestibule. Apropos of 149 cases treated at the Institut Gustave-Roussy].

Functional surgery for treatment of 149 cases of cancer of vestibule of larynx admitted to the Institut Gustave-Roussy, Paris, included 92 supraglottic horizontal laryngectomies and 57 reconstructive subtotal laryngectomies with crico-hyoidopexy. General selection criteria for performing subtotal laryngectomy were very strict: local criteria included tumor of vestibule with possible extension to ventricle, to an arytenoid cartilage or to the HTE space, and regional criteria, more particularly, required absence of any palpable gland or mobile gland of less than 2.5 cm. This rigorous selection explains excellent carcinologic results: 90.8% survival after 5 years following subtotal laryngectomy as against 37.9% after supraglottic horizontal laryngectomy, equivalent to a survival rate for all cases of cancer of vestibule of larynx treated by functional surgery of 65% at 3 years and 58% at 5 years.

Adult↗

PubMed1985

Thyroid cartilage flap reconstruction of the larynx following vertical partial laryngectomy: a preliminary report in two patients.

Reconstruction of the larynx following vertical partial laryngectomy may be undertaken with many techniques. Methods using soft tissue employ readily accessible structures within the operative field with straightforward reconstructive designs. However, decannulation is often delayed, and variable degrees of atrophy must be planned for. Methods using cartilage may lead to early decannulation without long-term atrophy as a problem. However, grafts or flaps are less accessible, and reconstructive designs are often complex. In addition, chondritis may be a significant problem, especially in radiated patients. A supraglottic thyroid cartilage flap is described that is readily accessible and maintains its blood supply from external and internal perichondrium, as well as internal mucosa. Its use is reserved for unilateral glottic lesions without supraglottic spread. Experience with this technique is described in two patients.

Carcinoma, Squamous Cell↗

PubMed1985

The role of fibreoptic bronchoscopy in the management of respiratory burns.

We found that fibreoptic bronchoscopy was a useful, simple, safe and accurate method in the diagnosis of inhalation injury, determining the type, the site and the extent of damage sustained. The most common mucosal damage was erythema and oedema of the supraglottic and glottic tissues, though in a few cases more severe and extensive injury was seen. Death seemed to be determined largely by the extent of skin burn but since there did not appear to be a close relationship between the severity of skin burn and the presence of inhalation burn, we suggest that the two types of injuries be evaluated separately. The main therapeutic role lies in the assessment and anticipation of imminent upper airway obstruction caused by oedema of the supraglottic tissues and the glottis. Endotracheal intubation could then be carried out promptly. Changes in clinical features and laboratory results were too slow to be of use in the prediction of upper airway obstruction, but could be indirect indicators of lower and peripheral airway injury.

Adolescent↗

PubMed1979

[Results from 215 patients with laryngeal carcinoma treated with sole radiotherapy or with a combination of radiotherapy and operation (author's transl)].

Results of radiotherapy alone or in combination with surgery in 215 patients with laryngeal cancer are reported (treatment time between 1963 and 1976). In patients with glottic cancer, the cure rate is about 80% and surgical treatment for persistent/recurrent cancer was necessary only in a few cases. Analysis of tumor dose, tumor control rate and complication rate shows that in cases with glottic cancer a tumor dose between 1900 and 2000 ret is necessary and tolerable. In patients with supraglottic laryngeal cancer, the cure rate is about 55%. Early stages (T1N0M0) were mostly treated by radiotherapy alone, moderately advanced stages (T1N1,T2N0+1) mostly received radiotherapy as a primary treatment and were operated in case of irradiation failure. Advanced stages were primarily treated by a combined therapy, and by radiotherapy alone if they were inoperable. In early cases, who are to be treated by radiotherapy alone, the tumor dose should be about 1900 ret. In moderate cases, treatment by primary irradiation alone is possible, if the patient can be followed up regularly; surgery is indicated, if the patient cannot unequivocally be classified as symptomless. In some of these cases, there is no tumor demonstrable histologically in the excised larynx. In using this treatment policy, there is a better functional treatment result than in using primary combined treatment in moderately advanced cases with supraglottic laryngeal cancer.

Adult↗

PubMed1978

Five-year survival of patients with larynx carcinoma treated with irradiation.

182 cases of laryngeal carcinoma treated with irradiation alone or combined surgery and radiotherapy are presented. The five-year survival of the whole series was 56%. 109 (60%) of the cases had a glottic, and 73 (40%) a supraglottic tumour. Of the patients with glottic tumour 58% and of those with supraglottic tumour 53% survived five years. There was no significant difference between cases treated with conventional X-rays and cobalt therapy except in T1 cases which were treated with radiotherapy alone: of the 21 cases treated with X-rays eleven (52%), and of 29 treated with cobalt 24 (83%) survived five years.

Adult↗

PubMed1983

[Prospective study of laryngeal epitheliomas (1975-1981). Results of a multicenter study].

Cases of endolaryngeal epithelioma diagnosed during 1975 were followed up for 5 years in 23 French Laryngology Units. Precise clinical descriptions were reported in 734 cancers: of the vocal cords in 37.5 p. cent of cases and of the vestibule in 32.5 p. cent. Other localizations were observed more rarely. The T1 T2 cancers represented 83 p. cent of glottic tumors and 53 p. cent of supraglottic cancers, their proportion varying from one centre to another. Recovery chances are excellent for cancer limited to the glottic region, both radiotherapy or surgery (5-year survival: 79 p. cent). Prognosis is much poorer and almost identical for supraglottic cancers and those extending to 2 or 3 levels. An analysis of recurrences combined with a multivariate study was conducted to assess clinical and therapeutic factors influencing the course of the disease.

Adult↗

PubMed1981

[Combined radiosurgical treatment of advanced carcinoma of the larynx (T3-4 NO-3). A retrospective comparison between sandwich technique and post-operative irradiation (author's transl)].

From 379 cases of laryngeal and pharyngeal carcinomas we picked out the T3-4 NO-3 tumors and proved whether the sandwich technique or the postoperative irradiation will give the better 5 year survival rates. For supraglottic carcinomas the 5 year survival rate is 59.9% after sandwich therapy and 53.0% after post-operative irradiation. In advanced glottic and hypopharyngeal cancers the prognosis does not depend on one of the both therapeutic schedules: the 5 year survival rate is 55.5% resp. 51.3% and 10.0% resp. 8.3%. Summarizing the carcinomas of all regions of the larynx, that is without the hypopharyngeal neoplasms, we got 54.6% after sandwich and 53.2% after post-operative irradiation. The statistical calculations demonstrate that the sandwich technique will improve the prognosis of supraglottic carcinomas distinctly. Radiotherapy alone in the treatment of advanced cancers of the larynx and hypopharynx is insufficient. The survival chance however depends essentially on the preoperative established lymph nodes. In our material the 5 year survival rate has been deteriorated by more than 25% in the case of N1-3.

Female↗

PubMed1981

Radiotherapy of carcinoma of the Larynx.

123 patients suffering from carcinoma of the larynx were treated by radical radiotherapy at Queen Mary Hospital in Hong Kong between 1970 and 1977. The results are presented. 69(56.1%) were in the supraglottic, 53(43.1%) in the glottic, and 1(0.8%) in the subglottic regions. The incidence of cigarettes, heroin, and opium smoking, and that of alcohol consumption is analysed. The overall actuarial 5-year survival rate for supraglottic cancer was 47.7%, and 80.4% for glottic cancer. The solitary patient with subglottic cancer was alive 9 years after radical radiotherapy.

Adult↗