Oat cell carcinoma of the larynx.
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Carcinoma, Small Cell↗
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[Larynx resistance produced by upper respiratory airways stimulation (author's transl)].
Larynx resistance changes during the respiratory cycle at rest and after mechanical stimulation of the epithelium on different zones of the upper airways (extrathoracic trachea, glottis, nasopharynx) were studied in the dog by isolated glottis in situ technique. In reposed breathing, the increase in larynx resistance always started when inspiratory airflow reached its maximum value. Resistance remained high during expiration and had its lowest value when expiratory airflow decreased towards zero. The electromyogram reading for the abdominal muscle evinced low or no activity during the smaller larynx resistance period. The extrathoracic trachea mechanical stimulation with cough response was determined by a significant decrease of larynx resistance. There was also a significant increase in expiratory airflow and abdominal pressure. Inspiratory and expiratory total lung resistance values were both significantly increased with regard to reposed breathing. Mechanical larynx stimulation determined reflexive closing of the glottis, expiratory apnea, minimal abdominal pressure. No potentials were formed in the expiratory abdominal electromyogram. The response was similar to a spontaneous swallowing. Larynx resistance reached its minimal value before the expiratory airflow reached zero. Mechanical nasopharyngeal stimulation significantly increased larynx resistance.
Airway Resistance↗
Monitoring of antitumor immunity in patients with larynx cancer by tube leukocyte adherence inhibition assay.
The presence of specific antitumor immunity was examined by the tube leukocyte adherence inhibition (LAI) assay in patients with carcinomas of the larynx. Peripheral blood leukocytes (PBL) from patients with larynx cancer gave positive reactions in the LAI assay with the antigen prepared from the carcinoma of the larynx but not with antigen from normal larynx tissue. Adherence of PBL from normal donors did not differ significantly irrespective of whether antigens from tumor or normal larynx tissue were used. With a panel of tumor extracts tested, PBL of some patients reacted to only one antigen, wheras PBL of other patients reacted to several antigens. LAI reactivity disappeared after surgery, reappeared at 4 weeks after surgery, and then declined when patients were tumor free. These results show that the tube LAI assay may be of value in diagnosing larynx cancer and in following up its treatment.
Antigens, Neoplasm↗
Measuring larynx movement in standard Thia using the cricothyrometer.
Vertical movement of the larynx during connected speech was investigated in Standard Thai - a language that has five phonologically contrastive tones. The effects of pitch, consonant phonation-type, vowel quality, tonal categories, and position in the utterance were determined. Utterance position was found to be the factor most clearly associated with variations in larynx movement. The occurrence of an overall rise-fall pattern of larynx movement distributed over utterances of varying pitch patterns leads to the conclusion that larynx height is not a principal factor regulating pitch in connected speech. Implications for models of pitch production, distinctive features for tone, theories on the historical development of tone and the role of larynx movements in the production of consonants and vowels are discussed.
Adult↗
[Bronchopulmonary influences in larynx resistance (author's transl)].
Larynx resistance changes have been studied in the dog by means of in situ isolated glottis technique. Bronchiolar tone changed through isoprenaline and histamine administration, and after recurrent and vagus nerve bilateral section. Isoprenaline administration (0.1 mg/kg) was followed by larynx resistance decrease, expiratory duration increase, and expiratory abdominal pressure decrease with regard to respiration preceded by rest. Cough response by mechanical tracheal stimulation and glottis closing by larynx stimulation were abolished after isoprenaline administration. Histamine administration (0.1 mg/kg) was followed by larynx resistance increase, expiratory duration decrease, expiratory abdominal pressure increase, and expiratory abdominal pressure/maximum expiratory airflow relation increase. Larynx resistance decreased after recurrent nerve bilateral section, and increased later when vagus nerves were sectioned.
Airway Resistance↗
Supraglottic larynx and its pathology as studied by whole laryngeal sections.
The need for additional data regarding the behavior of carcinomas of the supraglottic larynx was recognized during attempts to identify candidates for supraglottic laryngectomy. The crux of the matter was whether supraglottic carcinomas remain confined at the supraglottic larynx. If some do not, can these exceptions be detected preoperatively? Information gained from whole-organ study of 40 larynges with such tumors showed that most tumors do remain confined to the supraglottic larynx; however, there are exceptions, and these are usually high-grade tumors. Preoperative biopsy demonstrating undifferentiation in a tumor suggests a potential for atypical behavior. Patients with these high-grade lesions are not candidates for supraglottic laryngectomy. Fortunately, most supraglottic carcinomas are well-differentiated, behave in a typical manner, and fulfill the expectations gained from the preoperative mucosal appearance. Supraglottic laryngectomy is, therefore, feasible and successful in carefully selected candidates. The conclusions of this study are the following: 1. Most supraglottic cancers behave as expected, being typically well-differentiated tumors that remain confined to the supraglottic larynx. 2. Exceptions to such behavior are exemplified by tumors manifesting submucosal extension some distance away from the main tumor mass, tumors invading the thyroid cartilage, second primaries, and tumors disseminating emboli away from the main tumor. 3. Present preoperative diagnostic measures still fail to detect tumors with atypical behavior. Subsequent supraglottic laryngectomy in patients with such tumors would, therefore, leave residual tumor. 4. Carcinomas exhibiting atypical behavior are characteristically undifferentiated and aggressive. 5. The epiglottis and pre-epiglottic space are easily invaded by supraglottic cancer. The pre-epiglottic space is removed during either supraglottic or total laryngectomy. 6. The thyroid cartilage is an excellent barrier to the spread of supraglottic cancers. Tumors that invade it penetrate the anterior commissure first. 7. The pitfalls in the selection of candidates for supraglottic laryngectomy are assessment problems in which the tumor mass makes it difficult to see its full mucosal extent. Inadequate biopsy may also fail to detect a tumor. 8. In the preoperative assessment of a patient with supraglottic carcinoma, supraglottic laryngectomy is contraindicated if the biopsy does show high-grade differentiation and if the tumor is situated near the petiole. 9. Undetected extension submucosally to the level of the glottis will result in some failures with conservation surgery of the larynx.
Carcinoma, Squamous Cell↗
[Vagal control of larynx resistance to the air flow (author's transl)].
Air flow larynx resistance changes have been recorded in dogs after electrical stimulation and lesion of the recurrent and vagus cervicalis nerves respectively. Experiments were carried out with glottis in situ and isolated. The effects of the administration of athropine i.v. (0.3 mg/kg) were also studied. Air flow larynx resistance decreased after secting the right recurrent nerves as well as after athropine administration. Electrical stimulation of the central end of the right vagus nerve produced a complex response characterized by an initial apnaea followed by a larynx resistance decrease. After a few seconds the response continued with glottis spasms followed by typical emetic movements. During the emetic movements larynx closed and opened throughout the respiratory cycle, the closing movement being simultaneous with the inspiratory position of the thorax and with minimal values of the intraabdominal pressure. Larynx resistance increased after uni- and bilateral sections of the vagus cervicalis and after the electrical stimulation of the peripheral end of the right vagus cervicalis. According to the present results, the possible existence of a controlling reflex of laryngeal sphincter motility, generated at the bronchopulmonary level, is postulated.
Airway Resistance↗
Endotracheal intubation and Venturi (jet) ventilation for laser microsurgery of the larynx.
Meeting the exacting requirements for microsurgery of the larynx is a challenge for the anesthesiologist. To accomplish, the necessary dissection, the otolaryngologist has several requirements. They are a quiet relaxed field, excellent illumination with magnification, binocular vision for depth perception, and, above all, an unobstructed field. The management of anesthesia for suspension microsurgery on the larynx presents many problems, the most vexing of which is the fact that the otolaryngologist and anesthesiologist are in competition for access to the patient's airway. In sharing this, neither has been able to perform with the degree of control that he would like due to either inadequate operating conditions or insufficient access to ventilatory mechanisms. Several anesthetic techniques have been used for inspection or operative laryngoscopy: topical anesthesia, apneic techniques, translaryngeal topical anesthesia, chest respirator, neuroleptanalgesia, and general endotracheal anesthesia with muscle relaxants. The latter has proven most popular, particularly in children, because ventilation and surgical conditions are considered to be most controllable. However, the presence of the requisite endotracheal tube obscures the full view of the larynx and vocal cords, and the tube may itself become obstructed. Additionally, use of the laser involves the further risk of heat effects on the endotracheal tube if the beam hits the tube. This report presents our experience and development of the combined technique of endotracheal intubation and Venturi (jet) ventilation. We believe it represents the safest available approach while providing near ideal working conditions for the otolaryngologist during laser microsurgery of the larynx.
Adolescent↗
Benign pleomorphic adenoma of the larynx. A case report.
Minor salivary gland tumors of the larynx are relatively rare. Morphologically the majority of them are adenoid cystic carcinomas and the overwhelming location is the subglottic larynx. Benign pleomorphic adenomas are rare minor salivary gland tumors of the larynx which usually occur at the glottic and subglottic levels. We present only the sixth case of a supraglottic benign pleomorphic adenoma that we could find in the literature. A preoperative laryngogram localized the tumor to the supraglottic larynx and the intact mucosa suggested a specific differential diagnosis. The tumor was removed by a lateral pharyngotomy with retention of good laryngeal function. The relatively asymptomatic presentation of our case is a somewhat unusual finding which, however, was previously noted in similar case reports.
Adenoma, Pleomorphic↗
Urinary androgen- and estrogen excretion in men with pachydermia laryngis and cancer of the larynx.
Considering the larynx as a hormone dependent secondary sex characteristic has previously led to successful antiandrogentherapy of pachydermia of the vocal cords, which may constitute a precancerous state. As a first step to further evaluate the endocrine state of patients with precancerous lesions or cancer of the larynx, the urinary excretion of 17-hydroxysteroids, 17-ketosteroids, testosterone and estrogens has been determined in male patients with pachydermia laryngis (n = 15) or cancer of the larynx (n = 20) as compared to controls with different other otorhino-laryngological affections (n = 20). No difference between groups was found in 17-hydroxysteroids and no significant difference in 17-ketosteroid excretion. The pachydermia group as a whole showed significantly increased levels of testosterone (p = 0.01) and estrogen (p = 0.04) of 64.6 +/- 39.9 microgram/24 hr testosterone versus 34.7 +/- 19.3 microgram/24 hr in controls and 31.7 +/- 16 microgram/24 hr in laryngeal cancer and 277 +/- 14.8 microgram/24 hr total estrogens versus 19.1 +/- 12 microgram/24 hr and 17.8 +/- 8.1 microgram/24 hr respectively. These data further support the idea of hormonal factors playing an important role in the pathogenesis of pachydermia and thus possibly cancer of the larynx. So far, however, they do not permit definite conclusions on the pathogenetic mechanisms involved.
17-Ketosteroids↗
Malignant tumors of the larynx.
A rational choice of treatment for patients with malignant tumors of the larynx depends upon a thorough evaluation of the location, size, and extent of the lesion. Roentgenological examinations of the larynx are a valuable adjunct to clinical and laryngoscopic examinations. In interpretation of roentgenographic findings of malignant tumors of the larynx, a good knowledge of the anatomy of the head and neck, and of the nature, history, and routes of spread of the lesions of the larynx is essential. A correct interpretation needs careful scrutiny of all the roentgenograms; only a persistent abnormality should be regarded as significant. Many of the changes are subtle and require judicious elucidation. Others are quite straightforward and easily recognized. Constant attention to details and willingness to use wisely the different techniques are necessary if the maximum contribution to the diagnosis and management of malignant tumors of the laynx is to be achieved.
Glottis↗
Computed tomography of the normal larynx.
A computed tomographic analysis of normal laryngeal anatomy was undertaken using cadaver larynxes. This was part of a larger project in which patients with laryngeal carcinoma were routinely evaluated in the computed tomographic (CT) body scanner. The appearance of normal laryngeal anatomy had to be delineated before disease processes of the larynx were evaluated, and this was accomplished using a computed tomographic technique with 5-mm slice thicknesses and a 3-mm overlap. The scan slices were then compared with anatomic sections taken at the same levels. The comparisons demonstrate an ideal level of accuracy that can be approached in the in-vivo larynx only with use of the latest-generation scanners. However, CT scanning is of immediate usefulness in the diagnosis of laryngeal pathology.
Humans↗
Fourth Daniel C. Baker, Jr. memorial lecture. Energy and the larynx.
Review of the logistics of energy supply in animals indicates that the advent of the larynx was part of a response to an earlier energy crisis. It permitted a major increase in the flow of energy available to the organism and became the mechanical control point and rate-limiting factor of the increased inflow. Phylogenetically, a succession of structural innovations steadily enhanced the flow capacity of the larynx and rendered the mechanism more versatile, most recently with the accrual of phonation (in mammals), pressurized closure (in primates and odontocetes), and vocal formants and efficiency (in man). The larynx is thus a marker of the animal's capabilities for energy intake, energy utilization and information emmission and, apparently, of the size and complexity of the brain. Today's energy crises appear to continue those of the past.
Anatomy, Comparative↗
[Reconstruction of a larynx and trachea after polytraumatism (author's transl)].
The sourse of a larynx and oesophagus-which had suffered repeated lesion-is reported. Because of the cicatrization and the proliferation the lumen of the larynx was unadapted to respiration. Into the stoma of the cicatrized trachea only a child's cannula could be inserted. The tracheal proliferation was removed surgically and the cicatrial entrance was duly dilated. Afterwards by dilating operation satisfactory air passage was assured. Finally, by wandering of a flap obtained from a thoracal skin the larynx and the tracheostoma were covered. The satisfactory results of the surgical intervention are verified by the time of two years, passed symptom-free and free of complaints since the operation.
Adult↗
[Surgical correction of the severed larynx, associated with severe swallowing disturbances (author's transl)].
After complete separation of the larynx from its cranial suspensions, the larynx is displaced caudally and the base of the tongue cranially. This produces an enlargement of the distance between the larynx and the base of the tongue, which can be demonstrated radiographically. Severe dysphagia is the result which may produce complete inability to swallow. Surgical management of this condition consists of mobilization of the laryngotracheal complex and its attachment to the hyoid bone by sutures. Successful results in two cases are described.
Deglutition Disorders↗
Adenoid cystic carcinoma of the larynx: a report of four cases and a review of the literature.
Adenoid cystic carcinoma (cylindroma) is a well-recognized tumor that is frequently encountered in the major salivary glands, the lacrimal glands and in the minor salivary glands of the oral cavity and upper respiratory tract. Only 60 cases of adenoid cystic carcinoma have been described arising in the larynx. Four new cases are reported and the literature is reviewed. In the larynx, these tumors arise almost exclusively in the subglottic and supraglottic regions--areas having large numbers of seromucinous glands of the minor salivary gland type. These malignant tumors, whether occurring in the larynx or elsewhere, tend to grow quite slowly with prolonged non-specific symptomatology and protracted clinical course. Despite their slow growth, in a majority of cases, they eventually lead to the death of the patient.
Adult↗
Histiocytic tumors of the larynx: a clinicopathological study with review of the literature.
A case of primary malignant fibrous histiocytoma of the larynx occurring in a 58-year-old man is described. This neoplasm is extremely rare in the larynx and the case reported (the second described by me) is the fifth so far reported in the world literature. The patient died after 19 months from first surgical treatment and the autopsy confirmed the histological diagnosis. The cases of histiocytic tumors of the larynx previously reported in the literature are re-examined and reclassified. Biological behavior and the therapy of the tumor, as well as differential diagnosis from other neoplasms, are discussed.
Aged↗
Osteosarcoma of the soft tissue of the larynx: report of a case with light and electron microscopic studies.
A case of osteosarcoma arising in the soft tissue of the larynx in an elderly man is presented with light and electron microscopic documentation. The patient developed chronic hoarseness and a recurring polypoid laryngeal tumor, causing acute airway obstruction. He was treated by total laryngectomy, but he died with multiple pulmonary metastases within three months of laryngectomy. This is the third (or possibly fourth) recorded case of osteosarcoma arising in the soft tissues of the larynx, and the previous cases were clinically and pathologically similar to this one. The prognosis of sarcoma of the larynx is poor but may be improved with early recognition and adequate surgical excision.
Aged↗