[3 cases of congenital laryngeal diastema].
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Biomedical subjects
Publications and source records attributed to H Laccourreye.
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The laryngeal margin constitutes an anatomic and clinical entity that differs from what is commonly referred to as supraglottic. The present retrospective study reviews 189 cases of carcinomas occurring in this specifically defined region. Local, nodal, and distant metastatic spread of these tumors varied depending on whether the initial tumor site was located in the anterior or lateral margin. Treatment regimens were planned according to the tumor's origin. Primary tumor site surgery associated with a modified or radical neck dissection according to N staging, followed by postoperative radiation is advocated for treatment of these tumors. Cervical nodal metastases are frequent and often bilateral (36%) in cases of anterior margin carcinoma suggesting that bilateral neck dissection sparing two jugular veins for N0 staged carcinoma and one jugular vein when there is evidence of a palpable node, be routinely used. Nodal involvement in cases of lateral margin carcinoma is also frequent but is almost exclusively confined to the ipsilateral nodes. It is suggested that homolateral neck dissection therefore be systematically associated with primary tumor site surgery for these tumors. The various anatomical aspects and pathways of extension of laryngeal margin carcinoma are discussed and a modified TNM classification is proposed.
Three hundred seventy-one primary squamous cell carcinomas of the pyriform sinus were treated at Hôpital Laennec from 1970 through 1984 and retrospectively analyzed. The local and regional treatment consisted of initial surgical resection followed by postoperative radiotherapy. Forty-three patients were not treated by induction chemotherapy; 95 patients received preoperative chemotherapy with bleomycin as a single agent; 98 patients received three preoperative courses of vincristine, methotrexate, bleomycin, or endoxan, and 46 patients were treated by three courses of induction chemotherapy consisting of cisplatin, bleomycin, methotrexate, or 5-fluorouracil. Seventy-two patients received less than 150 mg of bleomycin and 17 patients received only one or two cycles of multiple-agent chemotherapy. Survivals were higher when multiple-agent chemotherapy was employed as compared with single-agent induction chemotherapy. Further prospective investigations are necessary to confirm that induction chemotherapy enhances survival in pyriformk sinus cancers.
The vocal quality attained with a tracheoesophageal myomucosal shunt (MMS) as described by Strome was evaluated in four patients and compared with three esophageal speakers and two normal subjects. The patients with MMSs acquired speech sooner. Fundamental frequency, pitch, timbre, and melody were analyzed with computerized electroglottography and sonography. Intelligibility was deemed better after the MMS primarily because phonation time approximated that of normal speech, and this study suggests that, following total laryngectomy, the vocal quality achieved using the MMS is preferrable to that of esophageal speech.
One case of isolated type IV posterior glottic stenosis successfully treated with CO2 laser posterior transverse cordotomy is presented. This report emphasized the value of the CO2 laser posterior transverse cordotomy in this situation. A review of the various therapeutic options advocated in the medical literature to treat isolated posterior glottic stenosis is also presented.
The supracricoid hemilaryngopharyngectomy consists of resection of the supracricoid hemilarynx and ipsilateral pyriform sinus. Two hundred forty patients underwent this procedure from 1964 through 1983. Two hundred twenty-two patients had no airway impairment, and 204 recovered normal deglutition. The local recurrence rate was 5.2%. Indications for the procedure are carcinoma of the supracricoid upper part of the pyriform sinus and carcinoma of the lateral laryngeal margin with normal vocal cord mobility.
The authors describe ten cases of these rare tumours. They run through rapidly the histological and anatomical classifications. The cases consist of 8 schwannomas (one retropharyngeal schwannoma, two which had developed in the anterior sub-parotid space one of them a malignant schwannoma, the other two were two schwannomas of the sympathetic and three schwannomas of the X). A ganglioneuroma of the sympathetic and a paraganglioma of the X are also described. The authors draw attention to the clinical and anatomopathological distinction between the anterior and posterior sub-parotid spaces; to the need to treat tumours which develop there by surgery; to the different surgical techniques and methods of approach.
The authors describe a microsurgical procedure for translaryngeal arytenoidectomy in bilateral vocal cord paralysis and relate their clinical experience. They consider this approach as very valuable in as much as a rather minimal surgical procedure will create a good airway while conserving a satisfactory vocal function.
We present our method for treatment and follow up in patients with head and neck cancer. We have modified Laennec's Hospital Protocole (Paris), and afterwards we have developed a new computerized database system.
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