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Biomedical subjects

K H Lam

Publications and source records attributed to K H Lam.

113 records · Page 7Linked to original sources
PubMedDate not supplied

Recurrence of laryngeal or hypopharyngeal primary tumor after radical neck dissection for postradiotherapy neck nodal metastases.

BACKGROUND: When the primary tumor in the larynx or hypopharynx responds well to radiotherapy, nodal metastasis in the neck may persist or recur. The primary site is usually left alone when no lesion is evident, but its long-term control is uncertain. METHODS: Radical neck dissection was performed in 23 patients who had nodal metastasis, while the primary tumor in the larynx or hypopharynx was controlled after radiotherapy. The primary site was left alone and kept under surveillance. RESULTS: Seven patients (30%) had recurrence at the primary site on follow-up. Two significant risk factors for development of recurrences at the primary site were identified; the neck node staging at presentation (p < 0.03) and presentation with persistent neck lymph nodes (p < 0.03). The 2-year survival of those patients with recurrences at the primary site was 29%. CONCLUSION: Radical neck dissection alone was justified, but close surveillance of the primary site after surgery is mandatory, especially for those patients with high-risk factors.

Adult↗
PubMedDate not supplied

Extralaryngeal spread of cancer of the larynx: a study with whole-organ sections.

Thirty total laryngectomy and five pharyngolaryngoesophagectomy specimens were studied with the whole-organ sectioning technique. The horizontal plane of sectioning was chosen to study the pattern and degree of extralaryngeal spread in carcinoma of the larynx. There were 22 transglottic, 6 supraglottic, and 7 infraglottic tumors. Among them there were 1 T1, 2 T2, 5 T3, and 27 T4 lesions. Spreading anteriorly, the tumor was found to penetrate the thyrohyoid membrane in 7 (32%) out of 22 transglottic tumors. Among the entire group of 35 specimens the thyroid cartilage was penetrated in 18 cases (51%), and the infrahyoid strap muscles were invaded by tumor in 17 cases (49%). The cricothyroid membrane was penetrated in 19 cases (54%). Spreading posteriorly, the tumor reached or eroded the mucosa of the pyriform fossa in 15 cases (43%), including 10 total laryngectomy specimens. The postcricoid submucosa was involved by tumor in 13 cases (37%) among which 9 were total laryngectomy specimens. It is thus recommended that the wide-field technique should be used for laryngectomy. Awareness of the possibility of tumor reaching the mucosa of the pyriform fossa and the postcricoid area allows the surgeon to keep clear of tumor in performing total laryngectomy.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

The preepiglottic and paraglottic spaces in relation to spread of carcinoma of the larynx.

The submucosal compartments of the larynx were examined using a whole-organ sectioning technique. Seven specimens of normal larynx and 35 specimens of carcinoma of the larynx were studied. Victoria blue and van Gieson stains were used to demonstrate connective tissue elements. The preepiglottic space was distinctly separated from the paraglottic spaces by membranous partitions made up of collagen and elastic fibers. These partitions offer some resistance to tumor invasion in the early stages of laryngeal cancer, keeping the tumor from extending to the adjacent compartment while allowing it to spread freely within the same compartment. In the absence of mucosal extension across the midline, submucosal spread of tumor to the opposite side is unlikely. In view of possible cranial spread of tumor along the preepiglottic and paraglottic spaces, excision of all these spaces, together with the hyoid bone, is indicated in total laryngectomy.

Epiglottis↗
PubMedDate not supplied

Mandibular invasion in carcinoma of the lower alveolus.

PURPOSE: Efforts to conserve the mandible in resection for oral cancer tend to bring the resection margin progressively closer to the tumor front. This study of the manner of mandibular invasion by carcinoma of the lower alveolus provides added information regarding the behavior of the cancer within the bone. MATERIALS AND METHODS: Twenty-four resected specimens of squamous carcinoma of the lower alveolus were studied with x-rays and step-serial whole-organ histological sections. RESULTS: In 19 of the 21 specimens showing bone invasion, the spread was in the form of a broad front. Insinuation of tumor beyond the tumor front was extensive in 9 of 13 tumors showing deep mandibular invasion. Horizontal subcortical spread took place in 5 of 18 specimens for a distance of up to 1 cm. Perineural spread along the inferior alveolar nerve was found in 4 of 13 specimens in which the tumor extended to the canal; tumor spread along the canal, without neural involvement, was never seen. Preoperative orthopantomogram correctly estimated the extent of mandibular invasion in 16 of 24 patients. CONCLUSIONS: The tumor front of mandibular invasion by carcinoma of the lower alveolus is usually broad. In the absence of deep invasion, which is defined by invasion reaching the alveolar canal, there is little or no insinuation of cancer cells beyond the tumor front, and no spread along the alveolar canal. Marginal mandibulectomy can be applied more widely, taking a margin of 1 cm in all directions.

Alveolar Process↗