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PubMed1984

Advanced supraglottic carcinoma: a comparative study of sequential treatment policies.

Data from 131 consecutive patients with operable stage III or IV (American Joint Committee) supraglottic carcinoma were analyzed. Based on existing treatment policies at the time of presentation, patients received either preoperative radiation therapy (RT) (48 patients), surgery alone (42 patients), or postoperative RT (41 patients). Preoperative RT dose levels were either 2,000 rad in five fractions (33 patients) or 5,000 rad in 25 fractions (15 patients). Postoperative RT dosages were 5,000 to 6,000 rad in 6 to 6 1/2 weeks. Surgical procedures included either subtotal or total laryngectomy and radical neck dissection. Tumor control was achieved in 21 of 42 patients (50%) treated with surgery alone, 23 of 48 patients (48%) treated with preoperative RT, and 29 of 41 patients (71%) treated with postoperative RT (P = 0.005). The actuarial, recurrence-free survival at 5 years was 36% and 35%, respectively, in the surgery alone or preoperative RT groups as compared to 55% in postoperatively irradiated patients. The authors conclude that advanced but resectable supraglottic carcinomas may be best treated with surgery followed by RT, rather than with surgery alone or with combined preoperative RT and surgery.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Manofluorography of deglutition after supraglottic laryngectomy.

Manofluorography (mano: manometry, fluoro: videofluoroscopy, graphy: picture) provides a simultaneous display of manometry and fluoroscopy on one video screen. This study uses manofluorography to analyze the swallowing patterns of nine patients who had undergone supraglottic laryngectomy. The results show that during swallowing the pharyngeal mechanism for preventing aspiration depends upon three processes: (1) tight lingual-laryngeal contact, (2) coordination of the swallowing reflex, and (3) tongue base and pharyngeal constrictor clearing of the hypopharynx and laryngeal inlet. Anterior suspension of the larynx under the tongue base serves to improve lingual-laryngeal contact. This close contact during deglutition protects the airway from the bolus and also opens the postcricoid region, aiding bolus passage into the esophagus. Impairment of the swallowing reflex, which can cause severe aspiration before the swallowing reflex is triggered, can be rehabilitated by swallowing therapy. Minor aspiration is commonly caused by impaired clearing of the superior hypopharynx after supraglottic laryngectomy.

Deglutition Disorders↗
PubMed1983

Association of some supraglottic laryngeal carcinomas with EB virus.

Thin sections of biopsies from five patients with supraglottic laryngeal carcinoma who possessed antibody to early antigen of EB virus were examined for the presence of EB virus nuclear antigen (EBNA) and EB virus DNA by cytological hybridization in situ. Both EBNA and EB virus DNA were found in the tumour cells of three of the patients. The present findings suggest an association between EB virus and supraglottic carcinoma of the larynx.

Aged↗
PubMed1988

The barrier-like role of activated connective tissue against the spread of supraglottic laryngeal carcinoma.

Light microscopic investigations of whole organ serial sections of 15 laryngectomy specimens with supraglottic carcinomas and comparative electron microscopic studies of the upper and lower poles of the tumors were carried out. The ultrastructure of different poles of the same supraglottic tumors was investigated and showed a more progressive fibrillogenesis with an activation of the connective tissue elements of the border on the lower pole of the malignancy. A significant role is attributed to the barrier-forming feature of activated connective tissue with respect to the inhibition of the extension of tumor into the glottic region.

Carcinoma, Squamous Cell↗
PubMed1988

Mast cell pharyngitis as a cause of supraglottic edema.

A 30-year-old nonatopic woman had experienced a 9-year history of persistent symptoms of supraglottic edema. She had previously undergone epiglottectomy and excision of redundant left arytenoid tissue to improve her breathing and dysphagia. Uvular tissue was removed surgically at our clinic for histopathological examination of the excised tissues. This revealed diffuse infiltration by mast cells, many of which appeared degranulated. Uvular tissue from control patients undergoing uvulopalatopharyngoplasty for obstructive sleep apnea contained significantly fewer mast cells per high power field. To our knowledge such a degree of mast cell infiltration into supraglottic tissues has not been reported previously or associated with clinical symptoms.

Adult↗
PubMed1979

Supraglottic surgery in vestibular cancer.

This paper deals with the experience acquired in the E.N.T. Clinic of the University of Ferrara regarding horizontal supraglottic laryngectomy in vestibular cancer. The anatomical background of this functional surgery and the most important principles of the technique are specified. The results regard 121 cases (13 T1 cases, 93 T2 cases and 15 T4 cases) divided into three groups: 1. patients who had only surgery (68 cases); 2. patients who for various reasons also had complementary postoperative radiotherapy (39 cases); 3. patients with extralaryngeal expansion who had preoperative radiotherapy (14 cases). The high overall survival rate for the 121 cases is particularly significant, as is the shortening of the high-risk period to less than the usual 5 years. The 4-year cure rate is 78% and remains unchanged right through the 7-year follow-up. The authors feel that these data demonstrate further the validity of supraglottic laryngectomy when its precise indications are rigorously observed.

Female↗
PubMed1999

Current value of double-contrast pharyngography and of computed tomography for the detection and for staging of hypopharyngeal, oropharyngeal and supraglottic tumors.

In light of recent endoscopic techniques the current value of double-contrast pharyngography (DCP) and of CT for detection and staging of hypo-, oropharyngeal, and supraglottic tumors is evaluated. The DCP of 151 patients and CT obtained from 99 of these patients were retrospectively analyzed in a double-blinded manner. We used a standard protocol which comprised all relevant anatomical subregions. Results were compared with direct microlaryngoscopy (DL), indirect laryngoscopy (IL), and post-operative histopathological findings. Sensitivity and specificity of DCP was 75.0 % and 86.7 %, respectively. The DCP and IL techniques together yielded a higher sensitivity (96.7 %) than each method separately. Sensitivity and specificity of CT was 87.5 and 100 %, respectively. In 74.7 % CT provided correct staging. Subregional analysis revealed that the results of DCP and CT depend highly on the localization of the tumor. Our results indicate that DCP represents an important screening method for diagnosing hypo-, oropharyngeal, and supraglottic tumors to complete IL and DL. We show that CT is a reliable method for preoperative staging, although small superficial tumors may occasionally be missed by this method.

Administration, Oral↗
PubMed2002

Videofluoroscopy of the swallowing act after partial supraglottic laryngectomy by CO(2) laser.

The evaluation of functional deglutition in patients after partial supraglottic laryngectomy by CO(2) laser was performed by videofluoroscopy of the swallowing act. We studied 20 patients in PA and LL projections, and the swallowing act, at 25 frames per s, was captured on videotape. Aspiration was found in six patients, four of whom had manifest clinical symptoms of aspiration. Four patients had post-deglutitive, one intra-deglutitive and one both intra- and post-deglutitive aspiration. Other swallowing disturbances or structural deformities were not detected. Dynamic radiological studies of swallowing, such as videofluoroscopy of the swallowing act, can provide valuable information regarding functional results after surgical procedures in the upper aerodigestive tract. Our encouraging results prove the validity of partial supraglottic laryngectomy by CO(2) laser as a method of treatment for carcinoma of the larynx.

Aged↗
PubMed2006

Pediatric dyspnea caused by supraglottic stenosis: a rare complication of alkali corrosive injury.

Acquired supraglottic stenosis is a rare, but potential late sequela of corrosive injury, usually occurring 1 to 2 months after the initial trauma. The presentation may be delayed in children and is potentially lethal. We describe two pediatric patients, aged 31 and 16 months, who developed progressive inspiratory stridor and hoarseness about 2 months after accidental alkali ingestion. Fiberoptic laryngoscopy showed supraglottic stenosis. Intubation was achieved with a very small endotracheal tube under fiberoptic laryngobronchoscopic guidance prior to general anesthesia. Both patients successfully underwent CO(2) laser treatment under direct laryngoscopic guidance. There has been no case of recurrence reported after 1 year of follow-up other than a thin membranous scar in one case at the 3rd month of follow-up, which was easily dealt with by bronchoscopy dilatation. For such patients, monthly laryngoscopic examinations are advisable after alkaline corrosive injury for a minimum of 6 months. Prompt diagnosis and early airway intervention can reduce the need for tracheostomy and decrease the mortality rate.

Alkalies↗
PubMed2000

Histopathological predictors of occult lymph node metastases in supraglottic squamous cell carcinomas.

Lymph node metastasis appears to be the most important factor determining survival in patients with squamous cell carcinoma of the larynx. Supraglottic laryngeal carcinomas have a known tendency to metastasize to cervical lymph nodes because of the extensive lymphatic network present. This retrospective cohort study was conducted to define possible histopathological parameters affecting cervical lymph node metastasis and then using these parameters to create a scale to predict occult lymph node metastasis in supraglottic squamous cell carcinoma. The pathological slides of 61 operated patients were reevaluated for tumor grade, lymphatic-vascular invasion, invasion pattern of tumor margins, perineural invasion and lymphocytic infiltration. Grade (P < 0.001), lymphatic-vascular invasion (P < 0.001) and tumor margins (P = 0.007) were found to be closely associated with neck metastasis. To define the risk factors for occult metastasis, a grading scale was created by using grade (G), lymphatic-vascular invasion (L) and tumor margin (M) findings of patients. None of the patients with a GLM value of zero developed occult metastasis. On the other hand occult metastasis was found in 58.8% of N0 patients with a GLM value that was more than zero. These findings indicate that patients with high-grade tumors having infiltrating borders and lymphatic-vascular invasion have a high risk for occult metastasis so that elective treatment of the neck either by neck dissection or radiotherapy should be added to therapy. Serial sections of specimens are needed to avoid missing metastatic loci of disease.

Adult↗
PubMed1999

Minimally invasive surgery for recurrent neuroendocrine carcinoma of the supraglottic larynx.

Calcitonin-secreting neuroendocrine carcinomas of the supraglottic larynx are infrequent tumors, making it difficult to agree on treatment plans for recurrent tumors. Furthermore, this rare malignancy is often confused with the more common medullary thyroid carcinoma, resulting in inappropriate thyroidectomies. We present a case report of a calcitonin-secreting recurrent neuroendocrine carcinoma of the supraglottic larynx, in which surgery and pentagastrin stimulation were performed repeatedly at various stages of the disease. The recurrent laryngeal tumor was ultimately identified and, after construction of a protective tracheostomy, resected transorally en bloc with the underlying arytenoid cartilage. Postoperatively, the patient did well and stimulated calcitonin levels never exceeded double baseline values. Laryngoscopic removal of smaller laryngeal carcinomas is both technically feasible and safe, even when tumors are recurrent. In calcitonin-secreting malignancies, pentagastrin stimulation may facilitate the distinction between laryngeal and medullary thyroid carcinoma and thus help avoid unnecessary thyroidectomies.

Calcitonin↗
PubMed2001

Swallowing function after endoscopic resection of supraglottic carcinoma with the carbon dioxide laser.

From April 1998 to May 2000, 14 patients with supraglottic cancer underwent transoral laser surgery (T-stage T1-2: 11 patients, T3: 3 patients). In three patients, an epiglottectomy or hemi-epiglottectomy was performed. In 11 patients, further structures (false cords, the valleculae and the base of the tongue and/or parts of the arytenoid cartilage) had to be resected. Thirteen patients had to undergo neck dissection and post-operative irradiation. Tracheostomy was carried out prophylactically in two cases. Every patient received a nasogastric tube perioperatively. One week after surgery, an evaluation of dysphagia was performed by video endoscopy (VEED). Aspiration was the main problem; in no case did dysphagia occur. The aspiration was graded according to videolaryngoscopical classification. Four patients had an occasional and ten patients a permanent aspiration after surgery. According to this assessment, an individual deglutition therapy management was established. Ten patients with permanent aspiration received a temporary percutaneous endoscopic gastrostomy (PEG) and were integrated in a rehabilitation programme (stimulation of the swallowing reflex, training of compensatory swallowing manoeuvres, dietary regime). Due to this training programme, the PEG could be removed in eight patients after 2-9 months. No patient needed a laryngectomy or a tracheostomy due to aspiration. There were no cases of aspiration-associated pneumonia. To obtain satisfying functional results after transoral laser surgery of supraglottic cancers with resection of the epiglottis, post-operative deglutition management, consisting of video endoscopy, a training programme and often a PEG, is necessary.

Adult↗
PubMed2001

Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction.

Simultaneous videoradiography and solid-state manometry (videomanometry) was performed in 8 patients (4 women, 4 men; age range = 46-81 years, mean age = 70 years) with pharyngeal dysfunction. Five patients had severe pharyngeal dysfunction with frequent misdirected swallows. Three patients had moderate pharyngeal dysfunction with delayed initiation of pharyngeal swallow. Three different swallowing techniques were used: supraglottic swallow, effortful swallow, and chin tuck. Ten video radiographic variables and six manometric variables were analyzed. Contrast media penetration to the airways was analyzed regarding number of events and level of penetration. Supraglottic swallow, effortful swallow, and chin tuck did not reduce the number of misdirected swallows, but effortful swallow and chin tuck significantly (p = 0.008) reduced the depth of contrast penetration into the larynx and trachea. There was no significant improvement of pharyngeal retention. Chin tuck reduced the distance between the thyroid and the hyoid and the distance between the mandible and the hyoid. No other measured variable was significantly altered. This study shows that none of the different swallowing techniques reduced the number of misdirected swallows. However, there was a significantly reduced depth of the misdirected swallows. The swallowing techniques did not seem to prevent the occurrence of retention or improve weak pharyngeal constrictor muscles in this group of patients with severe to moderate dysfunction.

Aged↗
PubMed2002

Supraglottic swallow, effortful swallow, and chin tuck did not alter hypopharyngeal intrabolus pressure in patients with pharyngeal dysfunction.

Simultaneous videoradiography and solid-state manometry (videomanometry) were performed in 8 patients (4 women, 4 men; age range = 46-81 years, mean age = 70 years) with pharyngeal dysfunction in order to disclose any changes in intrabolus pressure during swallowing maneuvers. Five of the patients had severe pharyngeal dysfunction with frequent misdirected swallows. Three of the patients had moderate pharyngeal dysfunction with delayed initiation of pharyngeal swallow. Three different swallowing techniques were applied: supraglottic swallow, effortful swallow, and chin tuck. Pharyngeal intrabolus pressure was analyzed at the level of the inferior pharyngeal constrictor. Supraglottic swallow, effortful swallow, and chin tuck did not alter peak amplitude or duration of the intrabolus pressure.

Aged↗
PubMed1991

Association of supraglottic and gingival idiopathic plasmacytosis.

Three cases of gingival plasmacytosis in which laryngeal symptoms eventually developed are reported. Two of the three patients underwent endoscopic biopsy of supraglottic lesions, which proved to be similar to those in the oral cavity. The third patient had supraglottic erythema only and was not subjected to biopsy. Known etiologic factors associated with plasma cell gingivitis were excluded. Treatment with oral and topical steroids resulted in good control of the lesions.

Adult↗
PubMed1995

Submental stimulation and supraglottic resistance during mouth breathing.

We studied submental stimulation on supraglottic resistance (Rsg) in 5 normals and 6 patients with obstructive sleep apnea. We then examined the most effective sites of stimulation in the submental regions, and the relationships between Rsg and stimulation frequency and voltage in the supine position. Inspiratory and expiratory Rsg's were obtained as the slope of the linear portion of the pressure-flow relation determined at zero flow. Before stimulation, inspiratory and expiratory Rsg's were 0.76 +/- 0.06 (means +/- SE) and 0.61 +/- 0.02 cmH2O.L-1.sec, respectively, in normals, and 1.04 +/- 0.20 and 0.92 +/- 0.29 cmH2O.L-1.sec, respectively, in patients. Stimulation in the proximal half submental region with surface electrodes 1 cm apart decreased inspiratory and expiratory Rsg's in patients, and inspiratory Rsg in normals. Inspiratory Rsg measured in this submental region showed a stimulation frequency-and voltage-dependency in both groups, but expiratory Rsg did not. These findings suggest that submental stimulation in the proximal half region widens the supraglottic airway during mouth breathing and probably involves the upper airway muscles.

Adult↗
PubMedDate not supplied

Tongue-base-cancer resection with partial supraglottic laryngectomy.

INTRODUCTION: Cancer in the tongue base, which is adjacent to or invading the lingual epiglottis, requires resection of part or all of the larynx to assure adequate surgical margin. Based on whole mount laryngeal sections, a tongue base-partial supraglottic laryngectomy procedure was designed for tumors adjacent to or minimally invading the lingual epiglottis. METHODS: A group of five patients with carcinoma of the tongue base adjacent to or minimally invading the lingual epiglottis was identified. This technique requires excision of the epiglottis, hyoepiglottic ligament, and pre-epiglottic space with the lesion. The structural physiological integrity of the false vocal cords with or without the hyoid bone is preserved. RESULTS: Clear tumor margins were obtained in all five patients. In three patients who required up to 50% resection of the tongue base, decannulation and resumption of a full oral diet was achieved. Two patients with more extensive lesions required 70% resection of the tongue base. Both patients underwent completion laryngectomy months later because of persistent aspiration. CONCLUSION: This preliminary report suggests that partial supraglottic laryngectomy may be used with acceptable functional results in patients with limited tongue base lesions.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Endoscopic laser management of supraglottic cancer.

Current concepts of endoscopic management of supraglottic cancer are an extension of precepts fostered by Jackson. The current approach has been facilitated by a half century of technological developments: the surgical microscope, the CO2 laser, improved laryngoscopes, and general endotracheal anesthesia. Selected small-volume cancers can be curatively resected, whereas excisional biopsy can be performed on larger neoplasms. With this cost effective minimally-invasive surgical approach, there is less disturbance of normal tissue, thereby minimizing morbidity rate and hospitalization. If the transoral excision is inadequate, radiotherapy can not be depended on to eradicate known residual disease. Endoscopic resection of supraglottic cancer should not alter the surgeon's standard management of the neck.

Endoscopy↗