Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Supraglottitis”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 253 records · Page 14Linked to original sources
PubMed2000

331 cases of clinically node-negative supraglottic carcinoma of the larynx: a study of a modest size fixed field radiotherapy approach.

PURPOSE: For node-negative supraglottic carcinoma of the larynx, radiotherapy with surgery in reserve commonly provides very good results in terms of both local control and survival, while preserving function. However uncertainty exists over the treatment of the node-negative neck. Elective whole neck radiotherapy, while effective, may be associated with significant morbidity. The purpose of this study was to examine our practice of treating a modest size, fixed field to a high biologically effective dose and compare it with the patterns of recurrence from other centers that use different dose/volume approaches. METHODS AND MATERIALS: Over a 10-year period 331 patients with node-negative supraglottic carcinoma of the larynx were treated with radiotherapy at the Christie Hospital Manchester. Patients were treated with doses of 50-55 Gy in 16 fractions over 3 weeks. Data were collected retrospectively for local and regional control, survival, and morbidity. RESULTS: Overall local control, after surgical salvage in 17 cases, was 79% (T1-92%, T2-81%, T3-67%, T4-73%). Overall regional lymph node control, after surgical salvage in 13 cases, was 84% (T1-91%, T2-88%, T3-81%, T4-72%). Five-year crude survival was 50%, but after correcting for intercurrent deaths was 70% (T1-83%, T2-78%, T3-53%, T4-61%). Serious morbidity requiring surgery was seen in 7 cases (2.1%) and was related to prescribed dose (50 Gy-0%, 52.5 Gy-1. 3%, 55 Gy-3.4%). DISCUSSION: Our results confirm that treating a modest size, fixed field to a high biologically effective dose is highly effective. It enables preservation of the larynx in most cases, with acceptable regional control and no loss of survival compared to whole neck radiotherapy regimes.

Adult↗
PubMed1997

Prognostic value of nucleolar organizer regions in supraglottic carcinoma.

The relationship of nucleolar organizer regions (NORs) to proliferative activity and tumor progression was studied in 16 supraglottic carcinomas. The number of NORs stained by a silver colloid staining method (AgNOR staining method) was determined. The mean AgNOR number tended to be higher (but not significantly so) in poorly differentiated tumors. Moreover as T and N categories and stage of the tumor rose, the AgNOR number also rose, but not significantly. More interestingly, the mean AgNOR number was significantly higher in the presence than in the absence of lymph node metastasis. These studies indicate that the AgNOR number might be of clinical value as a predictor of lymph node metastasis of supraglottic carcinomas.

Aged↗
PubMed1996

Expression of p34cdc2 protein kinase and p53 in supraglottic carcinomas.

The clinicopathological significance of the simultaneous expression of the p34cdc2 protein kinase oncogene product and mutant-type p53 oncogene product was studied in 15 supraglottic squamous cell carcinomas. Clinical and histopathological data were recorded from the medical records, and immunohistochemical and DNA cytofluorometric analysis were performed. p34cdc2 was positive in 80% and mutant-type p53 in 53% of the tumors. Their simultaneous expression was seen in 33% of the tumors, but the probability was not statistically significant. Correlations between the expression of p34cdc2 or mutant-type p53 and T, N categories, histological differentiation, and DNA ploidy pattern were not significant. However, when the percentages of p34cdc2 and mutant-type p53-positive cells in the tumor were high, aneuploidy tended to be present and the clinical stage more advanced. It is suggested that the growth and progression of supraglottic carcinomas are associated with the disruption of the regulatory system of the cell cycle.

Aged↗
PubMed2003

Radical radiation vs surgery plus post-operative radiation in advanced (resectable) supraglottic larynx and pyriform sinus cancers: a prospective randomized study.

AIM: Survival in head and neck cancers reflect loco-regional control. With an aim of organ and function preservation the present study was undertaken to compare local failure and survivals. MATERIAL AND METHODS: Between August 1991-December 1995, 72 patients with resectable advanced supraglottic cancers, were randomized to radical surgery followed by post-operative radiation therapy (Sx+PORT) (Arm I) or radical radiation therapy followed by salvage surgery (RRT+/-SSx) (Arm II). RESULTS: Sixty-four of 72 patients were evaluable, 55 were T3 (86%) and 9 were T4 (14%) tumors. In Arm I (n=35) with a mean follow-up of 24 months (2-86 months), 21 patients were alive without disease. Six patients had recurrence, one each at local and tracheostomy stoma, four had nodal recurrence only, and two developed 2nd primary in soft palate/tonsil and parotid at 15 and 18 months respectively. In Arm II (n=29), with a mean follow-up of 24 months (3-81 months), 14 patients were alive without disease. Thirteen patients had recurrence, eight had local (one patient had persistent disease), two nodal only, three loco-regional and two patients developed distant metastasis (lung). One out of eight local recurrence and 2/2 nodal recurrences were salvaged with Sx. There was a significant difference in disease-free survival between the two treatment arms, DFS (5 years) of 70% in Arm I vs 50% in Arm II (p=0.04), but did not have any impact on overall survival OAS (5 years); 73% vs 77% (p=0.79). Voice/laryngeal preservation was possible in 18/29 patients (62%) treated with RRT+/- Sx, without significantly affecting the OAS. "Pathological upstaging" was another significant finding seen in 64% of clinical T3 after radical surgery. CONCLUSION: RRT+/-SSx can be a feasible option in low volume, favourable resectable stage III and IV supraglottic lesions for better quality of life.

Adult↗
PubMed2002

Expression of E-cadherin in squamous cell carcinomas of the supraglottic larynx with correlations to clinicopathological features.

The aim of this study was to investigate the prognostic significance of E-cadherin expression in squamous cell carcinomas of the supraglottic larynx. 101 primary carcinomas were retrospectively studied. The level of E-cadherin expression was determined by immunohistochemistry. There was a significant correlation between decreased E-cadherin expression and the presence of nodal metastases (P=0.007). T-stage (P=0.025) and histological grade (P=0.043) were also associated with nodal metastases. Multivariate analysis confirmed that these three parameters were independent predictors of nodal metastases. Decreased E-cadherin expression also correlated with an increase in recurrence rates (P=0.019). However, in multivariate analysis only pathological N-stage was significantly associated with disease-specific survival. We conclude that E-cadherin is an independent predictor of nodal metastases in supraglottic squamous cell carcinomas. Determination of E-cadherin expression levels might be useful in identifying patients with clinically negative lymph nodes who are at risk of occult metastases, allowing more effective treatment strategies to be implemented.

Biomarkers, Tumor↗
PubMed2003

Survival from glottic and supraglottic laryngeal carcinoma in Mumbai (Bombay), India.

The survival experience of patients with cancer of the larynx (ICD 10) registered by the Bombay population-based cancer registry India, during the years 1992-1994, is described. The vital status of these subjects were established by matching with death certificates from the Bombay Municipal death register and by active methods such as reply-paid postal enquiries, telephone enquiries, scrutiny of case records and house visits. Of the 675 eligible cases for analysis, 458 (67.9%) were dead and 217 (32.1%) were alive at last follow-up. The 5-year observed and relative survival rates were 29.1 and 38.2%, respectively; these were 52.1 and 58.5% for glottic laryngeal cancer and 24.2 and 31.4% for supraglottic laryngeal cancer, respectively. The 5-year observed survival was 53.1% for those with localised cancer and 17.8% for those with regional extension. Advancing age, regional and metastatic disease and supraglottic cancers were associated with significantly reduced survival. Early detection and prompt treatment should improve overall survival from laryngeal cancer.

Adult↗
PubMed1992

Surgical approach to submucosal lesions of the supraglottic larynx: the supero-lateral thyrotomy.

The surgical approach to the hypopharynx by lateral pharyngotomy as described by Trotter has found widespread use in management of supraglottic carcinoma. A similar but more conservative approach may be employed for removal of cysts and benign or well-encapsulated neoplasms of the epiglottis and supraglottic space. We call this approach a supero-lateral thyrotomy, to differentiate it from the classic lateral pharyngotomy. Surgery consists of subperichondrial resection of the superior half of the ipsilateral thyroid cartilage with preservation of internal lining and superior laryngeal nerve. The lesion may then be enucleated or resected, and the defect, if any exists, closed with overlying mucosa and the flap of preserved perichondrium. The technique has been employed in cases of paraganglioma, haemangiopericytoma and saccular cysts.

Aged↗
PubMed1990

Atypical supraglottitis caused by Streptococcus sanguis.

A case of atypical supraglottitis in an 11-year-old boy is presented. The epiglottis was only mildly inflamed. The organism isolated from blood culture was Streptococcus sanguis. This organism is a normal commensal of the oral cavity and has not previously been reported as a cause of supraglottitis.

Child↗
PubMed1999

[The hyoid bone and its preservation in the framework of supraglottic partial resection of the larynx].

BACKGROUND: Whether to remove the hyoid bone as part of the horizontal partial laryngectomy is a question which is discussed controversially. Pathohistological examination of the region involved should help to answer this question. MATERIAL AND METHODS: Regarding the involvement of the hyoid bone, 71 surgical specimens of supraglottic carcinoma invading the pre-epiglottic space were studied by whole-organ serial sections. RESULTS: Only four specimens demonstrated mandatory resection of the hyoid bone because of its proximity to the advancing border of the tumor. In these cases, large tumor masses were palpable directly under the thyrohyoid membrane after the strap muscles had been dissected during the operation. DISCUSSION: Except for these rare cases in which the tumor was already palpable from outside the larynx, preservation of the hyoid bone during horizontal supraglottic laryngectomy is oncologically safe. It provides a more secure closure of the pharyngotomy and promotes earlier return of the swallowing function because of the maintenance of the normal position of the larynx and pharynx.

Deglutition↗
PubMed2001

Occult lymph node metastases in supraglottic cancers of the larynx.

Occult cervical lymph node metastases may often be associated with cancers of the supraglottic larynx. The aims of this investigation were: (1) to determine the incidence of occult lymph node metastases in patients with cancer of the larynx; (2) to assess whether the presence of such metastases was related to the extent of the primary tumor (T) and its grading (G); and (3) to discuss which therapeutic approach should be followed in treating clinically occult lymph node metastases. Our investigation included 97 patients who underwent supraglottic horizontal laryngectomy and elective cervical lymph node dissection. The incidence of occult lymph node metastases in the series considered was 27%. Based on the preoperative staging of the tumor, 14% of the cases had metastatically involved lymph nodes in the T1 tumors, 21% in the T2 tumors, 35% in the T3, and 75% in the T4. In the statistical analysis, a significant difference was shown to exist when T1 + T2 and T3 + T4 (P = 0.04) were compared. In terms of grading, occult metastases were found in 16% of the G1 tumors, 27% of the G2, and 42% of the G3. The statistical analysis demonstrated a significant difference between G1 and G3. In brief, the incidence of occult metastases was higher for the less differentiated tumors and for the ones with a higher T value; the effects of both factors are combined thereby increasing the rate of occult metastases (P = 0.05).

Adult↗
PubMed2003

Do micrometastases detected with cytokeratin immunoperoxidase reactivity affect the treatment approach to neck in supraglottic cancers?

OBJECTIVES: The aim of this study was to determine the occult lymph node metastasis rates with immunoperoxidase staining for cytokeratin in supraglottic larynx cancers and to assess our approach to the neck. STUDY DESIGN: Twenty-two patients who had squamous cell carcinoma in the supraglottic region and no histopathologic metastasis in the neck who had their cancer detected with the use of hematoxylin-eosin were included in the study. All of the specimens were reevaluated with the use of immunoperoxidase staining for cytokeratin. RESULTS: Micrometastatic disease (pN1) has been detected in 3 patients (13.61%) in whom no metastasis was detected with routine histopathologic examination. CONCLUSION AND SIGNIFICANCE: Results suggest that the occult metastasis rates are higher than those detected with routine hematoxylin-eosin staining. However, because it is accepted that neck dissection alone has adequate therapeutic efficiency in pN1 patients, the detected 13.61% rate of micrometastases has not changed our treatment plan in the neck.

Carcinoma, Squamous Cell↗
PubMed1975

Symposium. ENT for nonspecialists. Supraglottic.

Because supraglottic cancer usually is diagnosed late and metastasizes early, the cure rate is poorer than for glottic cancer. Supraglottic lesions can spread in any direction. The main method of diagnosis is either indirect or direct laryngoscopy, and the main symptoms are vague throat pain, otalgia, hemoptysis, hoarseness, and enlarged cervical lymph nodes. Roentgenographic examination is useful only as a supplement to other diagnostic measures. Staging of the disease is important in determining the most effective therapy and in predicting the results of treatment. Treatment should be individualized for each patient and should be selected on the basis of lesion size and site, the presence or absence of regional metastasis, the general health of the patient, and the likelihood of faithful follow-up.

Female↗
PubMed1995

Emergency use of the laryngeal mask airway in severe upper airway obstruction caused by supraglottic oedema.

We report two cases of severe upper airway obstruction caused by supraglottic oedema which developed rapidly at the time of anaesthesia. Conventional methods to relieve the obstruction failed and it was only overcome when a laryngeal mask airway (LMA) was inserted and positive pressure applied manually during inspiration. In one case a fibrescope was passed via the LMA and this revealed two cushions of oedematous false vocal cords protruding into the bowel of the LMA which were pushed out of the way when positive pressure was applied during inspiration. We believe that the LMA should be considered in the emergency management of severe upper airway obstruction even when this involves supraglottic oedema.

Airway Obstruction↗
PubMed2002

Management of a known difficult airway in a morbidly obese patient with gross supraglottic oedema secondary to thyroid disease.

We describe the use of awake fibreoptic intubation in the management of a patient with a known difficult airway, who presented with stridor resulting from supraglottic oedema. The aetiological factors contributing to this supraglottic oedema included coexisting thyroid swelling and congestive cardiac failure. Options for appropriate airway management in such cases are discussed.

Edema↗
PubMed2005

Percutaneous transtracheal jet ventilation as a guide to tracheal intubation in severe upper airway obstruction from supraglottic oedema.

We report two cases of severe upper airway obstruction caused by supraglottic oedema secondary to adult epiglottitis and Ludwig's angina. In the former case, attempts to intubate with a direct laryngoscope failed but were successful once percutaneous transtracheal jet ventilation (PTJV) had been instituted. In the case with Ludwig's angina, PTJV was employed as a pre-emptive measure and the subsequent tracheal intubation with a direct laryngoscope was performed with unexpected ease. In both cases recognition of the glottic aperture was made feasible with PTJV by virtue of the fact that the high intra-tracheal pressure from PTJV appeared to lift up and open the glottis. The escape of gas under high pressure caused the oedematous edges of the glottis to flutter, which facilitated the identification of the glottic aperture. We believe that the PTJV should be considered in the emergency management of severe upper airway obstruction when this involves supraglottic oedema.

Airway Obstruction↗
PubMed1989

Radiation therapy for squamous cell carcinoma of the supraglottic larynx.

Sixty-five patients with invasive squamous cell carcinoma of the supraglottic larynx received irradiation with curative intent between 1975 and 1984, with a 5-year actuarial survival of 48% and a local control rate of 70%. Five-year survivals for clinical Stages I, II, and III + IV were 60, 53, and 52%, respectively; local control rates were 88, 76, and 63%, respectively. These patients included one treated with preoperative irradiation, 35 treated with surgery followed by postoperative irradiation, and 29 treated with radiation therapy alone. In the surgery plus irradiation group, 5-year local control was 93% for clinical Stages I + II (14 patients), and 61% for clinical Stages III + IV (21 patients). Three patients had pathologic Stage II disease, with the remainder demonstrating a higher pathologic than clinical stage. Multiple positive nodes predisposed to local/regional recurrence, while no relationship could be established between recurrence and extracapsular nodal spread, positive margins, emergency tracheostomy, total versus less-than-total laryngectomy, radiation field size, radiation dose, or delay until radiation therapy, probably because of patient numbers. Six patients, five with positive nodes, developed distant metastases, and three developed second primary tumors outside the head and neck region. In the radiation therapy alone group, 5-year local control rates were 86, 59, and 53% for clinical Stages I (7 patients), II (11 patients), and III + IV (11 patients), respectively. However, three of four Stage II local/regional failures were surgically salvaged for periods greater than 30 months, for an ultimate Stage II local control of 89%. No relationship could be established between local control and radiation dose or field size, again probably because of small patient numbers. Three patients developed distant metastases, and eight developed second malignancies, one within the irradiated volume. Fifteen patients developed acute toxicity during irradiation, and there were eight chronic complications, five requiring surgery; toxicity was more common in the group treated with radiation alone. Radiation therapy alone with surgical salvage is an effective, function-preserving treatment for clinical Stages I and II carcinoma of the supraglottic larynx, and appears to yield local control and survival comparable with that of combined irradiation and surgery in more advanced disease.

Actuarial Analysis↗
PubMed2000

Patterns of swallowing after supraglottic laryngectomy.

OBJECTIVE: To understand the anatomical and physiological basis for early recovery of swallowing function after supraglottic laryngectomy. STUDY DESIGN: Retrospective review. METHODS: The records of nine patients who had undergone supraglottic laryngectomy at the Stratton Veteran's Administration Hospital (Albany, NY) between 1994 and 1998 were reviewed. Videofluoroscopic swallowing studies were obtained on all patients as early as was safely possible and were reviewed by a multidisciplinary team of physicians, nurses, and speech pathologists with regard to anatomical and functional differences between successful and unsuccessful recovery of swallowing function. RESULTS: Five of nine patients resumed regular diets including thin liquids within 1 year of surgery; three patients remained dependent on enteral support. Swallowing success was most closely associated with short oropharyngeal transit time and an anterosuperior position of the larynx. Laryngeal positioning, tongue base mobility, and placement and coordination of the bolus for maximum swallowing efficiency can be improved with time and speech therapy. CONCLUSIONS: Factors that placed patients at significantly higher risk for aspiration included low laryngeal position and delayed oropharyngeal transit time. Tight lingual-laryngeal closure did not completely prevent aspiration. At the time of the initial surgical procedure it may be important to position the laryngeal remnant as far superior and anterior under the tongue base as possible.

Aged↗