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PubMed1978

Supraglottic laryngectomy.

This paper describes the experience with subtotal supraglottic laryngectomy for laryngeal carcinoma at the Department of Otolaryngology of the Tulane University School of Medicine. Of 36 patients, 32 (89%) had local control of diseases at one year. Of 27 patients followed up for at least three years, 22 (81%) are free of disease. Postoperative aspiration was the most frequent complication, but was a serious problem in only one patient. Because of the significant functional advantage of partial laryngectomy, the high rate of disease control, and an acceptable complication rate, we believe supraglottic laryngectomy is the procedure of choice for laryngeal carcinoma in selected patients.

Follow-Up Studies↗
PubMed2005

Initial anatomic investigations of the I-gel airway: a novel supraglottic airway without inflatable cuff.

The I-gel airway is a novel supraglottic airway that uses an anatomically designed mask made of a gel-like thermoplastic elastomer. We studied the positioning and mechanics of this new device in 65 non-embalmed cadavers with 73 endoscopies (eight had repeat insertion), 16 neck dissections, and six neck radiographs. A full view of the glottis (percentage of glottic opening score 100%) occurred in 44/73 insertions, whereas only 3/73 insertions had epiglottis-only views. Including the eight repeat insertions with a different size, a glottic opening score of > 50% was obtained in all 65 cadavers. The mean percentage of glottic opening score for the 73 insertions was 82% (95% confidence interval 75-89%). In each of the neck dissections and radiographs the bowl of the device covered the laryngeal inlet. We found that the I-gel effectively conformed to the perilaryngeal anatomy despite the lack of an inflatable cuff and it consistently achieved proper positioning for supraglottic ventilation.

Epiglottis↗
PubMed1976

Pulmonary complications following supraglottic laryngectomy.

Supraglottic laryngectomy has been generally assumed to protect the patient from aspiration changes in the lungs. This paper details a retrospective survey, the results of which suggest that respiratory infections are common after supraglottic laryngectomy and that pneumonia is a fairly common cause of death. The need for prolonged follow-up after this operation is emphasized.

Bronchitis↗
PubMed1996

Extended supraglottic laryngectomy for primary base of tongue carcinomas.

A retrospective review of 56 patients with a primary base of tongue carcinoma was undertaken to determine the value of supraglottic laryngectomy. All the patients had a supraglottic laryngectomy and a total of 77 neck dissections. Forty-three (76.8%) patients received post-operative radiotherapy. The incidence of local recurrence was 23.2%, neck relapse being seen in 16.1% of patients. The 3 year survival was 47%. The overall survival of the whole series and by stage was not improved by combined therapy compared with surgery alone.

Adult↗
PubMed2005

Use of a new supraglottic airway device--the CobraPLA--in a 'difficult to intubate/difficult to ventilate' scenario.

A 67-year-old male was scheduled for cadaveric renal transplant. Following rapid sequence anaesthesia, only the tip of the epiglottis was visualized. Mask ventilation was difficult, and therefore an alternative airway device was considered. A size 4 CobraPLA (Engineered Medical System, Indianapolis, IN) was inserted into the hypopharynx, and ventilation was easily accomplished. Then, a size 7 endotracheal tube was threaded over a fiberoptic bronchoscope, through the CobraPLA, into the trachea. The description and insertion technique of the CobraPLA, a new supraglottic airway device is shortly discussed. This is the first report of successful management of difficult mask ventilation with the new CobraPLA, supraglottic airway device.

Aged↗
PubMed1989

Stereological estimation of nuclear volume and other quantitative histopathological parameters in the prognostic evaluation of supraglottic laryngeal squamous cell carcinoma.

The aim of this study was to investigate various approaches to the grading of malignancy in pre-treatment biopsies from patients with supraglottic laryngeal squamous cell carcinoma. The prospects of objective malignancy grading based on stereological estimation of the volume-weighted mean nuclear volume, nuclear Vv, and nuclear volume fraction, Vv(nuc/tis), along with morphometrical 2-dimensional estimation of nuclear density index, NI, and mitotic activity index, MI, were investigated and compared with the current morphological, multifactorial grading system. The reproducibility among two observers of the latter was poor in the material which consisted of 35 biopsy specimens. Unbiased estimates of nuclear Vv were on the average 385 microns3 (CV = 0.44), with more than 90% of the associated variance attributable to differences in nuclear Vv among individual lesions. Nuclear Vv was positively correlated with MI, negatively with NI, whereas no correlation with Vv(nuc/tis) was found. No relationship between nuclear Vv and the morphologically interpreted degree of nuclear dedifferentiation was demonstrated. Nuclear Vv showed no differences between lesions in different clinical T-stage of disease. None of the investigated categorical and quantitative parameters (cutoff points = means) reached the level of significance with respect to prognostic value. However, nuclear Vv showed the best information concerning survival (2p = 0.08), and this estimator offers optimal features for objective malignancy grading. Further analyses of larger series of patients are needed to establish the prognostic value of nuclear Vv for objective malignancy grading of supraglottic laryngeal squamous cell carcinoma.

Aged↗
PubMed1987

Neck evaluation with barium-enhanced radiographs and CT scans after supraglottic subtotal laryngectomy.

Supraglottic subtotal laryngectomy (SSL) is a radical, yet voice-conserving, surgical procedure commonly performed for carcinoma of the supraglottic larynx. The pharyngograms and computed tomographic (CT) scans of 35 patients obtained after SSL were evaluated retrospectively. These examinations reliably demonstrated the changes in anatomy caused by removal of the epiglottis, aryepiglottic folds, and false vocal cords. Fourteen patients had documented recurrence of cancer; five mucosal, nine extramucosal. Three of five macroscopic mucosal recurrences in the larynx/pharynx were detected on the barium pharyngograms; the two mucosal lesions not seen were in the base of the tongue and tonsillar fossa. CT enabled detection of five of five recurrences and was superior to pharyngography in demonstrating the soft-tissue extent of disease. CT findings mimicking recurrence were seen in two patients: one with diffuse histiocytic lymphoma; the second, with benign hyperkeratosis. Barium and CT examinations are useful adjuncts to the clinical examination in detecting recurrent squamous cell carcinoma in patients following SSL.

Adult↗
PubMedDate not supplied

Exclusive surgery versus postoperative radiotherapy for supraglottic cancer.

AIM OF THE STUDY: To verify the effectiveness of prophylactic postoperative radiotherapy for supraglottic cancer. PATIENTS AND METHODS: 97 patients underwent supraglottic horizontal laryngectomy with bilateral neck dissection: 35 patients (group A) received postoperative radiotherapy (60-70 Gy, 2 Gy fractions daily); 62 patients (group B) received only surgery. RESULTS: Overall 5-year actuarial survival and corrected actuarial survival rates were 74 and 90% in group A and 61 and 80% in group B (p = 0.2 and 0.4, respectively). As for tumor extent, no significant differences were observed between the two groups. In N0 patients overall actuarial survival rate was significantly higher in group A as compared to group B (p = 0.01); most likely this difference was due to errors in clinical staging for the presence of reactive lymphadenitis and micrometastases. CONCLUSIONS: The present study did not document the effectiveness of postoperative radiotherapy. Radiation therapy should be avoided in those patients in whom surgery was proven to be curative while it could be considered in combination with surgery when the resection margins are dubious and/or inadequate.

Adult↗
PubMed1984

Invasive multiple supraglottic squamous cell papillary carcinoma in an adult. Report of a case.

Invasive papillary squamous cell carcinoma of the supraglottic larynx is described in an adult male. The clinicopathological appearance was that of a multiple growth which displayed various gradients of neoplastic changes: in situ, microinvasion, frank invasion of cartilage and cervical node metastases. No previous history of radiotherapy was elicited. The growth was excised by supraglottic laryngectomy and neck dissection. Typical metastatic papillary formations were observed in lymph nodes.

Carcinoma, Papillary↗
PubMed2004

Endoscopic supraglottic laryngectomy with postoperative irradiation.

Sixty-eight consecutive patients with infiltrating squamous cell carcinoma of the supraglottic larynx were referred to the senior author (R.K.D.) from January 1987 through December 1999. Forty-six patients (clinically staged T2) were selected to undergo endoscopic carbon dioxide laser supraglottic laryngectomy. Thirty-eight of these patients underwent planned postoperative irradiation. The other 8 patients were treated by surgery only, either because they had previously undergone irradiation or because they had refused postoperative irradiation. Eighteen cases (39%) were restaged from T2 to T3 on the basis of preepiglottic space invasion demonstrated on final pathology review. Primary site control was maintained in 97% of the combined-therapy patients and in all of the surgery-only patients without any salvage procedures. Regional control was attained in 96% of NO patients treated with irradiation alone, and 91% of N+ patients treated with modified radical neck dissection and postoperative irradiation. The combined-therapy group had only a 3% gastrostomy dependency rate, no tracheotomy dependency, a 5% aspiration pneumonia rate, and an average onset of independent swallowing at less than 2 weeks.

Adult↗
PubMedDate not supplied

Supraglottitis and concurrent Hemophilus meningitis.

Acute epiglottitis is a true pediatric emergency. The intense inflammation of the supraglottic larynx may completely obstruct the larynx within several hours. This infection is secondary to infiltration of Hemophilus influenzae type b (HIB), and 90% to 95% of patients have positive blood cultures. During this period of generalized septicemia HIB involvement of other soft tissue sites may occur. The goal of this article is to alert otolaryngologists to the possibility of extraepiglottitic HIB involvement. In particular, HIB meningitis, concurrent with supraglottitis, will be discussed. Although the overall incidence of multiple site involvement is relatively low, it is important to be aware of the possibility, since the outcome may be significantly altered.

Acute Disease↗
PubMedDate not supplied

Supraglottic jet ventilation for laser surgery of the larynx in children.

To investigate the efficacy and safety of supraglottic jet ventilation for laser surgery on the larynx, ten studies were performed in seven children scheduled for laser excision of juvenile laryngeal papillomata. The children were anesthetized using halothane, nitrous oxide, fentanyl 3 micrograms/kg, and a succinylcholine infusion. After the Leonard-Jako laryngoscope was in place, jet ventilation with 70% nitrous oxide in oxygen was begun through a 12-gauge Medicut intravenous cannula inserted in the right-hand light channel of the laryngoscope. Tracheal, inspired, and end-tidal oxygen, nitrous oxide, nitrogen, and carbon dioxide were determined by mass spectrometry simultaneously with arterial blood gases. Oxygen and carbon dioxide levels were always within normal limits, the end-tidal to arterial differences averaging 50 +/- 9 and 2 +/- 1 (SEM) mm Hg, respectively. Room air entrainment averaged 32 +/- 2%. The end-tidal nitrous oxide averaged 39 +/- 2%. The advantages of this technique are that it leaves the larynx completely free for the surgeon and it eliminates the possibility of endotracheal tube ignition. Supraglottic jet ventilation for this surgical procedure was determined to be effective and relatively safe.

Anesthesia, Inhalation↗
PubMedDate not supplied

Deglutition following supraglottic horizontal laryngectomy.

In order to determine factors that may contribute to deglutition problems following supraglottic horizontal laryngectomy or its modified techniques, clinical records of 38 patients were studied. Contribution of the following factors was investigated: age; sex; tumor classification; radical neck dissection; extent of and symmetry in removal of the aryepiglottic folds, arytenoid cartilages, and false folds; removal of the base of the tongue, hyoid bone, and a part of the vocal folds; extent of removal of the epiglottis and thyroid cartilage; cricopharyngeal myotomy; and some complications and concomitant diseases. The results suggest that removal of the arytenoid cartilage and asymmetrical removal of the false folds contribute to deglutition problems. We conclude that the standard supraglottic horizontal laryngectomy associated with surgical approximation of the larynx to the base of the tongue and cricopharyngeal myotomy does not usually cause serious deglutition problems. When the arytenoid cartilage is removed, reconstruction of the structure is required for the prevention of severe aspiration.

Aged↗
PubMed1989

Partial laryngectomy and radiotherapy for supraglottic cancer: a conservative approach.

This is a retrospective study of 33 patients with supraglottic cancer treated with partial laryngectomy and moderate-dose radiotherapy at the University of Virginia from 1967 through 1986. All patients had a 2-year minimum follow-up. Ten patients received preoperative radiotherapy, and 23, postoperative radiotherapy. The 2-year adjusted survival rate was impressive at 97%. Local control at 2 years was 96%, including one patient who was salvaged with total laryngectomy. Control of the neck was 90% at 2 years. Ninety percent of the patients alive at 2 years had a functional voice. One patient required a completion laryngectomy for chronic aspiration. Conservation surgery with radiotherapy provides excellent survival as well as locoregional control rates with preservation of function in selected patients with supraglottic cancer. This approach may be especially helpful in the management of bulky T2 lesions as well as T4 lesions with minimal vallecula or base of tongue involvement.

Adult↗
PubMed1991

Sixteenth Daniel C. Baker, Jr, memorial lecture. Surgical management of supraglottic cancer and its lymph node metastases in a conservative perspective.

Supraglottic laryngectomy combined with functional elective or curative neck dissection is a priceless contribution toward treatment of supraglottic cancer and its lymph node metastases. The history and background of this conservative approach is reviewed. Results related to staging are presented. Irradiation as a combined or alternative therapy is considered.

Combined Modality Therapy↗
PubMed1995

Revascularization of a salvage supraglottic laryngectomy. Preliminary report.

After supraglottic laryngectomy, particularly if there has been a large preoperative dose of radiotherapy, significant ischemia at the suspension anastomosis site may ensue. Neovascularization may play a major role in the healing of this salvage horizontal laryngectomy anastomosis. We have analyzed the process of angiogenesis and neovascularization from a fascial flap in a case of salvage supraglottic laryngectomy.

Adult↗
PubMed1996

Evaluation of HER-2/neu (c-erbB-2) oncogene expression in whole organ sections of supraglottic squamous cell carcinoma.

Adequate pathologic material and careful clinical follow-up are prerequisites for the analysis of the expression of particular oncogenic proteins that are prognostically important in squamous cell carcinoma of the larynx. The Gabriel Tucker, Jr, Collection of 150 whole organ specimens allows for the potential immunohistochemical study of the entire tumor. Sections from 32 supraglottic carcinomas were studied immunohistochemically for the presence of HER-2/neu (c-erbB-2) oncogene expression. Long-term follow-up data were available in all cases to assist in determining the prognostic significance of the specified oncogene in supraglottic squamous cell carcinoma. Our study revealed that joint presentation of immune staining for c-erbB-2 and positive lymph node status was significantly associated with distant metastasis (p=.00760).

Adult↗
PubMedDate not supplied

An evaluation of elective irradiation of neck nodes in patients with cancer of the supraglottic larynx.

Between 1964 and 1973, 152 patients with supraglottic cancer limited to the larynx with clinically negative neck were included in the controlled randomized study designed to evaluate elective irradiation of the neck. The patients were randomized to one of the 2 treatment groups: 1) "T+N": irradiation of the larynx and all neck nodes, tumor dose 5130 rad/6-7 weeks, 2) "T": irradiation of the laryngeal portals only, tumor dose 5130 rad/5 weeks. All patients received 250 kV orthovoltage irradiation. The biologic dose delivered to the larynx was greater in group "T" because of faster fractionation and shorter overall time of therapy. The calculated NSD value for the patients in group "T+N" varied from 1620 to 1690 ret, and in group "T" it was 1800 ret. Five-year survival rates with a preserved larynx and without cancer were 45.3% for group "T+N" and 66.2% for group "T". Seven patients of group "T" developed metastatic cancer in the neck, and 4 of them were cured by neck dissection. It is concluded that patients with early supraglottic cancer can be successfully irradiated through laryngeal portals only, including the larynx, and possibly midjugular and digastric nodes. The tumor dose should be at least equivalent to the NSD of 1800 ret in the condition of megavoltage therapy.

Carcinoma, Squamous Cell↗