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PubMed2003

Management and outcome differences in supraglottic cancer between Ontario, Canada, and the Surveillance, Epidemiology, and End Results areas of the United States.

PURPOSE: We compared the management and outcome of supraglottic cancer in Ontario, Canada, with that in the Surveillance, Epidemiology, and End Results (SEER) Program areas in the United States. METHODS: Electronic, clinical, and hospital data were linked to cancer registry data and supplemented by chart review where necessary. Stage-stratified analyses compared initial treatment and survival in the SEER areas (n = 1,643) with a random sample from Ontario (n = 265). We also compared laryngectomy rates at 3 years in those patients 65 years and older at diagnosis. RESULTS: Radical surgery was more commonly used in SEER, with absolute differences increasing with increasing stage: I/II, 17%; III, 36%; and IV, 45%. The 5-year survival rates were 74% in Ontario and 56% in SEER for stage I/II disease (P =.01), 55.7% in Ontario and 46.8% in SEER for stage III disease (P =.40), and 28.5% in Ontario and 29.1% in SEER for stage IV disease (P =.28). Cancer-specific survival results mirrored the overall survival results with the exception of stage IV disease, for which 34.6% of Ontario patients survived their cancer compared with 38.1% in SEER (P =.10). This stage IV difference was more pronounced when we further controlled for possible cause of death errors by restricting the comparison to patients with a single primary cancer (P =.01). Three-year actuarial laryngectomy rates differed. In stage I/II, these rates were 3% in Ontario compared with 35% in SEER (P < 10(-3)). In stage III disease, the rates were 30% and 54%, respectively (P =.03), and in stage IV disease they were 33% and 64% (P =.002). CONCLUSION: There are large differences in the management of supraglottic cancer between the SEER areas of the United States and Ontario. Long-term larynx retention was higher in Ontario, where radiotherapy is widely regarded as the treatment of choice and surgery is reserved for salvage. In stages I to III, survival was similar in the two regions despite the differences in treatment policy. In stage IV, there may be a small survival advantage in the U.S. SEER areas related to the higher use of primary surgery.

Aged↗

PubMed2004

A new supraglottic airway, the Elisha Airway Device: a preliminary study.

We describe the Elisha Airway Device (EAD), a new reusable supraglottic ventilatory device. Its uniqueness consists of its ability to combine three functions in a single device: ventilation, blind and/or fiberoptic-aided intubation without interruption of ventilation, and gastric tube insertion. This study was performed in 70 ASA status I-II, Mallampati class I-II patients undergoing elective knee arthroscopy and receiving general anesthesia with mechanical ventilation. Anesthesia was induced with fentanyl and propofol and was maintained with isoflurane in N20/oxygen. Neuromuscular blockade was achieved with vecuronium. Blind insertion of the device was successful in 96% of patients, with a mean insertion time of 20 +/- 4 s. In these patients it was possible to maintain oxygenation and ventilation throughout the surgical procedure. Gastric tube insertion was successful in all cases. Endotracheal intubation via the EAD was attempted in 20 patients. Blind intubation was possible during the first and second attempts in 15 and 2 patients, respectively. Fiberoptic intubation was then successful in two of the remaining three patients. The EAD is a new alternative in the evolution of supraglottic ventilatory devices; however, further clinical studies are necessary to evaluate its efficacy.

Adult↗

PubMed2004

A proposed classification and scoring system for supraglottic sealing airways: a brief review.

We provide an approach to evaluating sealing supraglottic airways by using a classification based on a sealing mechanism. Three main sealing mechanisms are identified, thus defining three groups: cuffed perilaryngeal sealers, cuffed pharyngeal sealers, and uncuffed anatomically preshaped sealers. We provide a brief overview of supraglottic airways and present a scoring system that is relevant to particular requirements. Scoring airways for routine applications is the example provided.

Anesthesiology↗

PubMed2006

An evaluation of the insertion and function of a new supraglottic airway device, the King LT, during spontaneous ventilation.

Trials of the King LT trade mark (LT, King Systems, Noblesville, IN) in controlled ventilation of the lungs have shown that it is an effective supraglottic airway device. We designed this study to evaluate the King LT regarding ease of insertion, position within the airway, and anatomic sealing properties during spontaneous ventilation in 50 ASA physical status I-III, Mallampati I-III, adult patients undergoing routine general anesthesia. Anesthesia was induced with up to 2 microg/kg fentanyl and 1.5-2 mg/kg propofol and maintained with 70% N2O/30%O2 and isoflurane. Insertion time, oropharyngeal leak pressures, fiberoptic position, and spirometry and hemodynamic data were recorded. Any complications were noted. Insertion was determined to be easy and a patent airway was achieved in all patients. First, second, and third attempt insertion rates were 86%, 12%, and 2%, respectively. Time to place the King LT trade mark was <5 s in 90% of cases. Baseline leak pressures were 31 +/- 8.8 cm H2O (17-50 cm H2O). Complications included laryngospasm (1) and coughing (3) on extubation. The incidence of sore throat at 1 h and 24 h postoperatively was 22% and 15%, respectively. The King LT trade mark is a simple and reliable supraglottic airway device for airway management during spontaneous ventilation.

Adolescent↗

PubMed2001

Supraglottitis complicated by mediastinitis.

A rare case of supraglottitis complicated by mediastinitis is presented. Despite aggressive treatment with broadspectrum intravenous antibiotics, the patient persisted to have generalized supraglottitis. Subsequent computed tomography (CT) scanning revealed that she had developed a frank fluid collection starting at the suprasternal notch, extending retrosternally into the superior mediastinum. She recovered with conservative management and did not require aggressive mediastinal drainage as advocated by the literature.

Aged↗

PubMed2002

Growth of laryngeal glands in infants: a comparative study of the sub- and supraglottic larynx.

It is well established that laryngeal secretions, produced in the glandular tissue, contribute to the local defence system of the larynx. In this study, the distribution of glandular tissues in the subglottic and supraglottic larynx was examined in 55 infants, using an image analysing system. The average area of the mucosa or glandular acini at the level of the false vocal fold was almost three times larger than that of the subglottis. At both levels, the area occupied by the glands increased according to the age at death and became more evident according to the total development score (TDS) which was estimated by adding the age at death and the gestational period. The results indicate that the glandular structure of the level of the sub- or supraglottic larynx develops constantly and equally after birth.

Humans↗

PubMed1990

Acquired airway obstruction from histologically normal, abnormally mobile supraglottic soft tissues.

In patients with nonmalignant upper aerodigestive tract abnormalities such as cysts, neoplasms, and laryngomalacia, airway obstruction has been described as a function of not only size and location of abnormal structures, but also of their mobility. This paper describes three patients who developed upper airway restriction with stridor due to abnormally redundant and mobile, but histologically normal, supraglottic mucosa. The specific mechanism of and structures involved in obstruction were clearly defined by videolaryngopharyngoscopy. Endoscopic microdissection and/or laser excision of the redundant supraglottic mucosa restored airway patency and completely relieved the obstructive respiratory symptoms. The pulsion effects of inspiratory airflow are postulated as the cause of these acquired lesions. Recommended treatment is reviewed.

Aged↗

PubMed1990

Supraglottic laryngectomy for intermediate-stage cancer: U.T. M.D. Anderson Cancer Center experience with combined therapy.

We reviewed the records of all patients with previously untreated squamous cell carcinomas of the supraglottic larynx who presented to The University of Texas M.D. Anderson Cancer Center from 1974 to 1987. Of 404 patients, 60 (15%) underwent supraglottic laryngectomy and functional anterior neck dissection as a primary modality of therapy; these patients were studied. Fifty of the 60 patients (83%) received adjunctive postoperative radiotherapy. Tumor-free survival was 96% at 2 years and 91% at 5 years. There were no local failures, 4 regional failures, and 3 distant metastases. Second cancers, mostly of the lung, occurred in 9 patients (15%). Three patients required completion laryngectomies for intractable aspiration. Analysis of deglutition and tracheal decannulation rehabilitation revealed a higher incidence of complications in patients who underwent arytenoidectomies.

Algorithms↗

PubMed1995

Expiratory supraglottic obstruction during muscular relaxation.

Some reports have suggested occurrence of expiratory upper airway narrowing in patients with obstructive sleep apnea (OSA) during sleep and in awake humans during respiratory muscles relaxation. This is compatible with the hypothesis that upper airway muscles are activated during expiration. We studied five healthy volunteers and four patients with OSA in a tank respirator (Emerson; Cambridge, Mass). Supraglottic pressure (Psg) was measured with a catheter with the tip at the retroepiglottic level, tidal volume with an inductance plethysmograph and airflow with a pneumotachograph at the mouth. Diaphragmatic electromyogram was recorded with an esophageal bipolar electrode. Measurements were done at -30 cm H2O. Subjects were asked to breathe in phase with the respirator and then asked to breathe in phase with the respirator and then to relax their muscles. During muscular relaxation, there was supraglottic obstruction and flow limitation. This was observed during both inspiration and expiration. Upper airway obstruction was more severe in patients with OSA than in healthy subjects. In two healthy volunteers, fiberoptic bronchoscopy showed a wide-open oropharyngeal isthmus during active breathing that narrowed during muscular relaxation. This was true during both inspiration and expiration. We conclude that muscular relaxation is associated with upper airway narrowing and flow limitation occurring during both inspiration and expiration. We suggest that to preserve an open upper airway, airway muscles have to be activated during both inspiration and expiration.

Adult↗

PubMed1980

Fast neutron teletherapy for advanced carcinoma of hypopharynx and supraglottic larynx.

The results of a Phase I clinical trial using fast neutron teletherapy for advanced squamous cell carcinoma of the hypopharynx and supraglottic larynx are reported. Ten patients with hypopharyngeal tumors were treated for cure using neutrons alone and 6 patients with hypopharyngeal tumors were treated for cure using a combination of neutrons and photons as part of a mixed beam fraction scheme. In the neutron-only group, the initial complete remission rate was 4/10 (40%). The mean survival of this group of patients with initial complete remission was only 5.75 months (range 2--10) but all patients died without evidence of recurrent tumor at the primary site. In the mixed beam group, the initial complete remission rate was 5/6 (83%) but the local control rate dropped rapidly to 41 per cent when displayed on an actuarial plot. Six patients with advanced tumors of the supraglottic larynx were treated for cure, 5 with neutrons alone and one with a mixed beam regime. The initial complete remission rate was 3/6 (50%) but 2 of these patients rapidly recurred, which reduced the local control rate on an actuarial plot to 16 per cent. The relative adverse effects of the neutron-only treatment regime appear to be substantially greater than those of the mixed beam treatment regime.

Clinical Trials as Topic↗

PubMedDate not supplied

Fulminant meningococcal supraglottitis: An emerging infectious syndrome?

We report a case of fulminant supraglottitis with dramatic external cervical swelling due to associated cellulitis. Blood cultures were positive for Neisseria meningitidis. The patient recovered completely after emergency fiberoptic intubation and appropriate antibiotic therapy. We summarize five other cases of meningococcal supraglottitis, all reported since 1995, and discuss possible pathophysiologic mechanisms.

Adult↗

PubMed1990

[Biological characteristics and prognosis of supraglottic carcinoma--a multivariate correlation analysis of prognosis].

The biological characteristics of supraglottic carcinoma was studied with special reference to the correlations of various biological factors with the prognosis of the lesion. The study included 100 cases of supraglottic carcinoma treated by total laryngectomy in the First Hospital of China Medical University in the period from 1975 to 1978, and 7 factors including histopathological findings observed in serial sections of the whole larynx, clinical findings, clinical course, etc. These factors were statistically analyzed by multiple correlation analysis using the theory of quantification I to determine the relations of these factors to the prognosis, as well as their participations in post operative course. 1. Twenty-seven cases died within 5 years after surgery, and 4 cases could not be followed up. 3 and 5-year survival rates were 79.5% and 72.2%, respectively, as calculated in accordance with the UICC General Rule. 2. Histopathologically 5-year survival rate was 10.0% in cases with poorly differentiated carcinoma, 78.0% in cases with moderately differentiated type, and 83.5% in cases with well-differentiated type. It was remarkably lower in poorly differentiated carcinoma than that in moderately or well-differentiated carcinoma. 3. In cases having dense lymphocyte infiltration associated with lymph follicles in peripheral region of tumor, 5-year survival rate was higher (90.4%) than in the other cases. 4. It was found that, as tumor size increased, 5-year survival rate decreased and the risk of lymph node involvement increased in the neck region. 5. 5-year survival rate was lower (48.5%) in cases with lesion infiltrating the surrounding tissues than in cases with other growth patterns. 6. Multiple correlation coefficient between prognosis and the 7 factors analyzed was 0.766. The important factors were the degree of differentiation (0.735), the degree of lymphocyte infiltration (0.260), the size of primary tumor (0.215), the growth pattern of tumor (0.141) and neck metastasis (0.028).

Carcinoma, Squamous Cell↗

PubMed1997

[Contrast analysis of clinical and pathological staging of supraglottic carcinomas].

To evaluate the accuracy of clinical staging of supraglottic carcinomas, a retrospective histopathological study of larynges from 53 patients who had undergone total laryngectomy was adopted. All larynges were processed as whole-organ serial sections in coronal plane. The results showed that clinical underestimation had been made in 24.5% of all laryngeal cancer cases. Clinical underestimation occured in 54.5%, 33.3% of T2, T3 laryngeal cancer cases, respectively. There was no overestimation in clinical staging. The important factors that affected clinical underestimation were invasion of the pre-epiglottic space and thyroid cartilage. It is suggested that the pre-epiglottic space should be resected in early supraglottic carcinoma. The thyroid cartilage involvement should be suspected in laryngeal cancer with extensive invasion of anterior commisure or extensive invasion of the paraglottic space accompanied by cartilage ossification.

Adult↗

PubMed1999

The prognostic importance of volume-weighted mean nuclear volume, mitotic index, and other stereologically measured quantitative parameters in supraglottic laryngeal carcinoma.

BACKGROUND: Stereologically measured mean nuclear volume has been proven to have prognostic importance in several types of cancer, such as malignant melanoma and carcinomas of the breast, oral region, bladder, and uterine cervix. The main purpose of the current study was to investigate the possible prognostic importance of mean nuclear volume and mitotic index in carcinoma of the supraglottic larynx. METHODS: The study was performed with a stratified, random sample of 113 patients from a well-defined group of 386 patients with supraglottic laryngeal carcinoma treated with radiotherapy at the Finsen Institute in Copenhagen. Histologic sections from pretreatment biopsies were used to estimate the following parameters: mean nuclear volume (Vv(3)(0)), mitotic index (MI), number of nuclei per mm(2) (QA), mean nuclear profile area (Anuc), and the area fraction of nuclei in cancer tissue (AA). The geometric means of the parameters were used as cutoff points in a single factor and in a multivariate survival analysis with relapse free survival as the primary endpoint. RESULTS: The geometric means of the measured parameters were (Vv(3)(0)) = 480 micro(3), QA = 3630 nuclei/micro(2) cancer tissue, MI = 0.48 mitosis/100 nuclei, AA = 0.21, and Anuc = 57.9 micro(2). CONCLUSIONS: None of the stereologically estimated parameters proved to have prognostic importance, whereas tumor size, and lymph node status did. The method of adaptive, stratified, random sampling used in this study can save a great deal of work and is highly recommended by the authors.

Aged↗

PubMed1999

Do we need new supraglottic devices? Clinical appraisal of the cuffed oropharyngeal airway (COPA)

BACKGROUND: The laryngeal mask airway (LMA) has been widely studied for both conventional and nonconventional uses, while the literature on the cuffed oropharyngeal airway (COPA) is still limited. The purpose of this manuscript was to review the initial appraisal of efficacy, safety, effects on hemodynamics and respiratory function, induction agents and drug requirements of this new supraglottic device. METHODS: We reviewed main results of studies recently published on peer reviewed journals concerning the clinical uses of COPA. RESULTS: When used in healthy adults undergoing general anesthesia for routine minor procedures, the COPA and LMA are substantially equivalent. The LMA is associated with a higher first-time placement rate and fewer manipulations during usage, but the incidence of airway untoward events during COPA anesthesia is equivalent to that reported when using an LMA. The quality of breathing and capnography during COPA ventilation is similar to that provided by the LMA ventilation, with clinically relevant decrease in the physiological deadspace/tidal volume ratio and arterial to end-tidal CO2 tension difference compared with facemask ventilation. In selected patients without risk factors for regurgitation of gastric content, positive-pressure ventilation is similarly successful and safe with the COPA as with the LMA. The COPA seems to be less stimulating than LMA because it has been demonstrated to cause a lower incidence of pharyngeal trauma and sore throat in the immediate postoperative period, requires shorter exposure to an inhalational anesthetic and lower concentrations of propofol to be successfully placed, and is associated with lower effects on the patient's hemodynamic homeostasis than LMA. CONCLUSIONS: More extensive clinical evaluations should be advocated to better understand the risk/benefit ratio of this new supraglottic device; however, it may be concluded that in healthy adults receiving general anesthesia for short procedures the COPA allows for an effective and safe control of the patient's airway and ventilation.

Adult↗

PubMed2000

[Prognostic factors in supraglottic laryngeal cancer: a review of 74 cases].

Laryngeal carcinoma is a frequent neoplasm in Spain, constituting about 5.6% of all malignant tumors. The supraglottic location is more frequent than either glottic or subglottic sites. Prognostic factors were analyzed in a series of 74 supraglottic laryngeal carcinomas. Two statistical methods were used. Firstly, Cox regression, a multivariate analysis that defines a survival function of the patients, was used to detect variables with prognostic influence. Secondly, mortality tables were studied for all of them. This univariate method is used to determine the number of patients for every option of a study variable and their survival. The most important prognostic variables in our series were: tracheostomy before surgery, pathological study of the cervical nodes, time from surgery to radiotherapy, type of biopsy, and alcohol use.

Adult↗

PubMed2000

Need for tracheotomy is rare in patients with acute supraglottitis: findings of a retrospective study.

We retrospectively reviewed the cases of 23 adults and six children who had been given a presumed diagnosis of acute supraglottitis between 1987 and 1997. The most common symptoms in these patients were odynophagia, dysphagia, hoarseness, and fever. Stridor and drooling were also observed, primarily in the children. Fiberoptic laryngoscopy confirmed the presence of edema and erythema of the supraglottic structures in all patients. Blood cultures were positive for Hemophilus influenzae type b in three children and for Serratia marcescens in one adult. All other blood cultures were negative. All patients were treated with intravenous broad-spectrum antibiotics and humidified oxygen, and two-thirds received intravenous corticosteroids. Patients were monitored with pulse oximetry and serial fiberoptic laryngoscopy. Two patients required intubation; one had an epiglottic abscess, and the other had laryngeal edema so severe that vocal fold mobility could not be assessed. The length of stay in the intensive care unit ranged from 1 to 7 days (mean: 1.9). All patients recovered and were discharged free of symptoms after 2 to 11 days of overall hospitalization (mean: 4.4).

Acute Disease↗

PubMed1998

Supraglottic carcinoma: does preoperative radiotherapy reduce the incidence of cervical metastasis?

OBJECTIVE: To compare surgery (S) alone with combined radiotherapy and surgery (R + S) in the management of patients with supraglottic laryngeal cancer. METHODS: Between 1981 and 1994, patients were stratified according to stage and randomised to either surgery (S) or 4000cGy of radiotherapy and surgery. There were 102 patients in the S group and 99 in the R + S group who completed at least 3-year follow-up. RESULTS: Using Kaplan-Meier survival method showed no significant difference between the two groups. When the patients were grouped according to tumour stage, a significant reduction in the regional recurrence was noted in the R + S group for stage I-III disease (Cox multivariate analysis, P < 0.02). They had an increased relative risk of 1.8 (95% confidence 1.1-2.9) for neck recurrence. There was no significant difference in neck recurrence rates in the two groups for stage IV disease. When Cox proportional hazard model was used, only TNM stage (P < 0.02) and histological nodal status (positive lymph nodes, P < 0.01) were found to be independent risk factors for regional control. CONCLUSION: Preoperative radiotherapy can improve regional cervical control of stage I-III supraglottic cancer as compared with surgery alone.

Adult↗