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PubMed1975

Limitations of supraglottic laryngectomy and conservative neck dissection.

Limitations of supraglottic laryngectomy may arise from either the primary location, or secondary spread of the tumor in the vestibule. When a growth reaches the epilarynx a modified supraglottic laryngectomy or a more radical operation must be envisaged. Other limitations include poor bronchopulmonary condition, age of the patient, and previous radiotherapy. All these conditions may jeopardize healing and/or, even more important, functional rehabilitation. New hands to this surgery should know its limitations and should be warned against its risks. On the other hand no limitations exist to conservation neck dissection, except fixed nodes or lymph node metastases following radiation or earlier surgery. The conservative technique is as radical as the traditional technique, but respects essential structures and thus widens instead of limiting the indications for elective bilateral neck dissection.

Adult↗
PubMed2001

[Clinical comparison of bilateral neck dissection for supraglottic carcinoma].

OBJECTIVE: In order to rise the survival rate and quality of life, the patients with bilateral neck dissection was investigated in supraglottic carcinoma. METHOD: 76 cases were retrospectively analyzed. In terms of clinical diagnosis, 33 cases who had bilateral neck metastasis had received simultaneously bilateral neck dissection. 43 patients first diagnosed unilateral neck metastasis got subsequent bilateral neck dissection. All of the patients were pathologically diagnosed. RESULT: The 3 and 5 year survival rates, in the 33 cases who had received simultaneous bilateral neck dissection, were 81.5% (22/27) and 61.5%(16/26) respectively, while in the other 43 cases, was 69.2%(27/39) and 27.8%(10/36) respectively. CONCLUSION: It is necessary for those patients who have suffered from supraglottic carcinoma with bilateral neck metastasis to have simultaneous bilateral neck dissections. Meanwhile, the preservation of bilateral internal jugular veins is the best choice, at least one should be preserved.

Adult↗
PubMed2003

Adult supraglottitis subsequent to smoking crack cocaine.

Supraglottitis is one possible complication of smoking crack cocaine. From 1992 through 2001, our institution treated nine patients for thermal supraglottitis secondary to crack cocaine inhalation. In this article, we describe two of these cases, and we briefly review what is known about this entity and the mechanism of injury. We also provide our recommendations for management.

Adult↗
PubMed2001

[Detection mucin gene in cervical lymph nodes in supraglottic cancer by reverse transcription polymerase chain reaction].

OBJECTIVE: To investigate the efficacy of discovery of cervical lymph nodes micrometastasis of supraglottic carcinomas by detection of mucin (MUC1) gene. METHODS: Twenty-five supraglottic carcinoma patients with clinically negative lymph nodes were performed neck dissection. MUC1 gene mRNA in these resected lymph nodes was detected by reverse transcription polymerase chain reaction (RT-PCR) and histopathological examination to find the potential micrometastasis. RESULTS: Of all 93 cervical lymph nodes, micrometastasis were found in 23 nodes of 6 case by histopathological examination and RT-PCR. Four of 19 cases with negative lymph nodes pathologically showed MUC1 gene expression and were identified to have metastasis by clinical recurrence and serial-sectioning. Therefore, the rate of detection of micrometastasis by this way was 16% (4/25), higher than that of regular pathologic methods. CONCLUSION: Detection of lymph nodes micrometastasis with RT-PCR method was more sensitive than that of regular pathologic methods. It is a valuable method to detect early lymph nodes metastasis.

Aged↗
PubMed1999

[Immunohistochemical evaluation of micrometastases to cervical lymph nodes in supraglottic cancer].

OBJECTIVE: Supraglottic carcinomas of larynx tends to metastasize to cervical lymph nodes. The regular pathological method of diagnosis is easy to have the micrometastasis missed, and serial-sectioning is too difficult be used in the regular pathological examinations. The aim of this study was to evaluate the value of immunohistochemical assay in the detection of micrometastasis. METHODS: Monoclonal antibodies against cytokeratin (AE1/AE3) were used to detect the cervical lymph nodes of 46 cases (50 sides of neck) of supraglottic carcinoma with pathologically negative findings (pN0). RESULTS: Micrometastases were identified in 13 lymph nodes of 11 cases. CONCLUSION: It is suggested that the detection of lymph node micrometastases with immunohistochemical method is more sensitive than that of regular pathologic method. It is comparable to serial sectioning. Therefore, It is a valuable clinical method to detect the early lymph node metastasis.

Adult↗
PubMed1992

Design and evaluation of a subclassification system for supraglottic laryngeal cancer.

The management of supraglottic laryngeal cancer is predicted upon tumor staging as determined by the American Joint Committee Classification (AJCC). Because of changes in both radiotherapy and surgical treatment, the current AJCC may lack the detail and specificity required for accurate selection of treatment. An expanded classification system should provide predictive information that would aid in clinical decision making. Using the AJCC as a foundation, a subclassification system based upon existing knowledge of laryngeal anatomy, embryology and pattern of tumor spread was developed. This system identifies those cancers that involve subsites deemed to represent regions of increased risk for spread. The validity of this subclassification system and its clinical application was assessed by reviewing 139 cases of supraglottic laryngeal cancer and performing a statistical analysis with respect to treatment outcome. The results of this study support the conclusion that two subpopulations of laryngeal tumors, those with a subsite designation of infrahyoid epiglottis, and those demonstrating fixation of the vocal cord, may benefit from a more aggressive treatment protocol.

British Columbia↗
PubMed2003

[The effects of pharyngeal neurectomy and cricopharyngeal myotomy on postoperative deglutition in patients undergoing horizontal supraglottic laryngectomy].

OBJECTIVES: We compared the effects of pharyngeal neurectomy (PN) and cricopharyngeal myotomy (CPM) on postoperative deglutition in patients undergoing horizontal supraglottic laryngectomy (HSL). PATIENTS AND METHODS: The study included 20 male patients (mean age 53 years; range 39 to 67 years) who underwent HSL for squamous cell carcinoma of the larynx. Tumor stages were T1 in two, T2 in 16 , and T3 in two patients. None had received radiotherapy before surgery. In order to decrease cricopharyngeal muscle spasm following HSL, the patients were randomly chosen for CPM (n=11) and PN (n=9). The two groups were compared with respect to the time to postoperative oral food intake. RESULTS: No significant difference was found with respect to the time to postoperative oral feeding (mean 27 days, range 16 to 45 days in the CPM group; mean 25 days, range 16 to 36 days in the PN group; p>0.05). No significant relationship existed between primary tumor stages and the time to oral feeding (p>0.05). No complications were encountered in the two patient groups. CONCLUSION: In supraglottic partial laryngectomies, PN seems to be as effective as CPM to decrease postoperative cricopharyngeal muscle spasm, with additional advantages of ease and safety.

Adult↗
PubMed2004

[Histopathology study of supraglottic carcinoma with different vocal cord movement].

OBJECTIVE: To explore the histopathology characteristics of supraglottic carcinoma with different vocal cord movement, and to find the theory basis for partial laryngectomy. METHOD: Eighty-four cases of supraglottic laryngeal carcinoma specimen were imbedded in collodion, and then make whole-organ serial section for HE staining, observing under light microscope. RESULT: For the vocal cord fixation, the rate of invasion to arytenoids, to infra-paraglottic space and to both arytenoids and infra-paraglottic space was 46.2%, 15.4%, and 38.5%, respectively; For the vocal cord limitation, the rate of invasion to arytenoids, to infra-paraglottic space and to both arytenoids and infra-paraglottic space was 46.7%, 6.7%, and 13.3%, respectively; For the vocal cord with good movement, no cases occurred for the invasion to the infra-paraglottic space or arytenoids. The difference was significant between them (P<0.05). There was close relationship between the tumor invasion to infra-paraglottic space with to the ventricle of larynx: for the vocal cord limitation and fixation, the ratio of the tumor invading the infra-paraglottic space to the ventricle of larynx is 40.0% and 73.7%, respectively, the difference was significant between them (P<0.05). CONCLUSION: The invasion of supra-glottic carcinoma to the arytenoids or infra-paraglottic space is the main cause of the vocal cord limitation and fixation. We can do the operation of partial laryngectomy more precisely by observing the movement of the vocal cord and the invasion to laryngeal ventricle.

Adult↗
PubMed2005

Foreign body in the vallecula presenting as acute epiglottitis with unilateral supraglottitis.

Life threatening inflammatory swelling of the epiglottic and supraglottic regions secondary to a foreign body in the vallecula is an unusual occurrence. Upper airway obstruction is potentially a life threatening sequela. We present a unique case of acute epiglottitis with unilateral supraglottitis secondary to foreign body in the vallecula, which gradually improved after emergency endotracheal intubation for respiratory arrest, followed by intensive conservative management with intravenous antibiotics, cortisone and intravenous fluids. This case emphasizes that a foreign body in the vallecula presenting with severe dysphagia should be taken seriously as it may lead to life threatening complications.

Acute Disease↗
PubMed2006

Infantile supraglottic hemangioma: a case report.

Hemangiomas of the airway are benign vascular lesions that can involve any site from the nares to the tracheobronchial tree. Most of these lesions are seen in the subglottic area in infants. Supraglottic infantile hemangiomas are very rare. We report a case of supraglottic hemangioma in a 2-month-old boy who had been admitted to our hospital with inspiratory stridor and dyspnea. The hemangioma involved the left arytenoid and aryepiglottic fold. A tracheostomy was performed, and the patient was followed up endoscopically every 6 months thereafter The hemangioma disappeared when the child was 30 months old. Subsequently, a Montgomery T-tube was placed for 6 months to assist in maintaining normal breathing. The patient remains disease-free during ongoing follow-up. We also discuss the management strategies for infantile laryngeal hemangiomas.

Airway Obstruction↗
PubMedDate not supplied

[Histopathological parameters and lymphatic metastasis in supraglottic laryngeal carcinoma].

Histopathologic parameters in predicting lymph node metastasis of supraglottic laryngeal carcinoma. A systematic clinical-pathological study was performed on fifty-three resected cases of supraglottic laryngeal squamous cell carcinoma, followed up for at least 5 years. The aim of the research was to evaluate histopathologic parameters in predicting lymph node metastasis (N+) as expression of biological malignancy of the neoplasm. The following neoplastic microscopical features were studied: histopathologic and cytologic grading, pattern of growth, peritumoral inflammatory infiltrate, stromal reaction, tumoral necrosis. The results are as follows: stromal reaction and cytologic grading are not useful to identify N+ and N- cases. Cases with high and low degree of differentiation (Broder's grading) are significantly correlated respectively to low (14.3%) and high (70%) incidence of lymph node metastasis (p less than 0.03). A clear correlation is present between the pattern of growth "pushing" and lacking of node metastasis (84.6%). A favorable prognosis significance seems to be linked with the presence of peritumoral lymphoplasmocytic infiltrate, which results to be a marker of cases in which lymph node metastasis incidence is very low (5.5%; p less than 0.001). On the contrary lymph node metastasis incidence increase when tumoral necrosis is present (76.5%; p less than 0.001).

Carcinoma, Squamous Cell↗
PubMed1989

[Clinical analysis of supraglottic cancer].

We treated 159 cases of supraglottic cancer including 53 cases of transglottic type from July, 1978 to December, 1984. The mean age was 65 years and man to woman ratio was fifth. Of those patients 15 were classified as T1, 36 as T2, 56 as T3 and 52 as T4 and 113 as N0, 22 as N1, 14 as N2 and 10 as N3. Stage classifications were stage I in 13, stage II in 21, stage III in 50 and stage IV in 75. Treatment modalities were divided radiation in 25, operation only in 105, pre-or post-operative radiation in 29. Multiple primary malignancies were detected in 18 cases (11.3%). Until December, 1986, 52 patients died. Cause of death were original cancer (33 cases, 63.5%), additional malignancies (5 cases, 9.6%), intercurrent disease (12 cases, 23.1%) and others. Deaths of original cancer were attributable to the metastasis to the cervical lymph node and/or distant metastasis, mainly to the lung. Metastatic lymph nodes at the initial treatment were found in 66.7% of patients who died of supraglottic and/or transglottic cancer. In order to improve survival rates, early diagnosis and radical dissection of positive lymph nodes are seemed to be important.

Aged↗
PubMedDate not supplied

Adult supraglottitis. A prospective analysis.

Epiglottitis in pediatric patients is an infection caused by Haemophilus influenzae type b, which can lead rapidly to sepsis and an asphyxial death. In an effort to study the cause and clinical course of adult epiglottitis, eight serially hospitalized adult patients with supraglottitis over a ten-month period were prospectively evaluated, including a daily laryngeal examination. Although multiple anatomic sites in the larynx and oropharynx were inflamed, the epiglottis was often not the most involved area and was actually normal in one patient. Bacterial cultures were harvested from blood, the nasopharynx, the oropharynx, and the vallecula in all patients and the preepiglottic space in two patients. In no case was H influenzae demonstrated. No patient developed respiratory compromise. It was concluded that epiglottitis is an inaccurate description of this disorder and that this non-H influenzae adult variety of supraglottitis seemingly can follow a less pernicious course than the classically described infection.

Adolescent↗
PubMed1987

Approach to supraglottitis.

In my experience, steroids have no use in the management of ACSOL once the airway is secured, and may actually prolong and complicate the infectious process. The main use of antibiotics is probably for preventing systemic complications such as pneumonia and meningitis. It is possible, however, that neither drug can alter the natural course of this disease and may just hasten its expected inconsequential resolution. The key to successful management of acute supraglottitis is early recognition and prompt provision of airway assistance when indicated. This potentially fatal disease occurs in adults as well as children. To my knowledge, most deaths occur after the patient arrives at the hospital, when there is hesitation and indecision about the need for airway intervention. Whenever signs of UAO appear, artificial airway should be provided promptly, regardless of the eventual diagnosis. Those physicians who try all means to avoid intubation or tracheotomy early in the process may be cautioned that complications from either procedures are just a risk, while airway obstruction in most cases of ACSOL is a certainty. Finally, the examiner assessing patients with possible obstructive laryngitis, supraglottic, or subglottic, should first and foremost decide whether an airway is needed and should defer all diagnostic guesswork and laboratory data processing until the airway is secured.

Adult↗
PubMed1986

[Conservative surgery of cancer of the larynx. Cordectomy, hemilaryngectomy, supraglottic laryngectomy].

Of a total of 219 partial laryngectomies performed, 119 were cordectomies, 30 hemilaryngectomies and 70 supraglottic laryngectomies. Results of each type of operation are presented with emphasis on problems of local recurrences, evidence of validity of procedure selected and of its indications. Analysis of results, with the reservation that indications were sometimes wide but always reasonable, showed an extremely low incidence of recurrences, the quality of the resection (limited or insufficient) having finally little incidence on the latter, except perhaps in the supraglottic laryngectomies. It is suggested, therefore, that no attempt should be made to "recover" a histologically detected insufficient excision by complementary radiotherapy not required in principle. This assists follow up review and allows secondary therapy if an unfavorable course is noted.

Adult↗
PubMed1987

Supraglottic hemangioma during pregnancy.

A 37-year-old woman, gravida 10, para 1-0-8-1, presented in her second trimester of pregnancy with complaints of frequent sore throats, change in voice quality, and recumbent dyspnea. These symptoms were noted initially during her previous pregnancy, and resolved after delivery. She was found to have a supraglottic hemangioma which occluded 40% of her upper airway. This lesion was noted to dramatically involute beginning at 36 weeks' gestation. The supraglottic hemangioma is a very rare cause of dyspnea in pregnancy. Its growth during pregnancy and regression postpartum is possibly related to the effects of estrogen and progesterone.

Adult↗
PubMed1984

[Radiotherapy of supraglottic cancers. Report on 84 patients].

Ten of 84 supraglottic carcinomas were treated by primary surgery, 32 by pre or post operative irradiation and 41 by primary irradiation and salvage surgery if recurrence developed. A comparison of the treatment results between these groups is not possible because of the lack of randomization. After follow up of 4.4 years (range 0,1-19, 7 y) 44% of the patients had died of their primary tumour or complications of treatment, 22.5% had died of intercurrent disease and 11% of other malignancies. The actuarial 5-year survival in the pre/postoperatively irradiated group was 75%, 100% and 67% for Stage I-III respectively. None of the 13 patients in Stage IV survived 5 years. The actuarial 5-year survival for the Stage I-IV irradiated patients was 91%. 67%, 82% and 42%. If possible the primary treatment should preserve the larynx, which is of great importance for the patient's quality of life. With proper selection supraglottic laryngectomy is possible for certain tumours of Stage I and II. For more advanced tumours and those not suitable for partial laryngectomy, well planned curative irradiation should be given with "reducing field" technique allow for salvage surgery for radioresistant tumours or recurrences. A total dose of 62-72 Gy 5 x 2 Gy per week for 6-8 weeks is needed depending on the stage of the tumour. Preoperative irradiation in clearly operable tumours can be given with a short course of 5 x 5 Gy over 5 days as the method of choice. In doubtfully operable tumours conventional preoperative irradiation with 30-40 Gy in 3-4 weeks is preferable.

Carcinoma, Squamous Cell↗
PubMed1983

[The activity of the supraglottal sphincter during phonation].

By means of the measurement of the aperture of the upper laryngeal sphincter it is shown that the sphincter constriction increases when the pitch is lowered and/or the voice intensity is raised. The sphincter movement does not result from the action of extrinsic laryngeal muscles. Moreover, the action of the adductor muscles results in a constriction of the supraglottal sphincter. Out of this group of muscles the lateral thyroarytenoid muscle is dominant. Since it is the strongest muscle of the group of adductors, it also activates the glottal and the supraglottal sphincters, and only this muscle guarantees glottal closure at a relaxed vocalis muscle (low pitch) and/or high subglottal pressure (high intensity). EMG data acquired from the lateral thyroarytenoid muscle at phonation at various pitch levels and different voice intensities confirm the assumed muscular function. The EMG activity increases with descending pitch level and/or with increasing voice intensity.

Electromyography↗