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PubMed1981

[Enlarged supraglottic laryngectomy (author's transl)].

Malignant tumour of the upper hypopharynx is the most often the continuation of the supraglottic cancer of the larynx or it develops from the beginning between the lingual site of the epiglottis and the base of the tongue. The enlarged supraglottic laryngectomy has the best results. The large defect between the partial resected base of the tongue and the border of the resected laryngeal cartilage was covered by the fascia of the sternohyoid muscle. From 22 cases operated from 1979 on this way one local relapse was found.

Humans↗
PubMedDate not supplied

[Examination of the patient with supraglottic carcinoma at the medical office. Contribution of the rigid optical devices and the fiberscope].

Seventy one patients afflicted of supraglottic carcinoma were included in a prospective study whose purpose was to determine which of three optical tools available at the medical office--indirect mirror laryngoscopy, laryngotelescopy and fiberscopic examination--is the most suitable to examine the larynx of patients with this disease. No significant differences were found among these explorations in the easily observable regions, as the hypopharyngeal areas and the epilarynx. The examination of the pericommisural region--the most difficult area to see--was easier with the flexible fiberscope. The laryngotelescope provided better visualization than the mirror laryngoscopy. Exploration with the new optical devices did not correct the errors in the interpretation of images made with the mirror laryngoscopy. We conclude that flexible fiberoptic laryngoscopy provides better information than other diagnostic tools for the assessment of patients with supraglottic carcinoma at the medical office.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

[The histological study of adenopathies in laryngeal cancer with supraglottic localization].

A histopathologic study was made to establish the prognostic importance of lymph node involvement in operable supraglottic laryngeal carcinoma. A total of 51 cancer patients underwent supraglottic horizontal laryngectomy with bilateral cervical dissection. The number of adenopathies the presence of capsule rupture and type of corresponding infiltration were significantly related to survival (p < 0.01). Prognosis was poorer in patients with more than three metastatic adenopathies and/or capsule rupture of one or more of them. Patient survival in cases with capsule rupture affecting one or more nodes was 36%, versus 33% among patients with three or more metastatic nodes. It is concluded that (a) the poor survival rate observed among these patients points to the need for more aggressive treatment protocols; and (b) cervical dissection should be performed systematically not only for therapeutic purposes but also to improve patient prognosis.

Adult↗
PubMed1993

[The role of elective neck dissection in the surgical treatment of supraglottic carcinoma].

The survival rates of 622 operative cases with supraglottic carcinoma from October, 1977 to October, 1990 treated in The First Hospital of CMU were compared. The 3.5 and 10 year survival rates were 79.48%, 72.53% and 65.22% respectively. With regard to different surgical procedures, the 3.5 and 10 year-survival rates of END was 94.54%, 91.29% and 86.60% respectively; those of CND were 55.79%, 42.39% and 31.17%; and of NND, 79.15%, 74.53% and 68.56%. There were significant differences between either two groups. The authors suggest that elective neck dissection has an important role in surgical treatment of patients with supraglottic carcinoma.

Adult↗
PubMed1993

[Results of the surgical treatment of cancers of the supraglottic area].

The authors report a retrospective analysis of the results of surgery in 169 patients with supraglottic cancer referred to the Lille ENT clinic from 1976 to 1985. Partial surgery was performed in 53% of patients versus total laryngectomy in 47%. The 5 year survival rates in the patient groups treated by supraglottic laryngectomy and supracricoid laryngectomy with cricohyoidopexy were similar, 69.4% and 75.2%, respectively. The 5 year survival rate in the patient group treated by total laryngectomy or by total laryngectomy extended to the base of tongue was 62.8%.

Adult↗
PubMed1994

Endoscopic treatment of supraglottic and hypopharynx cancer.

Transoral excision of supraglottic and hypopharynx cancer as a single modality is effective when lesions are selected for small size and endoscopic accessibility. Excisional biopsy with clear margins of larger supraglottic tumors in combination with postoperative radiotherapy provides an excellent treatment alternative for selected lesions in patients who are not candidates for open surgery. In this preliminary report, 45 cases using this minimally invasive approach are reviewed outlining oncologic rationale and functional advantages. A large bore tubed laryngoscope or the adjustable bivalve supraglottiscope was used along with a carbon dioxide laser in all cases. In 22 of the 45 patients (mostly T1), local en bloc excision of the primary cancer was performed as sole treatment on selected lesions of the supraglottis and hypopharynx. There were no local recurrences, however, 1 patient developed a neck recurrence and was salvaged by neck dissection. Twenty-three of the 45 patients had more extensive primaries (mostly T2, T3) and N0 necks. Transoral excisional biopsy was followed by full-course radiation therapy to the primary site and both necks. All 23 were followed a minimum of 2 years, and the median follow-up period was 58 months. Clear margins were obtained in 16 of 23, and there were no recurrences in the larynx. Two of 16 did fail in the neck and died despite neck dissection. Seven of 23 patients had positive margins and, despite full-course radiotherapy to the primary site and both necks, 5 of 7 failed locally or regionally. Two of the 7 died of their disease despite open salvage surgery. Therefore, 4 of 23 patients who underwent transoral excision of larger lesions followed by full-course radiotherapy died of recurrent cancer.

Combined Modality Therapy↗
PubMed1995

[Pre-operative radiotherapy for N0 supraglottic carcinoma: a randomized study].

A randomized study on 100 patients of N0 supraglottic squamous cell carcinoma with at least 3 years of follow-up was performed. Surgery alone was used in 56 patients, and combined therapy in 46 patients. The neck failure occurred in 14 (26%) patients and 7 (15%) patients respectively, there was no statistically difference (P = 0.287). Neck failure was higher in T4 stage supraglottic carcinoma for controlling of regional recurrence.

Adult↗
PubMed1996

CT in adult supraglottitis.

We describe the CT appearance of supraglottitis and its complications in three adults. The most common CT findings were thickening of the epiglottis, aryepiglottic folds, false and true vocal cords, obliteration of the preepiglottic fa, thickening of the platysma muscle, and reticulation of the subcutaneous fat. Multiple loculated fluid-density collections consistent with abscesses were seen in one patient. Although the diagnosis of supraglottitis is generally made on the basis of the patient's history and by direct endoscopy, CT may be used to confirm the diagnosis when an adequate laryngoscopic examination cannot be performed. CT is also useful in evaluating the complications of this disorder.

Adult↗
PubMed1996

Supraglottic laryngeal or base of tongue cancer involving vallecula.

To determine the outcome of patients with supraglottic laryngeal or base of tongue cancer affecting the vallecula relative to the applied method of definitive treatment, a retrospective analysis was performed of 30 consecutive patients treated during a 12-year period (1981-93). Management consisted of surgical resection with adjuvant radiation in 19 patients and radiotherapy in 11 patients with adjuvant chemotherapy (n = 4). The overall actuarial survival rate was 20% at 2 years. Among the 29 evaluable patients, the locoregional failure rate was 52% and the distant failure rate was 31%. Surgery with radiotherapy was associated with better survival (p > 0.20) and less locoregional failure (p > 0.05) but more systemic failure (p > 0.20) than the nonoperative method(s) of treatment. Cure rate by conventional therapy in supraglottic laryngeal or base of tongue cancer involving the vallecula is dismal. In light of these observations, the multimodality treatment approach may have to be considered in the overall management of the disease.

Adult↗
PubMed1996

The use of the CO2 laser for airway maintenance in obstructive supraglottic carcinoma.

CO2 laser 'debulking' of obstructive supraglottic tumours is an alternative to tracheostomy to restore the compromised airway. Two patients have successfully undergone radiation therapy after laser vaporization of their large supraglottic tumours, and did not require tracheostomy. This technique is relatively simple, avoids the morbidity of tracheostomy and facilitates early irradiation.

Aged↗
PubMed1996

[Horizontal supraglottic laryngectomy. Technique, indications, oncologic results and early functional results. Apropos of 87 cases].

In this article, we advocate supraglottic laryngectomy with bilateral neck dissection for the treatment of supraglottic carcinomas with preserved laryngeal mobility. Post-operative results and follow-up of 87 patients are discussed. This technique allows an excellent loco-regional control of the disease with preservation of laryngeal function. Radiation therapy is preserved for treatment of metachronous (2nd primary) in cases with satisfactory local control without neck metastases. All stage 5-year overall survival rate was 55% with a 68.5% disease survival rate. Five-year local control of the disease and regional control of neck nodes were respectively 94% and 92%. Five-year disease survival rate for N- population was 71% Vs 61% for N+ population. Five-year disease survival rate according to the tumor classification was 70% for T1, 75% for T2, 69% for T3 and 54% for T4. In the post-operative follow-up, the median of time to decanulation was 17 days, that of nasogastric tube removal was 19 days, that of hospital stay 38 days.

Adult↗
PubMedDate not supplied

Role of accelerated fractionated irradiation for supraglottic carcinoma: assessment of results.

PURPOSE: We evaluated the results of locoregional control, patients' relapse-free survival, and voice preservation in patients with supraglottic carcinoma treated with accelerated radiation therapy. PATIENTS AND METHODS: The records of 164 patients undergoing accelerated fractionated radiation therapy for carcinoma of the supraglottis from 1981 to 1992 were reviewed and evaluated for locoregional control, disease-specific survival, and rates of voice preservation. All patients were treated with 1.6 Gy per fraction two fractions a day (BID) for 67.2 to 70.0 Gy in 6 weeks. The median follow-up was 56 months. Due to severe acute mucosal toxicity, all patients were given a short treatment break after 38.4 to 48.0 Gy. RESULTS: For T1, T2, T3, and T4 tumors, the 5-year actuarial local control rates were 96%, 86%, 76%, and 43%, respectively, and relapse-free survival rates were 78%, 82%, 64%, and 40%, respectively. With surgical salvage, the corresponding ultimate local control rates for the T1, T2, T3, and T4 tumors were 96%, 93%, 88%, and 51%, respectively. Regional control by T and N stage was non-significant. Voice preservation rates for the T1, T2, T3, and T4 tumors were 96%, 80%, 72%, and 43%, respectively, and for the entire group the rate was 79%. CONCLUSIONS: Accelerated fractionated radiation therapy resulted in excellent locoregional control, relapse-free survival, and voice preservation rates for patients with supraglottic carcinoma. The T stage and N stage were significant predictors of outcome. T4 tumors and node-positive neck disease portended a poor prognosis. These results as compared to our historical control and the published data in the literature with conventional once-daily radiation therapy (QD) suggested improved local control and patient survival after accelerated fractionated BID radiation therapy. For confirmation of these results, a prospective randomized trial is needed.

Carcinoma, Squamous Cell↗
PubMed1996

[Prognostic factors in radiotherapy of supraglottic cancer].

In 971 patients with squamous cell carcinoma of supraglottic larynx several clinical and physical prognostic factors were evaluated. There were 55% of patients with advanced primary tumours and 71% of patients with no regional neck metastases. All patients were irradiated radically using external megavoltage beam. The total dose was in range 60-70 Gy for 95% of patients. The 3-year local control rate and 3-year overall in whole group were 41% and 50% respectively. Clinical stage, haemoglobin level at the end of treatment, overall treatment time, sex and total dose were estimated as an independent and important prognostic factors for the outcome in radiotherapy of supraglottic larynx cancer.

Adult↗
PubMed1997

[The N0 neck in patients treated by supraglottic laryngectomy: abstention, surgery or radiotherapy?].

The authors examined the therapeutical approach to the N0 neck in patients submitted to supraglottic laryngectomy (SL). In these patients the choice of the therapeutical protocol may consist of simple abstention, of neck dissection or of elective radiotherapy: every decision has to be taken considering all specific inconveniences of each option. In their report the authors examined the follow-up of the N0 necks of 421 patients submitted to SL from 1970 to 1991. The patients submitted to wait and see policy were 225 whereas 196 received uni- or bilateral neck dissection. After the cervical failure's salvage the final 3-years control of the neck was the same in the two groups (91.1% vs 91.4%). In a previous research on 1157 N0 necks of patients submitted to total laryngectomy they observed a 5-years cervical control of 88.8% after wait and see policy and of 92.3% after elective radiotherapy. The conclusions of the authors is that no one of the two protocols is preferable to the other one and that subsequently in many cases of supraglottic T1 and T2 cancers a wait and see policy may be justified in absence of consistent counter-indications.

Carcinoma, Squamous Cell↗
PubMed1996

[Treatment and results of N1 supraglottic laryngeal carcinoma].

One hundred and eleven cases of supraglottic squamous cell cancer (T1-4N1) were retrospectively analysed. The result showed that: 1. the 3 years survival rate was 72% (80/111); 2, the rate of contralateral neck node metastasis after ipsilateral RND was 17.9%, and the cases of T3-4 with positive histologic findings of neck dissection samples had a higher rate contralateral neck node metastasis (38.6%); 3, the contralateral neck node metastasis rate (26.1%) in the group with surgery alone was significantly higher than that (7.1%) in the group with preoperative radiation (P < 0.05). The authors draw the conclusion that contralateral neck node metastasis is a high risk factor for recurrence of N1 supraglottic laryngeal cancer and that preoperative radiation may be be useful in controlling subclinical metastasis.

Adult↗
PubMed2001

Late lethal secondary hemorrhage after laser supraglottic laryngectomy.

Since 1971, a number of articles have been published regarding the complications encountered with laser surgery of the larynx. Most investigations focus on complications such as accidental burns caused by the reflection of the laser beam, endotracheal explosion, special anesthesiologic problems, edema of the mucosa leading to airway obstruction, and abnormal scar formation with functional problems. Secondary hemorrhage has played a subordinate role, and in the few articles that have focused on it, cases requiring postoperative treatment have been reported only sporadically. All of these cases occurred within the first postoperative week, and no case resulting in the death of a patient was reported. We describe a patient in whom a lethal secondary hemorrhage occurred 10 days after a laser supraglottic laryngectomy. Because of the increase of laser applications in the treatment of laryngeal carcinoma, similar complications may be encountered. We comment on possible pathophysiological mechanisms and consequences.

Carcinoma, Squamous Cell↗
PubMed1975

Simultaneous glottic and supraglottic laryngeal webs: report of a case.

In a rare case of simultaneous glottic and supraglottic webbing a tantalum keel, as described by McNaught, and a silcone elastomer keel, as described by Montgomery, were placed simultaneously via laryngofissure. Use of different materials appeared to have no bearing on the final, successful outcome.

Adult↗
PubMed1976

Cryosurgery of supraglottic cavernous hemangioma.

Cryosurgery is gaining more and more importance as a therapeutic modality within the field of head and neck surgery. It has been used effectively in the treatment of cavernous hemangiomas of the skin and oral cavity. Supraglottic vanernous hemangiomas present a challenge in management when surgical intervention is indicated. The results of cryosurgery in the treatment of such a lesion are reported.

Adult↗