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PubMed1984

Radiation recall supraglottitis. A hazard in head and neck chemotherapy.

The enhanced effects of chemotherapy on previously irradiated tissue have been well demonstrated. When chemotherapy is given some time after irradiation and elicits a tissue reaction in the radiation field, the reaction is termed radiation recall. We review known interactions between chemotherapy and radiotherapy and report, to our knowledge, the first case of a supraglottitis radiation recall reaction. Familiarity with this phenomenon and potential complications of chemotherapy following head and neck irradiation may expedite early diagnosis and appropriate lifesaving treatment.

Cytarabine↗
PubMed1989

Stevens-Johnson syndrome with supraglottic laryngeal obstruction.

Patients with the Stevens-Johnson syndrome or erythema multiforme exudativum may present to the otolaryngologist because of involvement of the mucosa of the upper aerodigestive tract. Stevens-Johnson syndrome is a symptom complex of uncertain cause that affects the eyes, skin, and mucous membranes throughout the body. The epithelial lesions progress from macules to bullae that desquamate, form pseudomembranes, and finally heal. Generally there is a prodromal period with fever and symptoms of an upper respiratory tract infection. The literature related to the otolaryngologic manifestations of the disease is reviewed and a case of Stevens-Johnson syndrome with early involvement of the supraglottic larynx is presented. The otolaryngologist should be aware of this syndrome and should be prepared to manage the possible airway compromise.

Adult↗
PubMedDate not supplied

Lateral supraglottic pharyngo-laryngectomy with arytenoidectomy.

BACKGROUND: Supraglottic laryngectomy for tumors of the epilarynx requiring arytenoid cartilage resection is frequently associated with problems in relearning to swallow, and aspiration is frequent. We propose a surgical procedure in which a local flap is used to close the pharyngeal defect. METHODS: An apron skin incision is used to expose the hyoid bone and strap muscles. The median raphe is opened, and the hyoid bone is cut along the midline and released on its posterior surface. The thyrohyoid and stemothyroid muscles ipsilateral to the tumor are separated, with the perichondrium from the thyroid cartilage. This forms a continuous flap that includes the suprahyoid muscles and hemihyoid bone, together with the strap muscles and thyroid lobe that will be used for closure. RESULTS: Thirty-three patients with T1-T3 carcinomas of the laryngeal margin, with extension to one arytenoid in all cases and to the pyriform fossa in 14, underwent this procedure. Only 5/33 (15%) patients had locoregional recurrences. Visceral metastases occurred in 11/33 (33%) patients, and second primary tumors were diagnosed at the time of surgery or during follow-up in 9/33 (27%) patients. Three-year and 5-year actuarial survival rates were 57% and 51%, respectively. Despite the need for radiotherapy in 26 patients, functional success was obtained in 26/33 cases (79%). CONCLUSION: This technique provided good tumor control and a high rate of satisfactory functional results. It can be applied to patients with tumors of the lateral margin which unilaterally extend to the aryepiglottic fold, the arytenoid, and the medial well of the pyriform fossa.

Adult↗
PubMed1996

Evidence for multiple tumor suppressor genes on chromosome arm 8p in supraglottic laryngeal cancer.

Loss of heterozygosity studies of a variety of human tumors suggest that there are several tumor suppressor genes on chromosome arm 8p. To localize these genes more precisely, we utilized polymerase chain reaction amplification of microsatellite repeat polymorphisms and examined the allelic loss patterns of 17 marker loci on 8p in a population of 59 supraglottic laryngeal squamous cell carcinomas. Twenty-three of these tumors (39%) had an allelic loss at one or more of the markers examined. The allelic loss patterns of these tumors support the presence of at least three different tumor suppressor genes on 8p: one in 8p23, one in 8p22-23, and another in 8p21.

Carcinoma, Squamous Cell↗
PubMed1985

Extracapsular spread of carcinoma in cervical lymph nodes. Impact upon survival in patients with carcinoma of the supraglottic larynx.

The treatment results and histologic findings in the cervical lymphatics of 96 patients with squamous cell carcinoma of the supraglottic larynx were studied retrospectively. The clinical assessment of the extent of disease in the cervical lymphatics correlated poorly with histologic findings. Forty-one percent of patients judged to have no evidence of cervical metastases were found to have carcinoma in the cervical lymphatics. Twenty percent of patients judged clinically NO were found to have extracapsular spread of tumor. Patients were subdivided according to the histologic findings in the cervical lymphatics. Three-year no-evidence-of-disease (NED) follow-up was available on all patients. Patients with no tumor in cervical lymphatics had a 71% 3-year NED. By comparison, patients with cervical metastases confined to the lymph node were 79% NED. Patients with histologic evidence of extracapsular spread of tumor were 45% NED (P less than 0.05). The use of histologic findings in predicting prognosis and treatment planning is discussed.

Carcinoma, Squamous Cell↗
PubMed1994

Frequent loss of heterozygosity for Rb, TP53, and chromosome arm 3p, but not NME1 in squamous cell carcinomas of the supraglottic larynx.

BACKGROUND: The inactivation of some tumor suppressor genes classically manifests itself through the loss of heterozygosity at nearby genetic mapping markers. Inactivation of these genes appears to have diagnostic/prognostic significance in some types of tumors. Molecular genetic tools based on suppressor inactivation might, therefore, have great utility in treatment planning. METHODS: The polymerase chain reaction and highly informative microsatellite markers were used to compare DNA derived from matched sets of tumor and normal tissue samples from 37 supraglottic laryngeal squamous cell carcinomas. Tumor samples were microdissected free of contaminating normal tissue to maximize the detection of allelic loss. Polymerase chain reaction products were fractionated by denaturing gel electrophoresis and were visualized by autoradiography. RESULTS: Allelic losses were frequent at TP53 (56% of the tumors), the retinoblastoma gene (Rb, 59%), and the p13-14 region of chromosome 3 (64%). In contrast, the putative metastasis suppressor, NME1 (also known as NM23), was lost infrequently (7%). NME1 allelic loss did not correlate with the presence of lymph node metastases in these patients. CONCLUSIONS: The high frequencies of allelic loss at TP53, Rb, and 3p13-14 suggest that these suppressors play a major role in laryngeal carcinogenesis. In sharp contrast, the low frequency of loss at NME1 and its equal distribution in nodal metastasis-positive and -negative patients suggests that inactivation of this gene by allelic loss probably does not play a role in the development of regional metastases from these tumors. Allelic loss in 3p13-14 was found in tumors of all histopathologic grades.

Base Sequence↗
PubMed2004

Functional outcomes of transoral laser surgery of supraglottic carcinoma compared with a transcervical approach.

BACKGROUND: Several functional advantages have been described for the transoral laser supraglottic laryngectomy as compared with open techniques. However, comparative studies have been rarely performed. METHODS: Functional results in 26 patients treated with a transoral approach were retrospectively compared with those of a comparable series of 26 patients who underwent a transcervical approach. RESULTS: The only significant differences found between the two groups were a lesser number of temporary tracheotomies and a shorter time of removal of the nasogastric tube in the laser group. No significant differences were found in the incidence of postoperative complications, hospital stay, and swallowing capacity. CONCLUSIONS: The rate of functional problems after transoral laser surgery did not greatly decrease compared with the rate after the conventional procedure. The mayor advantage of the transoral approach was the lower incidence of temporary tracheotomies.

Aged↗
PubMedDate not supplied

Modification of compensatory swallowing in a supraglottic laryngectomy patient.

Results are presented for repeated videofluoroscopic and scintigraphic examinations of a supraglottic laryngectomy patient, illustrating the successful use and later changes in a compensatory swallow. Issues in patient management are outlined, stressing the importance of interaction between radiologists and dysphagia therapists in the rehabilitation of such patients.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Factors influencing functional outcome in supraglottic laryngectomy.

BACKGROUND: The relationship between preoperative pulmonary function tests (PFTs) and postoperative aspiration and deglutition complications in supraglottic laryngectomy (SL) has not been adequately analyzed. The effects of numerous other variables are either controversial or have not been studied. METHODS: A retrospective chart review was performed on 46 SL patients, analyzing preoperative PFTs and arterial blood gases, demographic factors, stage of disease, extended resections, cricopharyngeal myotomy, hyoid preservation, neck dissection, and postoperative radiotherapy with regards to aspiration and deglutition problems. RESULTS: Eighteen (39%) patients had no problems, 15 (33%) had moderate problems, and 13 (28%) had severe problems; of these, 39 (85%) were ultimately successful with no further swallowing dysfunction, whereas seven (15%) suffered intractable aspiration difficulties. Decreasing FEV1/FVC was significantly correlated with a poorer outcome, as was a greater number of pack-years of smoking. The effect of FEV1/FVC was shown to be independent from pack-years, whereas the converse was not clearly demonstrated. Extensions of the standard procedure did not correlate significantly with increased problems. CONCLUSIONS: An FEV1/FVC less than 50% signifies a greater risk for severe aspiration and deglutition complications, although it must be regarded as one factor among many in determining operability. With careful attention to reconstruction, extensions of the standard SL procedure can be safely performed.

Adult↗
PubMed1983

Transoral partial supraglottic resection using the CO2 laser.

Transoral epiglottis resection or partial supraglottic resection was done with the CO2 laser in 20 highly selected patients. Visualization was best accomplished using the Lynch suspension system, but was satisfactory with the Jako-Pilling laryngoscope. The best indications for this procedure were: 1. for visualization of the true vocal cords in previously treated cancer patients whose epiglottis obstructed indirect mirror examination, 2. for removal of obstructing benign epiglottic lesions, 3. as an excisional biopsy in limited epiglottic cancer, especially of the suprahyoid epiglottis. No major complications or operative morbidity occurred. This approach obviated the potential morbidity of external surgical procedures In a select group of patients. Shortened hospitalization, avoidance of tracheotomy, minimal postoperative discomfort and edema, and excellent wound healing were additional advantages seen.

Adult↗
PubMed2000

Congenital supraglottic cyst: a rare cause of stridor.

Congenital laryngeal cysts are very rare and if mismanaged, lead to a high incidence of morbidity and mortality. The case may present as severe stridor and emergent management can obviate a tracheostomy, achieving cure in the process. We report here a case of supraglottic cyst, which was completely occluding the airway and was managed in the emergency setting.

Cysts↗
PubMedDate not supplied

Airway intervention in adult supraglottitis.

BACKGROUND: The timing of aggressive airway intervention in adult epiglottitis is controversial. AIMS: To correlate Friedman's staging of epiglottitis on admission with the airway interventions undertaken. METHODS: A retrospective study of 23 adult patients, mean age 51 years (range 29-81 years), who had been admitted with acute supraglottitis between March 1988 and December 2000 was undertaken. RESULTS: Three patients (13%) had airway interventions; two with tracheostomy and one with tracheal intubation. All were Friedman stage III and had rapid symptom progression during the 24 hours prior to admission. Three other stage III patients with symptom progression longer than 24 hours and all the remaining patients (stage II or less) were managed with observation and intravenous therapy. CONCLUSIONS: Friedman originally advocated airway intervention in any patient stage II or worse, but this intubation threshold should probably be lowered to those patients with rapid-onset stage Ill (moderate respiratory distress, stridor, respiratory rate > 30 per minute, pCO2 > 45mmHg) disease.

Acute Disease↗
PubMed2000

Initial treatment of the early stages (I, II) of supraglottic squamous cell carcinoma: partial laryngectomy versus radiotherapy.

The purpose of this study was to define the treatment of choice (partial laryngectomy vs radiotherapy) in the early stage of supraglottic squamous cell cancer (ESSC). One hundred and fifteen patients with ESSC were treated with either partial laryngectomy (25 patients) or with radiotherapy(90 patients) between January 1984 and December 1996. All patients had a follow-up of over 29 months. Radiotherapy (RT) had a local control rate of 79%, which increased to 90% with salvage surgery, and a high larynx preservation rate (83%). Partial laryngectomy (PL) offered a better initial local control rate of 84%, which increased to 88% with salvage surgery, and functional results were also good (80%). No statistically significant differences were found between RT and PL. RT was less costly, showed better suitability for treatment, produced moderate morbidity and sequelae, and local recurrence was easier to rescue. However, it is a once-only application technique. PL showed higher immediate postoperative morbidity, higher cost and lower suitability for treatment but had fewer sequelae, offered the best initial local control and is multi-applicable. No clear oncological arguments were found in our series to define whether PL or RT is the treatment of choice for ESSC. Both are effective therapies. Secondary factors such as suitability for treatment, morbidity, cost and applicability should be individually evaluated when choosing the type of treatment. As the laser endoscopic approach decreases morbidity and costs and makes the condition more suitable for treatment, it could be the treatment of choice for ESSC, in cases where local tumoral extent and larynx exposure allow radical excision.

Aged↗
PubMed2001

Efficacy of adjunctive cricopharyngeus myotomy in supraglottic laryngectomy.

This study investigates prospectively the effect of concurrent cricopharyngeus myotomy (CPM) on swallowing following horizontal supraglottic laryngectomy (SL) using fiberoptic, radiographic, and manometric evaluations and suggests possible mechanisms regarding the role of CPM following SL. Six patients undergoing horizontal SL between 1995 and 1997 were enrolled in a prospective evaluation with a followup of 0.5-2.25 years. Three patients underwent concurrent CPM and three did not. Fiberoptic, radiographic. and manometric assessments were performed postoperatively. Although mean resting pressures at the upper esophageal sphincter were reduced significantly by myotomy (12 mm Hg) compared with nonmyotomized patients (57 mm Hg), p < 0.01, no rehabilitative advantage was observed in the former group. In fact, of the myotomized patients, two required feeding gastrostomy tubes with resumption of an oral diet in one year and in two months, respectively, while the nonmyotomized patients were all capable of resuming a full oral diet within four weeks. It appears that CPM provides no rehabilitative advantage in patients undergoing SL.

Aged↗
PubMed1984

Supraglottic obstruction.

A case of supraglottic obstruction resulting from a penetrating temporal injury is described. Despite the innocuous entry wound extensive occult injury had occurred and was initially overlooked. Diagnostic, anatomical and therapeutic considerations are discussed.

Airway Obstruction↗
PubMed1993

Effect of upper airway muscle contraction on supraglottic resistance and stability.

The activation of upper airway (UAW) muscles is believed to increase UAW patency to air flow. To evaluate the mechanisms by which UAW muscles act to prevent UAW collapse, pressure-flow relationships of the isolated UAW as well as the negative pressure required to cause UAW collapse (Pcrit) were assessed before and during electrical stimulation of four UAW muscle pairs in anesthetized dogs. Stimulation of each of the muscles shifted the pressure-flow curve toward lower pressures for any given flow rate, indicating UAW dilatation. UAW resistance decreased from 7.9 +/- 0.6 to 0.4 +/- 0.1, 2.7 +/- 0.6, 2.3 +/- 0.8 and to 4.8 +/- 1.5 cmH2O.L-1.sec during genioglossus, geniohyoid, sternothyroid and sternohyoid stimulation respectively (P < 0.01 in all cases). However, only genioglossus stimulation significantly increased Pcrit (from -3.4 +/- 0.6 to -12.0 +/- 1.8 cmH2O, P < 0.001). Relaxation of the genioglossus thus appears to produce the main impediment to air flow through the UAW, and contraction of this muscle improves UAW patency both by dilating the supraglottic airway and by stiffening its walls.

Airway Resistance↗
PubMed1990

Surgical management of congenital supraglottic lateral saccular cyst.

A case is described of a neonate with a rare, congenital, supraglottic, lateral, saccular cyst presenting with stridor and asphyxia. Repeated needle aspirations of the cyst failed to provide sustained clinical improvement. CT scans proved useful for precise intralaryngeal location of the cyst and planning of the surgical excision. At two months of age the cyst was successfully excised by a paramedian thyrotomy via an external cervical approach, avoiding tracheostomy.

Cysts↗
PubMed1991

Nimorazole as a hypoxic radiosensitizer in the treatment of supraglottic larynx and pharynx carcinoma. First report from the Danish Head and Neck Cancer Study (DAHANCA) protocol 5-85.

Between January 1986 and September 1990, 442 patients with pharynx and supraglottic larynx carcinoma were randomized to receive the hypoxic cell radiosensitizer nimorazole (NIM) or placebo in association with a course of conventional primary radiotherapy. A preliminary analysis including the first 288 patients showed that the stratification parameters were significant (3-year actuarial local-regional tumor control, p less than 0.05) for sex (females 52% vs males 34%), tumor size (T1-T2 47% vs T3-T4 32%) and pre-irradiation hemoglobin (Hb) concentration (high 41% vs low 34%). Overall, the NIM group showed a significantly better local-regional control rate than the placebo group (46% vs 32%). There was an apparent additive effect of Hb concentration and NIM. Thus, in the male group, placebo patients with low Hb had a 23% control rate compared to 46% in NIM treated patients with Hb above 9 mmol/l (p less than 0.05). The similar effect in females could not be evaluated due to the small number of women with this disease. NIM was well tolerated and drug-related side effects were minor and tolerable, with transient nausea and vomiting as the most frequent complication. A final conclusion of the study must await an evaluation including all patients and a longer observation time.

Carcinoma↗