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PubMedDate not supplied

Clinical correlation of anomalies of the supraglottic larynx with the staged sequence of normal human laryngeal development.

The clinical correlation of the authors' observations on human laryngeal development with existing literature supports the suggestion that earlier concepts, specifically by Frazer, may not be valid. It is further proposed that development of the human larynx may similarly correspond in man to that of the rat. Congenital laryngeal malformations are fundamentally associated with a disturbance of epithelial mesenchymal interactions, particularly related to a premature arrest of the normally vigorous epithelial activity.

Congenital Abnormalities↗
PubMed1991

Supraglottic contributions to pitch raising. Videoendoscopic study with spectroanalysis.

Several questions pertaining to pitch raising recur frequently. Does the larynx rise with the production of higher frequencies? What happens to the pharyngeal walls between the soft palate and the larynx when the fundamental frequency is raised? How does the soft palate participate in pitch raising? To answer these questions, the present study was undertaken with the recently described simultaneous velolaryngeal endoscopy technique. Nine professional singers were asked to find the limits of their vocal range in any of six voice qualities: speech, falsetto, cry/sob, twang, belting, and opera. Simultaneous activities of the larynx, the pharyngeal walls, and the soft palate were submitted to videoendoscopy with synchronous voice recording and studied with spectroanalysis of discrete segments of the total phonation range. Our dual endoscopic study showed that 1) the larynx rose in all subjects with the production of higher frequencies, 2) with the highest fundamental frequency, the lateral pharyngeal walls significantly contracted toward the midline in an "upside-down V shape," creating a very narrow pharyngeal tube, and 3) the soft palate lifted and the velopharyngeal port narrowed considerably with higher frequencies.

Adult↗
PubMed1996

Supraglottic and pharyngeal sensory abnormalities in stroke patients with dysphagia.

Dysphagia and aspiration are two devastating sequelae of stroke, accounting for nearly 40,000 deaths from aspiration pneumonia each year in the United States. While motor deficits in the larynx and pharynx are thought responsible for dysphagia and aspiration in stroke patients, no prior study has evaluated whether these patients also have sensory deficits. The aim of this study was to evaluate the sensory capacity of the laryngopharynx (LP) in supratentorial or brain stem stroke patients who presented with dysphagia. Fifteen stroke patients (mean age, 66.7 +/- 13.8 [SD] years) were prospectively evaluated by means of our previously described method whereby air pulse stimuli were delivered via a flexible fiberoptic telescope to the mucosa innervated by the superior laryngeal nerve. There were 15 age-matched controls. No LP sensory deficits were found in any of the age-matched controls. In all stroke patients studied, either unilateral (n = 9) or bilateral (n = 6) sensory deficits were identified. Deficits were defined as either a moderate impairment in sensory discrimination thresholds (3.5 to 6.0 mm Hg) or a severe sensory impairment (> 6.0 mm Hg). These sensory discrimination thresholds were significantly greater than in age-matched controls (7.05 +/- 0.17 mm Hg for the supratentorial group and 6.05 +/- 1.22 mm Hg for the infratentorial group versus 2.61 +/- 0.69 mm Hg for the controls). Among patients with unilateral deficits, sensory thresholds were moderately to severely elevated in all 9 cases on the affected side compared with the unaffected side (p < .01, Fisher's exact test). Moreover, the sensory thresholds of the unaffected side were not significantly different from those of age-matched controls (2.51 +/- 0.25 mm Hg versus 2.61 +/- 0.69 mm Hg, respectively). All 6 patients with bilateral deficits had severe impairments. The results of an outcome assessment in 13 of 15 patients revealed that 2 out of 5 patients with moderate LP sensory impairment and 5 out of 8 with severe impairment developed aspiration. Our results show for the first time that stroke patients with dysphagia have significant sensory deficits in the LP and that these impairments are likely to contribute to the development of aspiration.

Aged↗
PubMed1997

Method and clinical results of a new transthyrotomy closure of the supraglottic larynx for the treatment of intractable aspiration.

A new procedure has been developed to surgically separate the pharynx from the trachea that employs the best features of the Montgomery technique, but restricts the closure to only the epiglottis and the aryepiglottic folds. The petiole of the epiglottis is plicated to the false vocal folds and the interarytenoid mucosa. It is performed entirely through a midline thyrotomy approach and avoids injury to any of the structures within the rima glottidis. It has been successfully performed on seven very ill patients to date. The surgical decision-making process involved, a complete description of the surgical procedure, and a summary of the patients' preoperative condition, workup, and outcomes are presented and discussed.

Adult↗
PubMed1999

Transoral carbon dioxide laser resection of supraglottic carcinoma.

Between 1981 and 1994, 34 patients with squamous cell carcinoma of the supraglottis were treated by transoral carbon dioxide laser resection, 12 of them palliatively. Additional treatment included neck dissection in 21 patients and radiotherapy in 24 patients. The 3-year overall survival was 62%, and the actuarial survival 80%. The overall survival for T1 and T2 tumors was 71%, and that for T3 and T4 tumors was 47%. The overall 3-year survival for the early stages, I and II, was 88%, and that for the advanced stages, III and IV, was 50%. These results are comparable to the outcome after conventional open partial resection. Given the significantly lower morbidity (only 7 patients required tracheostomy), we do not observe an age limit anymore. The transoral method can be recommended as curative treatment in T1 and T2 tumors and in selected T3 and T4 tumors in concert with neck dissection and/or radiotherapy. In patients with advanced inoperable tumors, laser surgery is an excellent alternative to tracheostomy and palliative radiotherapy. Prerequisites for successful application of the transoral carbon dioxide laser resection are adequate resection techniques.

Adult↗
PubMed1990

The "second" side of the neck in supraglottic cancer.

The purpose of this study was to assess the impact of decisions made at operation for primary neck tumor on survival and cause of death-specifically, whether bilateral dissection, unilateral dissection, or delayed dissection influences eventual outcome. Of 244 patients with primary cancer of the supraglottis who were treated surgically, 22 (9%) had no neck treatment, 188 (77%) had unilateral neck dissection, and 34 (14%) had bilateral simultaneous neck dissection. Dissection on one or both sides of the neck was required later in 6 (27%) of the 22 patients with no neck treatment and in 32 (17%) of the 188 patients who had unilateral dissection. There were no differences among the treatment groups in the incidence of death from any cause or in the incidence of death from cancer, although neck stage did differ from group to group. The influence of delayed metastasis on survival was analyzed to explain these findings. Multivariate analysis demonstrated that death occurred at a rate 1.81 times higher in a person with a positive neck stage than in a person of the same age who had a negative stage. Also, death occurred at a rate 1.5 times higher for a person 10 years older than for a person with the same stage of disease. The influence of stage on the probability of need for a second dissection indicated that a patient with a positive neck stage had a 6.3 times greater likelihood of requiring a subsequent neck dissection than a person with a negative neck stage.

Adult↗