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PubMed1993

Impact of bilateral neck dissection on recovery following supraglottic laryngectomy.

Previously reported data from our institution has led us to perform bilateral neck dissections for therapeutic as well as staging advantages for horizontal supraglottic laryngectomies. Concern over the possibility of increased morbidity associated with simultaneous bilateral neck dissection prompted this retrospective review of patients with supraglottic laryngectomy who were treated with either unilateral (46 patients) or bilateral (23 patients) neck dissection. No significant differences were found in morbidity when patients were evaluated for transfusion rate, cervical wound drainage, need for tracheotomy, oral diet, or duration of hospitalization. Significant differences were noted in surgical operating time, eg, it took 100 minutes longer to perform bilateral dissections, and slight increases were noted in estimated blood loss and fluids given intravenously. No significant differences were noted in the percentage or type of postoperative complications. It seems that bilateral neck dissection in conjunction with supraglottic laryngectomy does not increase postoperative surgical morbidity and may actually avoid complications associated with postoperative radiation therapy in patients with supraglottic laryngectomy.

Carcinoma, Squamous Cell↗
PubMed1997

Super-supraglottic swallow in irradiated head and neck cancer patients.

BACKGROUND: After radiotherapy to the head and neck, many patients experience swallowing difficulties. Preliminary work indicates that these patients benefit from the super-supraglottic swallow maneuver. METHODS: Lateral videofluoroscopic studies examined oropharyngeal swallowing in 9 patients who suffered from dysphagia after radiation to the head and neck. Each patient completed two swallows each of 1 mL or 3 mL liquid barium without a voluntary swallow maneuver and with the super-supraglottic swallow designed to close the entrance to the airway early. The videotape of each swallow was digitized and the location of pharyngeal structures marked throughout the swallow. Movement over time plots were generated to measure changes in structural movement resulting from the maneuver. RESULTS: The super-supraglottic swallow resulted in changes in airway entrance closure and hyolaryngeal movement. One patient who aspirated without the maneuver stopped aspirating with the maneuver. Two others had aspiration reduced to a trace with the maneuver. Fewer swallowing disorders were observed with the maneuver. CONCLUSION: The super-supraglottic swallow results in improved biomechanics of swallow in irradiated head and neck cancer patients.

Adult↗
PubMed2004

CO2 laser treatment of supraglottic cancer.

BACKGROUND: The aim of the study was to evaluate the effectiveness of endoscopic CO(2) laser microsurgery in the management of supraglottic cancer. METHODS: One hundred twenty-four patients (116 men and eight women; mean age, 59 years; range 31-81 years) with supraglottic cancer underwent CO(2) laser surgery (mean follow-up 5 years). The study patients were classified as follows: 45 patients, T1N0M0; 61 patients, T2N0M0; and 18 patients, T3N0M0. According to the staging, the following procedures were adopted: epiglottectomy, resection of aryepiglottic fold or false vocal cord in T1 patients (group A); resection of the false vocal cord and adjacent structures in T2 patients (group B); and supraglottic laryngectomy in T3 patients (group C). Statistical comparison of survival parameters was carried out with Wilcoxon test, considering p <.05 the minimum significance value. RESULTS: Overall actuarial survival, adjusted actuarial survival, and no evidence of disease at 5 years were 91%, 97%, and 82% in group A; 88%, 94%, and 59% in group B; and 81%, 81%, and 51% in group C, respectively. The statistical analysis of survival parameters showed a significant difference in the comparison of T1 versus T2 and T2 versus T3 tumors (p <.01). Actuarial local control, actuarial nodal control, and actuarial distant metastasis control at 5 years were 82%, 82%, and 100% in T1 patients; 63%, 90%, and 98% in T2 patients; and 77%, 75%, and 93% in T3 patients. Laryngeal preservation rate was 88.6% in T1 patients, 85.4% in T2 patients, and 93.7% in T3 patients. Patients in groups A and B were discharged after 3 to 12 days, and patients in group C, were discharged after 14 to 20 days. CONCLUSIONS: The results of this study show that endoscopic CO(2) laser surgery is highly effective in the treatment of T1 and T2 supraglottic cancer. In T3 cancer, the CO(2) laser should be implemented in those cases where radical excision by endoscopic route is feasible.

Adult↗
PubMed2006

Efficacy of routine bilateral neck dissection in the management of the N0 neck in T1-T2 unilateral supraglottic cancer.

BACKGROUND: The treatment of the clinically negative (N0) neck in supraglottic laryngeal cancer continues to be an area of controversy. The aim of this study was to analyze the long-term efficacy of routine bilateral neck dissection compared with ipsilateral neck dissection in T1-T2 N0 lateral supraglottic carcinomas. METHODS: A retrospective review of 108 patients who underwent surgery for T1-T2 supraglottic squamous cell carcinoma was performed. Forty-eight had undergone ipsilateral functional neck dissection, and 60 had undergone bilateral functional neck dissections. None of these patients received adjuvant radiotherapy. RESULTS: No significant differences (p = .78) in regional recurrence were observed between the patients treated with bilateral neck dissection (13%) and those treated with ipsilateral neck dissection (17%). The 5-year survival rates were 73% and 80% for the patients who received a bilateral and ipsilateral neck dissection, respectively (p = .51). CONCLUSIONS: This study suggests that routine bilateral neck dissection may not be necessary in the surgical treatment of all supraglottic cancers.

Adult↗
PubMed2001

Laminin alpha2 chain (merosin M chain) distribution and VEGF, FGF(2), and TGFbeta1 gene expression in angiogenesis of supraglottic, lung, and breast carcinomas.

The prognostic significance of vessel quantification in human solid tumours is still debated, due to the presence of multiple factors modulating neoangiogenesis and the invasiveness of neoplastic cells. This study examined ten supraglottic squamous carcinomas, ten non-small cell lung carcinomas (three squamous, five bronchioloalveolar, two adenocarcinomas), and nine classic (NOS) invasive ductal breast carcinomas. The properties studied in these tumours were vascularity; the immunohistochemical distribution of adhesion molecules such as alpha2beta1, alpha3beta1, alpha4beta1, alpha5beta1, alpha6beta4, and ICAM-1 in endothelial cells; extracellular matrix proteins (ECMPs) and laminin alpha2 chain (merosin M chain) in basal membranes of vessels; and gene expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (FGF2), and transforming growth factor beta1 (TGFbeta1), by in situ hybridization. Independently of tumour type and vascularity, laminin alpha2 chain expression was observed in the basal membranes of a limited proportion of vessels. In vitro experiments demonstrated laminin alpha2 chain expression mainly in early endothelial cell cultures, suggesting that laminin alpha2 chain expression in vivo can be considered a marker of early angiogenesis. Stromal and parenchymal vascularity was associated with laminin alpha2 chain expression in supraglottic carcinomas, whereas in the other tumours, laminin alpha2 chain-positive vessels were observed only in the stroma. In supraglottic carcinomas, VEGF-positive cells were mainly represented by neoplastic cells, whereas in the other tumours, the great majority of VEGF-positive cells were macrophages and fibroblasts. FGF2- and TGFbeta1-positive cells were macrophages and fibroblasts in all tumours. These observations suggest that in addition to the quantification and distribution of vessels, evaluation of their maturation may contribute to a better understanding of the role of angiogenesis in the growth and spread potential of solid tumours. In this regard, in supraglottic carcinomas, parenchymal angiogenesis seems to be regulated mainly by neoplastic cells, which may help to explain their high metastatic potential; in solid tumours of different histogenesis, different cells might be responsible for modulating tumour angiogenesis.

Aged↗
PubMed2004

Horizontal partial laryngectomy for supraglottic squamous cell carcinoma.

Between 1981-1999, 75 patients treated for supraglottic SCC with horizontal supraglottic laryngectomy (HSL) at the Otolaryngology Head and Neck Surgery Department of Lausanne University Hospital were retrospectively studied. There were 16 patients with T1, 46 with T2 and 13 with T3 tumors. Among these, 16 patients (21%) had clinical neck disease corresponding to stage I, II, III and IV in 12, 39, 18 and 6 patients, respectively. All patients had HSL. Most patients had either elective or therapeutic bilateral level II-IV selective neck dissection. Six patients (8%) with advanced neck disease had ipsilateral radical and controlateral elective II-IV selective neck dissections. Adjuvant radiotherapy was given to 25 patients (30%) for either positive surgical margins (n=8), pathological nodal status (n=14) or both (n=3). Median follow-up was 48 months (range, 24-199). Five-year disease-specific survival and locoregional and local control were 92, 90 and 92.5%, respectively. Among five patients who were diagnosed with local recurrence, one had a total laryngectomy (1.4%); the others were treated by endoscopic laser surgery. Two patients had both a local and regional recurrence. They were salvaged with combined surgery and radiotherapy, but eventually died of their disease. Cartilage infiltration seems to influence both local control (P=0.03) and disease-specific survival (P=0.06). There was a trend for worse survival with pathological node involvement (P=0.15) and extralaryngeal extension of the cancer (P=0.1). All patients except one recovered a close to normal function after the treatment. Aspiration was present in 16 patients (26%) in the early postoperative period. A median of 16 days (7-9) was necessary to recover a close to normal diet. Decannulation took a median of 17 days (8-93). Seven patients kept a tracheotomy tube for up to 3 months because of persistent aspiration. There was no permanent tracheostomy or total laryngectomy for functional purposes. Horizontal supraglottic laryngectomy remains an adequate therapeutic alternative for supraglottic squamous cell carcinoma, offering an excellent oncological outcome. The postoperative functional morbidity is substantial, indicating the need for careful patient selection, but good laryngeal function recovery is the rule. The surgical alternative is endoscopic laser surgery, which may offer comparable oncological results with less functional morbidity. Nevertheless, these two different techniques need to be compared prospectively.

Adult↗
PubMed1999

Twenty years of experience with Marullo's supraglottic laryngectomy.

We present a follow-up study of 142 patients on whom we performed supraglottic laryngectomy (SL) with an anterior subperichondral approach using Marullo's technique, which was described in 1975. Between January 1976 and December 1992, 142 patients (age range, 35-73 years) with squamous cell carcinoma of the supraglottic larynx were treated with SL or extended SL (ESL) and ipsilateral or bilateral neck dissections with or without postoperative radiotherapy. All cases were staged according to the 1997 UICC TNM classification. Survival was defined by the Kaplan-Meyer method and showed an overall survival of 77% and a local control rate of 78%. Regarding functional rehabilitation, the mean nasogastric tube-removal time was 16 days (range, 10-39 days) for SL and 23 days (range, 11-102 days) for ESL. Voice quality was very satisfactory after SL, while the voice was often harsh or breathy after ESL with postoperative radiotherapy. The overall oncologic and functional results obtained with Marullo's SL were very similar to those obtained with the classic Alonso's operation and demonstrated that this technique makes it possible to reach "en bloc" supraglottic sites and the hyothyroepiglottic space. We consider the operation to be safe and simple to perform, provided the sub-perichondral plane is correctly identified. This approach allows the surgeon easily to reach the correct transverse level above the anterior commissure of the vocal cords. Inferiorly, the resection cuts through the floor of the ventricle and is considered to be the safe oncologic plane for pure supraglottic lesions. This technique has also been used successfully in extended resections to treat tumors involving the base of the tongue, pyriform sinus and one arytenoid.

Adult↗
PubMed2003

[Treatment of the NO neck in supraglottic cancer].

INTRODUCTION: Occult regional metastases in supraglottic cancer NO are the object of classical controversies. The aim of our study is to provide our experience in order to determine how neck treatment affects on regional recurrence of NO supraglottic cancer. METHODS: A retrospective study of 246 patients with NO supraglottic cancer treated in our service between 1977 to 1999 is presented. RESULTS: 11.4% of patients did not have any cervical treatment, with a 23% of neck recurrence amongst the evolution. 66.7% of patients were treated with a modified radical neck dissection, 24% of these presented occult metastases in the histopathological study. Global regional recurrence was 2.9% in early stages (T1/T2) and 13.1% in advanced stages (T3/T4). In pN+ patients, 85% underwent postoperative radiotherapy, with a regional recurrence of 8.8%. Postoperative clinical control without any other treatment in pN0 patients showed a neck recurrence of 6.1%. We performed a unilateral neck dissection in those patients with clear-lateral tumours. In these cases the clinical control of the contralateral neck gave a 5.5% recurrencies on that side. Patients treated with elective primary radiotherapy suffered a 5.5% of regional recurrence. DISCUSSION/CONCLUSIONS: Neck treatment of the NO supraglottic cancer is recommended. We treat neck in the same way of primary tumour (surgery or radiotherapy) with good control of regional recurrencies, less than 10%. In case of a negative pathological study of the neck careful, watching is the elective attitude. In the positive pathological study of the neck (pN+), radiotherapy is the elective treatment in those with three or more affected nodes or capsular breakdown in any of them.

Adult↗
PubMed1999

Patterns of nodal metastasis and surgical management of the neck in supraglottic laryngeal carcinoma.

BACKGROUND: Appropriate management of the clinically negative (N0) neck in supraglottic laryngeal cancer continues to be an area of controversy in head and neck surgery. Our treatment policy has been aggressive surgical management even in the clinically N0 neck. METHODS: Between 1971 and 1991, 104 patients had the primary diagnosis of supraglottic laryngeal cancer. Ninety of these patients received their treatment at Roswell Park Cancer Institute and are the subject of this retrospective review. RESULTS: All neoplasms included in this study were squamous cell cancers. The most common subsite involved with tumor in our series was the epiglottis, followed by the aryepiglottic folds and false cords. Supraglottic laryngectomy was performed of 29% of the cases; the remainder received total laryngectomy. Thirty-six percent of the patients had pathologic stage I/II disease, and 64% had stage III/IV. The 5-year survival rates were 100%, 81%, 73%, and 63% for stages I through IV, respectively. Fifty-seven patients had clinically N0 disease at presentation; of these 34 underwent elective neck dissection, and the remaining 23 patients were observed. Of those patients receiving neck dissection, 30% (n = 10) were found to have histologically positive disease, and of the 23 patients observed, 30% (n = 7) had histologically positive regional (neck) disease. Of the 17 clinically N0 and pathologically N+ patients, 82% (14 of 17) had involvement of level I (submandibular triangle), and 100% had involvement of level II. The incidence of bilateral disease in the clinically N0 patient was 44%. There were no local failures. CONCLUSIONS: There is a high incidence of occult regional disease even in early-stage supraglottic squamous cell carcinoma of the larynx. In the surgical management the clinically N0 neck, we presently recommend bilateral neck dissection of levels I through IV to adequately address those regions at highest risk for occult disease.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Laryngeal long-term morbidity after supraglottic laryngectomy and postoperative radiation therapy.

PURPOSE: This study was performed to investigate factors associated with laryngeal morbidity when postoperative radiation therapy (RT) is added to supraglottic laryngectomy. MATERIALS AND METHODS: From 1980 to 1994, 56 patients affected with T1 to 4 N0 to 2c supraglottic squamous cell carcinoma selected for standard (59%) or extended (41%) supraglottic laryngectomy at 2 different institutions were retrospectively analyzed. Most of the patients (91%) also underwent neck dissection. Approximately 80% of the patients had stage T4 primary lesions or N2 neck disease. Postoperative RT was added for presumed microscopic disease at the primary site (13 patients), regional nodes (23 patients), or both (20 patients). Median delivered doses to the larynx and to the neck were 50 Gy (range, 40 to 64 Gy) and 46 Gy (range, 40 to 64 Gy), respectively. Median follow-up for living patients is 11 years (range, 2.8 to 16.9 years). Laryngeal complication was defined as the appearance of grade 2 or higher toxicity according to the European Organization for Research and Treatment of Cancer (EORTC) and the Radiation Therapy Oncology Group (RTOG) scoring systems. RESULTS: Two- and 5-year actuarial locoregional control rates were 85+/-5% and 83+/-5%, respectively. Thirty patients (54%) developed laryngeal complications. However, just one patient experienced grade 4 laryngeal oedema requiring permanent tracheostomy. Estimated actuarial survival without laryngeal complications were 50+/-7%, 43+/-7%, and 39+/-7% at 2, 5, and 10 years, respectively. At univariate analysis, treated volumes (P = .03) and total dose to the larynx (P = .03) were significantly associated with local toxicity. A trend was observed also for the maximum dose to the neck (P = .06) and dose per fraction (P = .09). A multivariate Cox proportional hazards model showed total dose to the larynx to be the only independent predictor of toxicity (P = .03). The hazard ratio of laryngeal toxicity was 2.2 (95% confidence interval: 1.1/4.6), for a total dose to the larynx greater than 50 Gy. CONCLUSION: After supraglottic laryngectomy, postoperative RT to the neck does not affect local morbidity, but careful RT treatment planning is necessary to avoid delivering a total dose to the larynx greater than 50 Gy.

Actuarial Analysis↗
PubMedDate not supplied

Adenoid cystic carcinoma of the supraglottic larynx: report of a case and review of the literature.

Although adenoid cystic carcinoma is the most common malignant tumor of the minor salivary glands, it seldom occurs in the larynx. Less than 0.25 per cent of all laryngeal carcinomas are adenoid cystic, and only 15 such cases of supraglottic origin are recorded in the literature. In only four cases the details of treatment and outcome are described. We report another case and review the literature in order to define the entity of adenoid cystic carcinoma of the supraglottic larynx. This case reveals the aggressive nature of the disease, which is often associated with the solid variant histology and also demonstrates the most rapid course of any cases described in the literature. Other histologic variants of adenoid cystic carcinoma of the supraglottic larynx follow a more prolonged course that can extend many years even with persistent local disease. However, development of distant metastases may eventually occur. Therefore, 5-year statistics are not adequate, and 10 or 20 years' follow-up is required to evaluate the curability of this disorder. Evaluation, treatment, and clinical course of adenoid cystic carcinoma of the supraglottic larynx are discussed.

Carcinoma, Adenoid Cystic↗
PubMedDate not supplied

Acute supraglottitis in adults: early indicators of airway obstruction.

PURPOSE: To show that cardinal signs of upper airway obstruction are characteristically absent in the early phases of potentially fatal supraglottitis. PATIENTS AND METHODS: The hospital records of 9 previously healthy adults who died from autopsy-proven supraglottitis within 12 hours after sudden onset of severe sore throat. RESULTS: Six patients who were discharged from the emergency room with a diagnosis of pharyngitis died at home within 4 hours after dismissal. Three patients suspected of supraglottitis were admitted and treated medically; by the time signs of respiratory obstruction appeared, attempts at airway intervention failed. None of the 9 patients presented with symptoms or signs of respiratory distress, but all gave a history of fulminant sore throat associated with chills and fever. In all patients, the pulse rate was above 100 per minute. CONCLUSION: In the early phases of acute supraglottitis, the most reliable indicator of impending airway obstruction is a rapidly developing severe sore throat. Dyspnea, tachypnea, retractions, stridor, and cyanosis are manifestations of advanced stages of the infection and should not be awaited to determine the need for airway intervention.

Adult↗
PubMed2002

Supraglottic and glottic carcinomas. clinically and biologically distinct entities?

This study aimed to examine the clinical and biological differences in 198 patients with either T1-T2 local glottic or supraglottic squamous cell carcinomas. The patients with supraglottic cancer had a poorer prognosis, as well as more advanced and histologically aggressive tumours than the patients with glottic tumours. They also had lower levels of haemoglobin and a poorer nutritional and performance status. Expression of alpha-catenin, hyaluronan, CD44, p53, p21/WAF1 and bcl-2 in the primary tumour were not associated with the site of the laryngeal carcinoma. In supraglottic tumours, the rate of spontaneous apoptosis and mitotic indices were significantly higher than in glottic tumours. The results suggest that clinical parameters including the haemoglobin level of the patient together with the tumour cell kinetics (mitotic and apoptotic rates) may contribute to the aggressive nature of supraglottic carcinoma.

Adult↗
PubMed2006

Early supraglottic cancer: how extensive must surgical resection be, if used alone?

OBJECTIVES: Two centre based evaluations of oncologic results of endoscopic resection of supraglottic cancer without post-operative irradiation. PATIENTS AND METHODS: Twenty-six patients with clinical T1 (n=5) or T2 (n=21) primary squamous cell carcinomas of the supraglottic larynx and with N0 (n=24) or N1 (n=2) neck disease were treated by endoscopic supraglottic laryngectomy coupled with neck dissection(s). Endoscopic resection was standardized whereas neck dissections (NDs) varied from classical modified radical ND to selective ND of levels I to IV. RESULTS: Pathologically, three T2 patients were upstaged to T3, four N0 patients to N1 and one N2 patient down-staged to N1. Within an average of 42 months, there were no local failures and only one regional failure. CONCLUSIONS: Endoscopic resection of T1 and T2 supraglottic cancer without post-operative irradiation achieved good oncological results. No patients with lateralized primary cancers were found to have contralateral cancer on pathological evaluation from bilateral dissections.

Carcinoma, Squamous Cell↗
PubMed1994

Mechanisms of recovery of swallow after supraglottic laryngectomy.

This study examines oropharyngeal swallow disorders and measures of pharyngeal and laryngeal movement during deglutition from videofluorographic studies of oropharyngeal swallow in 9 patients who had undergone supraglottic laryngectomy and 9 age-matched normal subjects. The swallows of surgical patients were examined at 2 weeks and 3 months postoperatively. Two critical factors in recovery of swallowing were identified: (a) airway closure at the laryngeal entrance, that is, the space between the arytenoid cartilage and the base of the tongue, and (b) the movement of the tongue base to make complete contact with the posterior pharyngeal wall. When patients achieved these two functions, they returned to normal swallowing. The duration of tongue base contact to the posterior pharyngeal wall and extent of anterior movement of the arytenoid increased significantly from 2 weeks to 3 months in the surgical patients. At 2 weeks postsurgery, patients who had undergone supraglottic laryngectomy exhibited significantly shorter airway closure and tongue base to pharyngeal wall contact, reduced laryngeal elevation, increased width of cricopharyngeal (CP) opening, and later onset of airway closure and tongue base movement than normal subjects. These significant differences remained at 3 months postoperatively, although swallow measures were moving toward normal in the patients who had undergone supraglottic laryngectomy. Comparison of patients not eating at 2 weeks with patients at the time of first eating revealed significantly longer duration of tongue base contact to the pharyngeal wall, longer duration of airway closure, and greater movement of the arytenoid in patients who were eating. Results indicate that the focus of swallowing therapy after supraglottic laryngectomy should be on improvement of posterior movement of the tongue base and anterior tilting of the arytenoid to close the airway entrance and improve bolus propulsion (in the case of the tongue base).

Barium Sulfate↗
PubMed2003

Incidence of supraglottic activity in males and females: a preliminary report.

Supraglottic activity was rated from flexible endoscopic video recordings of subjects with normal laryngeal structure and function as they sustained vowels and repeated syllables and sentences. Judges rated these recordings for false vocal fold (FVF) adduction and anterior-to-posterior (A-P) compression at the initiation of the speech task, throughout the whole speech task (static supraglottic activity), and as brief individual adductions within a speech task (dynamic supraglottic activity). Significant differences in A-P (p < 0.0003) and FVF (p < 0.0000001) compression were found between tasks. Dynamic FVF activity was associated with glottal stops. Static A-P and FVF activities were present in males significantly more (p < 0.0001) than females. FVF activity associated with speech initiation was found in females significantly more (p = 0.0256) than males. Supraglottic activity plays a role in normal speech production, and should not necessarily be considered suggestive of a voice use pattern with excessive muscle tension.

Adult↗
PubMed2003

T3 supraglottic cancer: treatment results and prognostic factors.

OBJECTIVE: A retrospective study was performed in order to analyze the treatment results and prognostic factors in patients with T3 supraglottic carcinoma and to differentiate between the treatment results obtained for T3 transglottic carcinoma and T3 pure supraglottic carcinoma. MATERIAL AND METHODS: Thirty-two patients who underwent surgery with or without postoperative radiation therapy between 1990 and 2000 were studied. Neck dissection was performed in 27 patients and 24 received postoperative radiation therapy. RESULTS: The 3-year overall survival rate was 81.7%. The 3-year overall survival rates for T3 pure supraglottic carcinoma and T3 transglottic carcinoma were 91.7% and 73.2%, respectively (p < 0.05). Univariate analysis revealed a prognostic significance for vocal cord fixation. T3 transglottic carcinoma was significantly correlated with vocal cord fixation. CONCLUSIONS: We suggest that surgery, either alone or in combination with postoperative radiation therapy, provides acceptable cancer control and survival rates for patients with T3 supraglottic carcinoma. Vocal cord fixation detected during preoperative fiberoptic laryngoscopy is a significant prognostic factor. T3 transglottic cancer needs more aggressive management.

Aged↗
PubMed1998

Supraglottal injection of botulinum toxin type A in adductor type spasmodic dysphonia with both intrinsic and extrinsic hyperfunction.

Patients with adductor type spasmodic dysphonia (SD) often exhibit both glottal and supraglottal hyperfunction. Based on the hypothesis that a "ventricular muscle" may contribute to the hyperfunction in these cases, eight patients with adductor type SD were treated with bilateral injection of botulinum toxin type A into the ventricular folds. Four weeks after injection, ventricular fold hyperfunction was absent in all cases. Number of voice breaks, standard deviation of fundamental frequency, and shimmer were significantly improved. Voice range profiles of the speaking voice were significantly extended in dynamic and frequency range. Side effects were a breathy phonation and mild swallowing difficulties without aspiration for about 1 week. Patients' self-rating concerning strangled and breathy voicing demonstrated an interval of acceptable voice quality between 1 week and 4 months after injection in all cases. Results suggest that supraglottal injection in patients with SD of both glottal and supraglottal hyperfunction, as a new approach, can normalize supraglottal activity and improve glottal voicing. Based on our experience with other patients with adductor type of SD, this injection technique is as efficient as injection into the thyroarytenoid muscle. Nevertheless, it remains to be proved that a pathologic ventricular muscle activity is addressed by this technique or if it is based on spreading to the thyroarytenoid muscle.

Acoustics↗