A simple manoeuvre to aid inhalation induction in a patient with a supraglottic mass.
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Airway Obstruction↗
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Acute supraglottitis: when a sore throat becomes severe.
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Acute Disease↗
[Comparative study of treatment methods for supraglottic carcinoma (author's transl)].
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Adult↗
[Therapy study. Comparison of postoperative irradiation versus omission of irradiation in mouth cavity and supraglottic carcinomas].
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Carcinoma, Squamous Cell↗
[Prognostic significance of DNA content measured by flow cytometry in supraglottic laryngeal carcinoma].
Eighty-five patients with squamous that were cell carcinoma of the supraglottis treated surgically in the Department of Otolaryngology at the Marqués de Valdecilla Hospital in Santander (Spain) over a 10-year period from January 1, 1978 to December 31, 1987 were studied retrospectively. In 81 cases a flow cytometric study was made from the surgical specimen included in paraffin blocks, to determine the DNA index and the percentage of cells in the S phase of the cellular cycle. An statistical analysis was made to determine the correlation between these parameters and survival was analyzed using the Kaplan-Merer method. Survival curves were compared using the log-rank test. In 67 cases (82.7%) DNA content was diploid and in 14 cases (17.3%) it was aneuploid. The percentage of cells in S phase was 3.8 and 55.4, with a mean value of 15.19. Comparison of with the five these parameters years survival showed no statistical differences between groups, although tumors with more than 19% S phase had worse prognosis (p < 0.1) and tumors in advanced stages were more frequently aneuploid and had higher S phase values (p = 0.1).
Adult↗
The use of CO2 laser for airway maintenance in obstructive supraglottic carcinoma.
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Airway Obstruction↗
[Extended supra glottic laryngectomies].
In the period 1976-1998, 408 patients with supraglottic laryngeal cancer were primarily treated by surgery using the method of supraglottic laryngectomy. Classical supraglottic laryngectomy was performed in 355 patients, while 53 underwent extended supraglottic laryngectomy. The objective of the study was to analyze the success of the extended supraglottic laryngectomy in relation to classical supraglottic laryngectomy in indicated cases. T1 tumor was found in 171 (42%) patients, T2 in 212 (52%), while T3 was found in 25 (6%) cases. Local recurrence developed in 3 out of 53 patients operated by the extended supraglottic laryngectomy technique, and in 17 out of 355 operated by classical supraglottic laryngectomy (chi2=0.075, DF=1, p=0.784; Yates=0.00, p=1.00). Five-year survival of patients operated by the extended supraglottic laryngectomy was reported in 40 out of 53 patients, while survival of patients operated by classical supraglottic laryngectomy was noted in 270 out of 355 cases (chi2=0.004, DF=1, p=0.926; Yates=0.00, p=1.00). There was no significant difference of local recurrence and five-year survival between patients treated by classical and extended supraglottic laryngectomy.
Carcinoma, Squamous Cell↗
[A clinical study of 1079 patients with laryngeal cancer].
A clinical study was made of 1079 patients with previously untreated laryngeal cancer registered in our department during the 15 years between 1979 and 1993. Their mean age was 64.2 years, ranging from 22 to 91. The male to female ratio was 13:1 and the proportion of non-smokers was 3.2%. These patients consisted of 687 with glottic carcinoma (64%), 373 with supraglottic carcinoma (35%) and 12 with subglottic carcinoma (1%). A sexual difference with regard to the proportion of glottic carcinoma was found; 66% in males and 39% in females. Therefore, the male to female ratios according to the primary sites were 22:1 for the glottis and 8:1 for the supraglottis. According to the TNM classification (UICC 1987), there was a marked difference in the distribution between glottic type and supraglottic type: of the glottic type 439 cases (64%) were stage I, 159 (23%) stage II, 73 (11%) stage III, 16 (2%) stage IV, whereas of the supraglottic type 22 (6%) were stage I, 99 (27%) stage II, 136 (36%) stage III, 116 (31%) stage IV. Our treatment policy for laryngeal cancer has depended not only on the T stage but also on the cancer characteristics including the growing type, anatomical location and extension and depth of invasion. Of the 1079 patients, 1050 were treated radically, 17 palliatively and 12 were not treated. According to the T stage, radical irradiation was chosen for 410 cases (93%) of glottic T1, for 75 cases (45%) of glottic T2 and for 21 cases (81%) of supraglottic T1. Partial laryngectomy was performed in 16 patients (4%) with glottic T1, in 15 patients (10%) with glottic T2 and in 8 patients (6%) with supraglottic T2. Total laryngectomy was performed in almost all patients with T3, T4. The overall 5-year relative survival rate, cumulative crude survival rate and cause-specific survival rate were 84%, 72% and 88%, respectively. The survival rates for the glottic type were significantly higher than those for the supraglottic type (p < 0.0001): the 5-year relative survival rate, cumulative crude survival rate and cause-specific survival rate for the glottic type were 93%, 80%, and 95% whereas for the supraglottic type they were 68%, 58% and 76%, respectively. The 5-year relative survival rates for stage I through stage IV were 96%, 87%, 72% and 53% overall and they were 98%, 91%, 74% and 52% for the glottic type, whereas they were 67%, 83%, 70% and 52% for the supraglottic type, respectively. The results suggested that the better survival rate for glottic T1, which accounted for 64% of all glottic cases, made a great difference in the survival rate between glottic and supraglottic carcinoma.
Adult↗
Partial laryngectomy after irradiation failure.
INTRODUCTION: Radiation therapy is often the first method of treating patients with early cancer of the glottis. There is a substantial failure rate among these patients. Total laryngectomy has usually been the means of treating patients with failure after radiation. In recent decades, partial laryngectomy has been used for salvage in such patients. This article will discuss the use of partial laryngectomy for radiation failure both from the oncologic result as well as the morbidity. PATIENTS AND METHODS: Between 1984 and 1995, 27 patients with early-stage laryngeal carcinoma underwent salvage partial laryngectomy after irradiation failure. Vertical laryngectomy was performed in 18 patients (13 with T1 N0 and 5 with T2 N0) and horizontal-supraglottic laryngectomy in 9 patients (3 with T1 N0, 1 with T2 N0, and 5 with T2 N1). The mean follow-up was 4.1 years. RESULTS: Local control was obtained in 77.7% of patients with glottic lesions (T1: 84.6%; T2: 60%, P = NS) and in 55.5% of patients with supraglottic lesions (T1: 66.6%; T2: 50%; P = NS). There was no regional recurrence in the vertical laryngectomy group, whereas the regional control rate in the horizontal-supraglottic laryngectomy group was 77.7%. Distant control was achieved in 94.4% of patients with glottic disease and in 77.7% of patients with supraglottic disease. The overall survival rate for glottic lesions was 88.8% (T1: 92.3%; T2: 80%; P = NS) versus 66.6% for supraglottic lesions (T1: 100%; T2: 50%; P = NS). CONCLUSION AND SIGNIFICANCE: Vertical laryngectomy was not associated with an increased complication rate. Morbidity in the horizontal-supraglottic laryngectomy group was higher, but a satisfactory functional outcome was obtained in all cases. Therefore, in early laryngeal cancer (glottic T1-T2, supraglottic T1) partial laryngectomy can be performed with good expectation of cure and satisfactory laryngeal function. In T2 supraglottic lesions, the oncologic results are less satisfactory; further research is required for developing more efficient complimentary or alternative treatments modalities.
Aged↗
[Function preserving laryngeal cancer surgery in Hungary-- a historical retrospect and 25 years personal experiences].
The continuity in the trends in conservation and surgery in the Hungarian laryngology are emphasized. The first Hungarian book on this topic, "Diseases of the Larynx" by Navratil, was published 127 years ago ("A gégebajok", Pest, 1866). Onodi popularized the laryngectomy and the results of the surgery of laryngeal carcinoma in the first two decades. In 1900, Herczel described on a vertical partial laryngectomy. Lénárt was an internationally accepted Hungarian surgeon in laryngology whose results (cordectomy 61%, partial laryngectomy 48%, hemilaryngectomy 42%, total laryngectomy 35%) were consistently successful. Réthi was a famous name in the recent period of Hungarian laryngeal surgery for laryngotracheal stenosis and laryngeal carcinoma. In the past 25 years, the occurrence of supraglottic cancer was the highest. The author reports his personal results and stresses the importance of conservation surgery. Of a total of 643 patients with supraglottic carcinoma, 126 (20%) were treated by primary radiotherapy, 169 (26%) were operated on by total laryngectomy, 245 (38%) by supraglottic laryngectomy, 61 (9.5%) by supraglottic subtotal laryngectomy (personal method) and 42 (6.5%) by resection of the supraglottic larynx and the base of the tongue. Local tumour control was constantly good with a local recurrence rate of 6.6%. The 5-year survival rate was 74.3% for supraglottic laryngectomy, 68.9% for subtotal laryngectomy and 62% for the resection of the supraglottic larynx and the base of the tongue group.
Combined Modality Therapy↗
[Clinical study of laryngeal cancer].
An analysis of 74 patients with laryngeal cancer treated between February 1985 and July 1995 is presented. Their mean age was 64 years, and the male to female ratio was 14:1. There were 48 cases of the glottic type, 21 cases of the supraglottic type, 2 cases of the subglottic type, and 3 cases of the transglottic type. Histopathologically, there were 72 cases of squamous cell carcinoma and 2 cases of mucoepidermoid carcinoma. Cervical lymph node metastasis was detected in 12 cases (16%). The incidence of cervical lymph node metastasis in supraglottic carcinoma was significantly higher (p < 0.01) than that in glottic carcinoma. There were 12 cases of second primary cancers. The location of the lesions was as follows: lung, 4; esophagus, 2; stomach, 2; prostate, 2; liver, 1; and gingiva, 1. Radical radiotherapy was performed in 52 cases; the local control rate was 98%, and the recurrence rate was 20%. Combined radiotherapy and total laryngectomy or laryngectomy alone was performed in 23 cases, and the recurrence rate was 23%. The recurrence rate for glottic carcinoma after initial therapy was 13%, supraglottic carcinoma 38%, subglottic carcinoma 100% and transglottic carcinoma 33%. Five-year total survival and cause-specific survival rate were 69% and 82%, respectively. Five-year cause-specific survival rates according to subsite were 95% for glottic carcinoma, 69% for supraglottic carcinoma, 0% for subglottic carcinoma, and 50% for transglottic carcinoma. The survival rate in glottic carcinoma was significantly better (p < 0.05) than in supraglottic carcinoma. These results led us to establish the following guidelines for the treatment of laryngeal cancer: for T1 or T2 cases of the glottic type, radiotherapy is recommended first; for T3 or T4 cases of the glottic type, total laryngectomy after radiation therapy is recommended; for T1 or T2N0 cases of the supraglottic type, radiotherapy is recommended first; for T2N(+) or T3 or T4 cases of the supraglottic type, total laryngectomy after radiation therapy is recommended. If cervical lymph node metastasis is presently, neck dissection is necessary.
Adult↗
Carcinoma of the tongue base.
AIM: This study reports the results of surgical treatment of patients with carcinoma of the base of tongue-supraglottic complex. The base of the tongue, the epiglottic valleculae, preepiglottic space and supraglottic part of the larynx develop from one central region. The proper term to refer to these structures is tongue base-supraglottic complex. Carcinoma of this complex is a challenge for the surgeons working in the field of head and neck surgery. METHODS: Patients with squamous-cell carcinoma of the tongue base present usually in advanced stage of the disease. The treatment includes surgery supplemented with radiation therapy. All patients underwent supraglottic laryngectomy through suprahyoid pharyngectomy and extended resection of the tongue base that allowed sufficient visualization of the tumor. One-stage functional or radical cervical dissection was applied. RESULTS: Twenty-eight patients with carcinoma of the tongue base-supraglottic complex were treated in the Department of Ear, Nose and Throat Diseases of the Medical University Plovdiv between 2001 and 2004. Twenty of these patients received postoperative radiotherapy. CONCLUSIONS: The supraglottic laryngectomy with suprahyoid pharyngectomy provides good exposure of the tumor in the area of the tongue base-supraglottic complex allowing thorough resection of the tumor and avoiding the functional and cosmetic defects characteristic of the combined method (mandibulotomy).
Aged↗
Videolaryngostroboscopy following frontolateral laryngectomy with sternohyoid flap.
We conducted a retrospective study to analyze the videostroboscopic findings in a group of 21 patients who underwent vertical frontolateral laryngectomy with reconstruction by use of the sternohyoid muscle flap. They had T1b and T2 glottic tumors and a follow-up of more than 1 year. Three observers analyzed the recorded videostroboscopic data. The cases in which the stroboscopic evaluation of the vocal folds was incomplete were studied in regard to the clinical staging, the supraglottic hyperfunction, and the vibratory site; the Fisher exact test was applied. The glottic closure was complete in 15 individuals, and 6 had irregular vocal gaps. The site of vibration was glottic in 10 cases, supraglottic in 7, and mixed in 4. The amplitude was normal on 4 and slightly diminished on 9 preserved sides, whereas it was moderately or severely diminished on 16 and absent on 5 reconstructed sides. The mucosal wave vibratory pattern was always totally present on 15 preserved and 5 reconstructed sides: normal or slightly diminished in the preserved vocal folds, and moderately or severely diminished in the reconstructed ones. The reconstructed vocal folds had a nonvibrating portion in 5 cases. The movement extent of the preserved side was larger than that of the other side in 8 cases, and the sides were similar in 13 cases. The symmetry was regular in 18 cases. The periodicity was always or generally regular in 9 cases. There was supraglottic hyperadduction in 16 cases, with a lateral constriction predominance. The mucosal appearance was normal in 15 patients and wet in 6 patients. The epiglottis was straight in 14 cases and crescent in 7. Mucus formation was observed in 1 patient in the posterior vibratory portion. Videolaryngostroboscopy allowed thorough evaluation of the vibratory pattern of the vocal folds in 52.4% of the patients. The supraglottic hyperadduction component and the supraglottic vocal source presented difficulty for this evaluation. The site of vibration was glottic in 47.6%, supraglottic in 33.3%, and mixed in 19.1% of the cases. The vibratory pattern was diminished on both sides, but mainly on the reconstructed one.
Female↗
[Clinical study on laryngeal cancer].
A clinical study was made of 131 patients with laryngeal cancer treated in our department during 13 years from 1975 to 1987. The mean age of patients was 64.8 years, and the male-female ratio was 20.8:1. There were 87 cases of the glottic type, 42 of the supraglottic, and 2 of the subglottic type. Cases in the early stages (stage I, II) predominated in the glottic type, whereas advanced stage tumors (stage III, IV) were predominant in the supraglottic type (chi 2-test, p less than 0.01). Hoarseness was the most frequent complaint in the patients with glottic cancer. The proportion of complaints other than hoarseness, such as sore throat, on the other hand, was significantly higher among patients with supraglottic cancer (chi 2-test, p less than 0.01). There was no significant correlation between stage and duration of complaints until visits to our department. The overall five-year survival rate was 73.8%. The five-year survivals for the glottic and supraglottic type were 84.3 and 54.3% respectively, and for stage I through stage IV were 94.6, 73.7, 58.6, and 36.4%, respectively. In patients classified as T1 or T2, the following treatment is recommended as basic policy: radiotherapy as initial treatment and, if unsuccessful, secondary salvage surgery should be performed. In patients classified as T3 or T4, however, total laryngectomy is recommended as initial treatment. Metastases to cervical lymph nodes were observed in 6 patients with glottic cancer and 14 with supraglottic cancer, and the incidence of cervical lymph node metastases was significantly higher in the supraglottic type (chi 2-test, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Airway protection: evaluation with videofluoroscopy.
During videofluoroscopic swallowing studies performed in the lateral view, the arytenoid cartilages are seen to elevate and approximate the down-folding epiglottis, effectively closing the supraglottic larynx and protecting the airway. This mechanism may be incomplete or delayed in patients complaining of dysphagia and may lead to "penetration" of bolus material into the airway. This study evaluates the timing of supraglottic closure relative to the arrival of the bolus at the upper esophageal sphincter in 60 young control subjects and in 63 elderly control subjects without dysphagia. Event timing was measured in 0.01-s intervals from videofluoroscopic studies for two liquid bolus size categories. Results of the analysis revealed that, in most individuals, the arytenoid cartilages approximate the epiglottis prior to the arrival of the bolus at the upper esophageal sphincter. However, in both bolus size categories, there were individuals who achieved complete supraglottic closure after the bolus had arrived at the sphincter, but never greater than 0.1 s later. No delay in the timing of supraglottic closure relative to bolus arrival at the sphincter was found in the elderly subject group compared with the young subject group. The information from this study has allowed us to objectively determine if supraglottic closure timing is delayed in patients with dysphagia and to address any delay with strategies and exercises designed specifically to correct the delay. A case study is presented to illustrate the clinical significance of this study.
Adolescent↗
Primary radiotherapy of T1 squamous cell carcinoma of the larynx: analysis of 478 patients treated from 1963 to 1985.
Radiotherapy was administered to 478 consecutively treated patients with laryngeal T1 squamous cell carcinoma between 1963-1985. One hundred and seventeen had a supraglottic, 358 a glottic, and 3 a subglottic tumor. Supraglottis: 71% males; 49% T1a; 14 patients with nodes. Glottis: 90% males; 82% T1a; 1 patient with node. The 10-year value for local control in the supraglottic group was 55% and in the glottic group 81%. No difference was observed between T1a and T1b. Regional nodes and distant metastases were seldom seen in the glottic, but frequently observed in the supraglottic group. The treatment results appeared to be most favorable in women. The 10-year corrected survival for supraglottic and glottic tumors demonstrated a highly significant difference, 67% compared to 94%. There was a significantly increasing incidence of events with lower tumor differentiation. Split-course and conventional radiotherapy gave equal treatment results, but late complications were significantly more common with the former. A major problem was new primary cancers, which within 20 years occurred in 34% of patients surviving a supraglottic tumor and in 23% of the glottic patients. The predominant new site was the lung (23% and 13%, respectively). Thus, in the glottic group more patients died from the new cancer than from the glottic carcinoma.
Adult↗
[Partial endoscopic resection with the CO2 laser in laryngeal carcinomas. II. Results].
This study presents the results of CO2 laser surgery in the curative treatment of 114 carcinomas of the vocal cord (Tis:8, T1a:88, T1b:10, T2:8) and 30 supraglottic carcinomas (T1:4, T2:11, T3:8, T4:7). In 21 patients with supraglottic carcinomas, additional radiotherapy was applied. Eleven patients underwent neck dissection. For the group of vocal cord carcinomas, 104 of 114 patients were free of recurrences after laser surgery. The ten recurrences were treated by irradiation (n = 3), repeated laser surgery (n = 3), and salvage laryngectomy (n = 3). One patient refused further treatment and died tumor related. 113 of 114 patients with glottic are without evidence of disease. For the group of patients with supraglottic carcinomas, six patients died without evidence of local disease. Two patients died of secondary malignancy without evidence of local recurrence. Four patients died of their tumor. Today, eighteen patients are without evidence of local or metastatic disease. In fourteen of these patients, the follow-up is longer than two years. Our data indicate that the oncological outcome after laser surgery is comparable to conventional open partial resection, whereas the functional outcome especially in supraglottic carcinomas is superior following laser surgery. In comparison to radiotherapy, the oncological outcome after laser surgery is better and functional results are only slightly inferior. Laser surgery should therefore take its place as an established treatment of supraglottic and glottic carcinomas.
Aged↗
Effects of three different swallow maneuvers analyzed by videomanometry.
PURPOSE: To evaluate the manometric effects of three different swallow maneuvers on healthy volunteers. MATERIAL AND METHODS: Ten healthy volunteers with no history of swallowing complaints were evaluated with simultaneous videoradiography and pharyngeal manometry (videomanometry). Three different swallow maneuvers were evaluated (supraglottic swallow, super-supraglottic swallow, and Mendelsohn's maneuver) and seven manometric and two videoradiographic variables were analyzed. RESULTS: The supraglottic swallow showed a significantly weaker peak contraction of the upper esophageal sphincter (UES). The super-supraglottic swallow had a significantly higher UES relaxation pressure and the Mendelsohn maneuver a significantly higher UES peak contraction. With the Mendelsohn maneuver, there was also a significantly longer duration of the pharyngeal contraction and a significantly weaker UES peak contraction. Both the super-supraglottic and the Mendelsohn maneuver had a significantly longer bolus transit time. CONCLUSION: Our study did not show any significant difference in the relaxation duration of any of the swallowing maneuvers compared to a control swallow. With the Mendelsohn maneuver, we found that both the pharyngeal peak contraction and contraction duration were increased, which might result in an improved propulsion of bolus into the esophagus.
Adult↗