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PubMed1983

Anatomical localization of the cells of origin of efferent fibers in the superior laryngeal and recurrent laryngeal nerves of dogs.

Using horseradish peroxidase, we identified the cells of origin of motor fibers in the superior laryngeal and recurrent laryngeal nerves of dogs. Cells giving rise to fibers in the superior laryngeal nerve were found in the dorsal motor nucleus and the nucleus ambiguus, whereas cells giving rise to fibers in the recurrent laryngeal nerve were found in the nucleus ambiguus and nucleus retroambigualis, but usually not in the dorsal motor nucleus.

Animals↗

PubMed2005

Laryngeal tuberculosis following laryngeal carcinoma.

Laryngeal tuberculosis is a rare entity and the disease related to laryngeal cancer is extremely rare. We describe a case of laryngeal tuberculosis in a 74-year-old man with a history of radiotherapy for laryngeal carcinoma four months earlier. Laryngoscopy demonstrated a white mass on the right vocal fold at the site carcinoma had previously occupied. Recurrence of the cancer was suspected, but the biopsy result showed histological features of tuberculosis. We discuss the derangement of the host's mucosal barrier by the malignancy as a contributing factor in secondary tuberculous infection. Tubercular bacilli may be reactivated due to the immunosuppression associated with the therapy.

Aged↗

PubMed1996

Intraoperative identification of laryngeal nerves with laryngeal electromyography.

The laryngeal nerves are at risk during thyroid surgery, and several techniques have been described for their intraoperative identification to minimize potential damage. Nerve protection is based on the electromyographic recording from the muscles innervated by the laryngeal nerves, and that electrical activity is picked up by various techniques. We evaluated an electrode attachment to the endotracheal tube that provides a stable method for continuous recording of the laryngeal electromyogram. In addition, we tested various modalities of electrical stimulation in the region where the nerves are located, identified the most reliable evoked electromyographic activity, and characterized the wave form and latency. The results, obtained in 28 patients scheduled for thyroid and parathyroid surgery, indicate that the technique of recording from electrodes attached to the endotracheal tube is safe and reliable. Insulated bipolar forceps or a monopolar electrode was used to deliver low-voltage pulses (1 to 3 V) at 1 to 2 pulses/s generated by either battery-operated or optically isolated stimulators. The most unequivocal recordings were obtained with the monitoring equipment set to the nerve-conduction velocity modality, with the sweep set at 2 msec/cm. The technique clearly differentiated the evoked electromyographic responses obtained from the superior or recurrent laryngeal nerve and was easily performed with no perioperative complications.

Adult↗

PubMed2006

Aggravation of laryngeal rheumatoid arthritis after use of a laryngeal mask airway.

We report a case of aggravation of laryngeal rheumatoid arthritis (RA) after the use of a laryngeal mask airway (LMA). The patient was a 55-year-old woman with severe RA who underwent wrist arthrodesis under general anesthesia using a size 3 LMA. A few days after the operation, she reported hoarseness. Inflammation of the arytenoid region and vocal cord immobility were observed by fiberoptic nasolaryngoscopy. Vocal function returned to normal by postoperative day 42 in response to prednisolone therapy. In this case, stridor was misdiagnosed preoperatively, and postoperative symptoms and local findings were probably caused by aggravation of laryngeal RA resulting from substantial compression of the arytenoid region by the LMA. For patients with RA referred for surgery, a careful search for cricoarytenoid arthritis is essential, particularly in those with laryngeal stridor, because it may be aggravated after general anesthesia.

Arthritis, Rheumatoid↗

PubMed1987

Laryngeal chemoreflex: anatomic and physiologic study by use of the superior laryngeal nerve in the piglet.

The laryngeal chemoreflex (LCR) was investigated in 21 piglets (ages 6 to 80 days old) with the use of physiologic and histologic techniques. The central projection of the superior laryngeal nerve (SLN) was determined in 14 animals by use of horseradish peroxidase-wheat germ agglutinin. Ipsilateral labeling of the solitary tract nucleus was seen. The caudal extent of the labeling varied with age. Sensory labeling of the nucleus ambiguus was present bilaterally in three younger animals and unilaterally in older piglets. Bilateral labeling of the nucleus dorsomedialis was seen in all ages. Apneic and cardiovascular response to water stimulation of laryngeal mucosa and the laryngeal adductor reflex (LAR) were examined in 16 piglets. Blunting of the apneic and cardiovascular response was seen after sacrifice of a single SLN. Hypoxia did not significantly affect the LAR or apnea duration in animals with only one intact SLN. A contralateral LAR was found in younger animals. Relevance to the LCR is also discussed.

Aging↗

PubMed2001

[Laryngeal tuberculosis. A rare, but important differential diagnosis to chronic laryngitis].

A middle-aged native Danish man became aphonic with chronic laryngitis. The symptoms persisted despite antibiotic treatment, and chest X-ray disclosed a central pulmonary infiltrate. Histopathology on specimens from the larynx and lung and microscopy and culture of the sputum revealed primary lung tuberculosis with spread to the larynx. At presentation, laryngeal tuberculosis often mimics non-specific chronic laryngitis or laryngeal carcinoma. It should be suspected when the clinical course is unusual. Tuberculosis may develop in the absence of risk factors.

Chronic Disease↗

PubMed2001

Use of the laryngeal mask airway in thyroid and parathyroid surgery as an aid to the identification and preservation of the recurrent laryngeal nerves.

A prospective study was carried out in patients undergoing thyroid and parathyroid surgery using a laryngeal mask airway (LMA) and electrical nerve stimulation to identify the recurrent laryngeal nerves. A total of 150 consecutive patients undergoing thyroid and parathyroid surgery by a single surgeon were assessed for suitability of anaesthesia via the LMA. Peroperatively, a fibre-optic laryngoscope was passed through the LMA to enable the anaesthetist to visualise the vocal cords while adduction of the cords was elicited by applying a nerve stimulator in the operative field. In all, 144 patients were selected for anaesthesia via the LMA. Fibre-optic laryngoscopy and nerve stimulation were performed in 64 patients (42.7%). The trachea was deviated in 51 (34.0%) and narrowed in 33 (22.0%). The recurrent laryngeal nerves were identified in all patients. There were no cases of vocal cord dysfunction resulting from surgery. The LMA can be safely used for thyroid and parathyroid surgery even in the presence of a deviated or narrowed trachea. It can assist in identification and preservation of the recurrent laryngeal nerve and is, therefore, of benefit to both patient and surgeon.

Adult↗

PubMed1979

Changes in laryngeal motoneurone activity and in laryngeal calibre during the expiration reflex.

In anaesthetized and paralysed cats, the response of the laryngeal motoneurones during the expiration reflex is characterized by pronounced activation of the expiratory laryngeal motoneurones in the compressive phase and the subsequent constriction phase. In the expulsive phase the frequency of these discharges is significantly reduced. The inspiratory laryngeal motoneurones are inhibited during the reflex. The expiration reflex, in anaesthetized cats, is accompanied in the compressive phase and the subsequent constriction phase by a two-phase increase in laryngeal resistance. In the expulsive phase there is a significant drop in resistance.

Action Potentials↗

PubMed1989

[Reaction of the laryngeal mucosa and skin of the neck to the combined use of irradiation, hyperthermia and chemotherapy in laryngeal cancer].

Reactions of the laryngeal and neck skin mucosa were studied in 93 laryngeal cancer patients on combined therapy including hyperthermia. Patients in the control groups received no local hyperthermia. Reactions on the laryngeal mucosa (hyperemia, insular and confluent epitheliitis) were observed in all the patients; in patients receiving chemotherapy they were more noticeable. In patients receiving local hyperthermia these reactions appeared somewhat later and were less noticeable and not repeated. Skin reactions correlated only with a radiation dose and did not depend on chemotherapy and hyperthermia. Local electromagnetic hyperthermia in laryngeal cancer patients neither influenced the appearance of radiation reactions nor enhanced them.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1986

[Course and branches of the recurrent laryngeal nerve, inferior thyroid artery and inferior laryngeal artery].

Length, width, and thickness of the recurrent laryngeal nerve and its extra-laryngeal twigs were estimated. Included is the course of the nerve to the suspensory ligament of the thyroid gland, to the inferior horn of the thyroid cartilage and to trachea and esophagus. The origin of the inferior thyroid artery, its width and course to the twigs of the recurrent laryngeal nerve were studied. The origin zone of the inferior laryngeal artery is also described. The different terms and opinions about the twigs of the truncus thyreocervicalis and the thyroid axis are discussed.

Aged↗

PubMed1998

Long-term quality of life after treatment of laryngeal cancer. The Veterans Affairs Laryngeal Cancer Study Group.

OBJECTIVE: To assess long-term quality of life in surviving patients with advanced laryngeal cancer. DESIGN: A follow-up long-term quality-of-life survey of patients randomized to the Veterans Affairs Laryngeal Cancer Study No. 268 on induction chemotherapy and radiation (CT + RT) vs surgery and RT. SETTING AND PATIENTS: Forty-six (71%) of the 65 surviving patients with prior stage III or IV laryngeal cancer who could be contacted completed the survey: 25 from the surgery and RT group and 21 from the CT + RT group. Baseline demographic and clinical characteristics among survey respondents were similar, except that those in the CT + RT group were significantly older (mean, 61.2 years) than those in the surgery and RT group (mean, 55.7 years; P<.05). INTERVENTIONS AND MAIN OUTCOME MEASURES: Patients completed the University of Michigan Head and Neck Quality of Life (HNQOL) instrument, the Medical Outcomes Studies Short-Form 36 (SF-36) general health survey, the Beck Depression Inventory as well as smoking and alcohol consumption surveys. RESULTS: Patients randomized to the CT + RT group had significantly better (P<.05) quality-of-life scores on the SF-36 mental health domain (76.0) than the surgery and RT group (63.0), and also had better HNQOL pain scores (81.3 vs 64.3). Compared with patients who underwent laryngectomy, patients with intact larynges (CT + RT with larynx) had significantly less bodily pain (88.5 vs 56.5), better scores on the SF-36 mental health (79.8 vs 64.7), and better HNQOL emotion (89.7 vs 79.4) scores. More patients in the surgery and RT group (28%) were depressed than in the CT + RT group (15%). CONCLUSION: Better quality-of-life scores in the CT + RT groups appear to be related to more freedom from pain, better emotional well-being, and lower levels of depression than to preservation of speech function.

Alcohol Drinking↗

PubMed1997

p53 mutation as a prognostic marker in advanced laryngeal carcinoma. Department of Veterans Affairs Laryngeal Cancer Cooperative Study Group.

OBJECTIVE: To determine the relationship of p53 mutations in advanced laryngeal carcinomas to p53 immunohistochemistry, organ preservation, and patient survival. DESIGN: Paraffin-embedded tumor specimens were obtained from patients enrolled in the Department of Veterans Affairs Laryngeal Cancer Cooperative Study, a multi-institutional randomized clinical trial comparing induction chemotherapy (cisplatin and fluorouracil) plus radiation therapy surgery plus postoperative radiation therapy. Tumor specimens were analyzed for p53 mutations in exons 5 through 8 by using single-strand conformational polymorphism (SSCP) analysis followed by DNA sequencing of all variants. Five-year follow-up data were available for all patients studied. SUBJECTS: Forty-four patients enrolled in the Department of Veterans Affairs Laryngeal Cancer Cooperative Study from whom paraffin-embedded tumor specimens were readily available. RESULTS: p53 immunostaining did not correlate with p53 SSCP and DNA sequencing results. More than half (62% [16/26]) of the tumors that overexpressed p53 immunohistochemically did not have a detectable p53 gene mutation. Similarly, 39% (7/18) of tumors that did not overexpress p53 did have a p53 gene mutation. p53 mutations were present in 39% of tumors tested. Mutations within exon 5 made up 41% of p53 gene mutations in laryngeal carcinomas. Transitions were the most common type of mutation in this study (92% of mutations). CONCLUSIONS: The presence of a p53 mutation as detected by SSCP is associated with decreased patient survival. Further study is required to confirm this relationship and to determine whether specific p53 mutations predict organ preservation.

Carcinoma, Squamous Cell↗

PubMed1995

Overexpression of p53 predicts organ preservation using induction chemotherapy and radiation in patients with advanced laryngeal cancer. Department of Veterans Affairs Laryngeal Cancer Study Group.

A critical research frontier in head and neck oncology involves defining the use of induction chemotherapy regimens to allow organ preservation and to avoid functionally debilitating surgical resections. Completed clinical trials in laryngeal cancer indicate that such an approach is feasible, but progress thus far has been limited by our inability to predict which patients are likely to respond to chemotherapy and preserve their larynx. Mutation of the p53 tumor-suppressor gene is the most common genetic alteration identified thus far in human cancers, and it may be important in regulation of cell proliferation and chemosensitivity. To determine whether p53 overexpression predicts chemotherapy response, organ preservation, and survival in patients with advanced laryngeal cancer, we analyzed immunohistologic expression of p53 in tissue sections from 178 patients with advanced laryngeal cancer who were entered in the Department of Veterans Affairs Laryngeal Cancer Cooperative Study, a multiinstitutional clinical trial comparing induction chemotherapy (cis-platinum and 5-fluorouracil) plus radiation therapy (94 patients) to surgery plus postoperative radiation therapy (84 patients). Larynx preservation was significantly higher in the group of patients whose tumors overexpressed p53 (74% vs. 52.5%; p = 0.03). The presence of p53 overexpression did not predict survival in either the surgery or the chemotherapy groups (p = 0.82 and p = 0.53).

Antimetabolites, Antineoplastic↗

PubMed1999

Laryngeal cancer and human papillomavirus: HPV is absent in the majority of laryngeal carcinomas.

Thirty laryngeal carcinomas from patients without pre-existing laryngeal papillomatosis were examined by PCR for the presence of HPV DNA. The utmost care was taken during sectioning of the tissue blocks and DNA-extraction in order to avoid false positive results. Three pairs of consensus primers were used: MY9/MY11, GP5+/GP6+ and CPI/CPII. HPV was detected in 1/30 carcinomas. The HPV type present could not be determined, but it was not type 6, 11, 13, 16, 18, 30, 31, 33, 35 or 45. In other studies the reported frequency of HPV in laryngeal carcinomas, as estimated by PCR, varies between 3-85%. The reasons for this unacceptable variation in reported results are discussed. The present results indicate that HPV DNA does not have a major role in malignant tumours of the larynx in patients without pre-existing recurrent laryngeal papillomatosis.

Aged↗

PubMed2000

Powered laryngeal shavers and laryngeal papillomatosis: a preliminary report.

Carbon dioxide (CO2) laser ablation is widely accepted as the most effective first line surgical treatment of recurrent laryngeal papilloma. However, vaporization of papilloma with the CO2 laser exposes the patient and staff to a potentially infective plume. Furthermore, unsuitable pathological tissue specimens and scarring of the surrounding laryngeal architecture are inevitable consequences of the thermal energy generated by this instrument. Following their innovative use in endonasal surgery, powered laryngeal microresecting instruments (Xomed Shavers) have been developed for laryngeal surgery. We assessed the value of these new instruments in five patients who had previously undergone laser ablation. All of the patients reported that their postoperative recovery was the 'same as' or 'better than' that following laser surgery. The surgeon reported that though there was more bleeding, shaver excision of papilloma provided good clearance of disease; easy collection of pathological samples; and a potentially safer and faster alternative to laser excision.

Adult↗

PubMed2000

A fibreoptic scoring system to assess the position of laryngeal mask airway devices. Interobserver variability and a comparison between the standard, flexible and intubating laryngeal mask airways.

We determined the interobserver reliability of a fibreoptic scoring system for assessing the position of the laryngeal mask airway (LMA), the flexible laryngeal mask airway (FLMA) and the intubating laryngeal mask airway (ILM). We also compare fibreoptic position between the devices. Thirty anaesthetised adult patients were studied in random order in a triple crossover manner. Two observers blinded to each others findings scored the fibreoptic position as follows: 4, only vocal cords visible; 3, vocal cords plus posterior epiglottis visible; 2, vocal cords plus anterior epiglottis visible; 1, vocal cords not seen. Interobserver reliability was examined using intraclass correlation coefficient (ICC). Interobserver reliability was graded as excellent for the LMA (ICC = 0.89), FLMA (ICC = 0.87) and ILM (ICC = 0.79). Fibreoptic scores were higher for the LMA and FLMA compared with the ILM (both p < 0.001). We conclude that interobserver reliability for the fibreoptic scoring system is excellent for the LMA, FLMA and ILM. Fibreoptic position is better for the LMA and FLMA compared with the ILM. Fibreoptic scoring has potential utility for research and clinical practice with laryngeal mask devices.

Adult↗

PubMed2002

[A comparison of the Proseal laryngeal mask to the standard laryngeal mask on anesthesized, non-relaxed patients].

It was our goal to compare the Proseal-laryngeal mask airway (PLMA) with the classical laryngeal mask airway (LMA) in a german multicenter trial. Handling of the instruments and application criteria were to be tested. 7 anaesthesia departments were able to take part in this study. 280 patients could be investigated after approval of the ethics committee of the medical faculty of the university of Goettingen. 145 patients received the PLMA and 135 the LMA. The surgical interventions were small to moderate procedures with a duration of at least 20 minutes in the sections general surgery, trauma/orthopedic surgery, urology, vascular surgery, gynecology, ENT-surgery and ophthalmology. There was equivalence of the two instruments PLMA and LMA concerning duration and ease of insertion, endoscopic position check, observations on emergence, potential for injury and some postoperative complaints. This equivalence could be confirmed statistically. Laryngospasm was observed in three, Bronchospasm in two patients with the PLMA, in no one with the LMA. In one case of laryngospasm and another of bronchospasm a mechanism of supraglottic laryngeal stenosis has been involved which may occur in rare instances with the PLMA. This mechanism is due to the double cuff of the PLMA with the instruments proximity to the laryngeal inlet. The seal pressure in both groups differs significantly (p = 0.001). The mean value for the seal pressure was 29,3 +/- 0,21 mbar for the PLMA and 20,9 +/- 0,21 mbar for the LMA. In the PLMA the gastric tube could be positioned with the first attempt in 118 patients, with the second attempt in 17 cases. In 10 patients the gastric tube could not be placed. Contrary to the LMA the tip of the PLMA cuff may be bent in some cases with loss of airway safety and positioning of the gastric tube. The symptoms sore throat and painful swallowing on the first postoperative day were more frequent with LMA application. These differences could be confirmed statistically (sore throat p = 0.01, painful swallowing p = 0.04). They may be explained by the more rigid LMA compared to the PLMA and by the fact that the LMA in this study was older than the PLMA, loosing plasticizer. The drainage tube within the PLMA offers safety from aspiration in patients with no primary aspiration risk, additional reassurance for a correct position and a better stability of the airway. Our data may support a wider indication range for the PLMA compared with the LMA. The PLMA may be applied in laparoscopies and lower abdominal surgical interventions. Careful clinical observation will show, if the minimal invasiveness of the PLMA offers an advantage for these patients. The PLMA should not be applied in patients with increased aspiration risk.

Adolescent↗

PubMed1998

[The importance of the laryngeal mask in the difficult intubation and early experience with the intubating laryngeal mask airway--ILMA--Fastrach].

UNLABELLED: The conventional laryngeal mask airway ("Standard" laryngeal mask airway SLMA is of outstanding importance in the management of the difficult airway. The intubating laryngeal mask airway (ILMA, commercial name Fastrach) has become available recently. First results indicate that the excellent ventilation characteristics of SLMA are maintained, but in addition blind intubation is successful in more than 90% of patients with normal anatomy as well as with difficult intubation. PURPOSE: We present the use of ILMA, compare the potential of the two laryngeal mask types in difficult intubation by own results, present the results of a first symposium on the ILMA held at Jersey in December 1996, the role of the SLMA in difficult intubation as proposed by the American and the French Societies of Anaesthesiology, as well as an outlook on possible uses of the ILMA in the light of the available results. METHODS: The SLMA was prospectively used between 1992 and 1997 for 66 operations in 55 patients with difficult intubation (laryngoscopic view Cormack grade IV, n = 24; grade III, n = 35; grade < III, n = 7). 48 operations were performed after resection of a facial carcinoma, 14 on patients without carcinoma who could not be intubated conventionally, 5 on patients with periglottic pathology, and on 50 normals. The ILMA was used on 150 patients between 11/1996 and 11/1997, 106 had normal anatomy, 33 were difficult to intubate (Cormack grade IV, n = 12; grade III, n = 21), 24 had a reduced mouth opening of < or = 2.5 cm awake, 14 of these also were difficult to intubate. RESULTS: Ventilation was superior to a face mask (FM): (SLMA: ventilation not sufficient (SaO2 < 90% > 30 sec) with a FM in 22 operations compared to 5 with a SLMA; ILMA: ventilation not sufficient with a FM in 7 operations compared to 3 with an ILMA). Blind intubation through a SLMA had a success rate of 50% and 34% in 50 normals and in 32 operations with difficult intubation after a mean of 2.6 intubation attempts each. The success rate per intubation attempt for the SLMA was 22% in normals and 13% in difficult intubation. Through an ILMA, blind intubation was successful in 92% of normals, 5 of them with immobile spine, in 91% in patients with difficult intubation, and in 83% in patients with reduced mouth opening. The success rate per intubation attempt was 60% in normals, 46% in difficult intubation, and 46% in reduced mouth opening, with a success rate for the first intubation attempt of 57%. This compares favourably with results presented at the Jersey symposium in 554 patients. CONCLUSION: The ILMA maintains the superb ventilation potential of a SLMA in difficult intubation but doubles the success rate of blind intubation irrespective of anatomical difficulties, with a 50% success rate during the first intubation attempt. Possible uses of the ILMA may be in difficult intubation situations including immobile spine, in cannot ventilate--cannot intubate situations comparable to a SLMA with an improved chance of successful intubation, and perhaps as a device for ventilation and intubation for untrained people. The use of the ILMA can be trained during everyday practice. Expert assessment of successful endotracheal tube position is mandatory.

Facial Neoplasms↗