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At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

Microlaryngosurgery for benign posterior glottal lesions using a posterior glottis direct laryngoscope.

When endolaryngeal microscopic laryngosurgery (microlaryngosurgery) with a direct laryngoscope is used to remove lesions of the posterior glottal area under endotracheal general anesthesia, the endotracheal tube interferes with the surgical field. To overcome this problem, we developed a special direct laryngoscope with a concave groove on the upper portion of its distal tip. The concave groove is used to move the endotracheal tube anteriorly, making it possible to obtain a good surgical field in the posterior glottal area. This laryngoscope facilitates the removal of posterior glottal lesions. The utility of this microlaryngosurgical technique for the removal of benign posterior glottal lesions is described.

Adult↗
PubMedDate not supplied

The interplay between glottis and vocal tract during the male passaggio.

The transition between 'chest' and 'head' register is essential for male opera singers in order to reach the higher pitches. The 'passaggio', which is a scale passage where this transition takes place, but also a maneuver of register equalization, is typically difficult to learn. Studies on parameters for a definition of this transition are restricted to a small number of singers so far. Audio, electroglottographic, and equivalent subglottic pressure signals of 11 male opera singers were recorded while singing scales on open back vowels and passing the register transition. A spectrum analysis of the audio signal revealed that the second harmonic (H2) dominates in 'chest', resonated by the first formant (F1), together with the fourth harmonic (H4), supported by the second formant (F2). During the passaggio, H2 level decreases because it loses the resonance of F1, while the third harmonic (H3) gains the resonance of F2. At this point the H4 level drops because that harmonic is no longer supported by F2. The transition from 'chest' to 'head' register is marked by characteristic changes in the amplitude patterns of the partials H2, H3, and H4, and the frequency progressions of the first two formants, defining an objective distinction between the two registers.

Adult↗
PubMed1993

Carcinoma in situ of the glottis: radiotherapy or excision biopsy?

Excision biopsy, radiotherapy, and laryngofissure cordectomy have all been used, but the best treatment regimen for glottic carcinoma in situ remains controversial. A 20-year experience of 37 cases is reported. For the first 10 years biopsy with radiotherapy was the first-line treatment (n = 20), but for the last 10 years surgical or laser excision biopsy alone has been performed (n = 17). The T stage of the carcinoma in situ does not determine its premalignant potential. Malignancy appears to be a recurrence, rather than a new expression of carcinogenesis. Excision biopsy alone provides local control results (75%) comparable to those of primary radiotherapy (85%). Excision biopsy alone, however, retains the option of subsequent radiotherapy with preservation of laryngeal function, but very close follow-up, especially in the first year, is required.

Biopsy↗
PubMed1988

An objective assessment of voice production after radiation therapy for stage I squamous cell carcinoma of the glottis.

Radiation therapy has been the primary treatment for early glottic carcinoma, especially when restoration of normal voice is essential; yet objective evidence of the status of vocal function after treatment is lacking. The purpose of this study was to assess vocal characteristics of patients with glottic carcinoma after they had undergone radiation therapy. Twenty males, who had previously been treated with external beam irradiation for T1N0M0 squamous cell carcinoma with no subsequent evidence of recurrence, volunteered for this study. Laryngovideostroboscopic, acoustic, aerodynamic, and perceptual measures of vocal function were used to determine the characteristics of voice production. Acoustic indices were compared to those of a normal group of 30 age-matched volunteers, and the other measures were compared to established values reported in the literature. On acoustic analysis, the study group was characterized by significantly worse voice production than their counterparts. A high degree of intersubject variability was noted that could not be accounted for in terms of variables in treatment and medical history. The aerodynamic, spectral, and video-stroboscopic findings correlated well; this indicated a poor vibratory source, characterized by diffuse stiffness. Further work is necessary in order to compare vocal function after endoscopic laser and conventional conservative excision.

Aged↗
PubMedDate not supplied

Radiotherapy for T1 carcinoma of the glottis.

AIMS AND BACKGROUND: The management of patients with T1 carcinoma of the glottic larynx is controversial, because surgery and radiation therapy are reported to be effective treatments. Several studies have shown radiotherapy to be safe and effective, with a high percentage of voice preservation and minimal complications, but most Italian physicians prefer to surgically treat such patients. METHODS: From 1980 to 1990, 36 patients with stage I squamous cell glottic carcinoma were treated with radiotherapy alone at the institute of Radiology of University of Rome "La Sapienza". In all patients the irradiation fields were limited to the larynx, with field size ranging from 4 x 4 cm to 7 x 7 cm. Total tumor doses ranged between 51 and 70 Gy (median 60 Gy) with a mean number of 30 fractions of 2 to 3 Gy per fraction (3 or 5 fractions per week). RESULTS: After a median follow-up of 98 months, we observed an overall survival rate at 5 years of 91.4% and actuarial 10-year survival of 85.7%. Local control was achieved in 97.1% of cases, with an event-free survival of 94.2% at 5 and 10 years. No major complications like necrosis or persistent edema of the larynx were observed. Minor complications like dysphonia (8%) and dysphagia (5.5%) were temporary; laryngeal function was completely preserved at the end of therapy. Final voice quality ranged from good to excellent. CONCLUSIONS: Our series confirms that radiation therapy has a major role in the management of early glottic cancer, with results comparable to surgical approaches and with better voice preservation.

Adult↗
PubMed1975

Carcinoma of the laryngeal glottis therapy and end results.

The end results of 264 patients with vocal cord carcinoma treated by either surgery or radiation therapy at the University of Illinois from 1955 to 1972 are analyzed. Stage I glottic carcinoma can be cured by either surgery or radiation alone (86 percent and 80 percent). Stage II glottic cancer treated by surgery has achieved survival rates of 70 percent. The five-year end results of Stage III glottic cancer are 49 percent for surgery and 30 percent for radiation. The management of glottic carcinoma, according to anatomic site and indications for various modalities are discussed.

Carcinoma↗
PubMed1975

Analysis of surgical therapy for epidermoid carcinoma of the laryngeal glottis.

Four hundred sixty-three patients with glottic carcinoma were treated by surgical techniques with or without preoperative irradiation. Two hundred eighty-one had hemilaryngectomy and 182 total laryngectomy procedures. The overall cure rate for the hemilaryngectomy group was 91 percent and 80 percent for the total laryngectomy group, with an overall cure rate of 87 percent. Our observations support the fact that Stage I glottic carcinoma has slightly better prognosis when treated by hemilaryngectomy. Stage II and III lesions have a significant improvement in cure rate and survival when treated with combined preoperative irradiation and partiall vertical laryngectomy or total laryngectomy than by irradiation alone.

Carcinoma, Squamous Cell↗
PubMed1999

Local recurrence after vertical partial laryngectomy, a conservative modality of treatment for patients with Stage I-II squamous cell carcinoma of the glottis.

BACKGROUND: Based on an inception cohort of 103 patients who had local recurrence (Group I) and a witness group of 311 patients who achieved local control (Group II) after vertical partial laryngectomy for Stage I-II glottic carcinoma, the current retrospective study documented the consequences and management of local recurrence. METHODS: Three hundred two patients (97.1%) in Group II and all 103 patients (100%) in Group I were followed until death or for a minimum of 10 years. Statistical analysis of survival, lymph node control, and distant metastasis was based on the Kaplan-Meier product limit method. RESULTS: The 10-year actuarial survival estimate was 30.8% for Group I patients and 63.1% for Group II patients. Survival was statistically more likely to be reduced in Group I patients (P < 0.0001) than in Group II patients. The percentage of patients who died of their initial disease was 44.6% in Group I and 6.3% in Group II. The 10-year actuarial lymph node control estimate was 70.2% for Group I and 96.1% for Group II. Lymph node recurrence was statistically more likely to occur in Group I patients than in Group II patients (P < 0.0001). The 10-year actuarial estimate for patients without distant metastasis was 80.2% for Group I and 96.7% for Group II. Distant metastasis was statistically more likely to occur in Group I patients than in Group II patients (P < 0.0001). Salvage treatment was unsuitable for 4.7% of patients with local recurrence; for other patients, it yielded a 86.7% local control rate, a 21.4% laryngeal preservation rate, a 4.5% death rate, and an 11.2% rate of incidence of severe complications. CONCLUSIONS: Among patients with Stage I-II glottic carcinoma managed with vertical partial laryngectomy, local recurrence results in a reduced rate of survival as well as a high rate of necessity for salvage total laryngectomy.

Adult↗
PubMed1975

[25 years experience with glottis widening surgery in our clinic (author's transl)].

Between 1949 and 1974, 137 patients with bilateral vocal cord paralyses were operated upon in our Department. In 127 cases King's method of extralaryngeal lateral fixation of the vocal cord or a modification thereof was executed on one or both sides. The modification consisted of securing the lateral-fixating suture around the superior thyroid cornu. This produces an additional displacement of the vocal cord in the vertical plane which provides good respiratory function in spite of only moderate lateral displacement of the cord. In seven cases endolaryngeal arytaenoidectomies and submucus hemicordectomies using Kleinsassers' technique were performed. In three cases endo- and extralaryngeal methods were combined. 120 (87.6%) of all patients could be decannulated. After unilateral extralaryngeal lateral cord fixation, 77.2% of patients could be decannulated within three weeks following operation. Operative results were analysed according to respiratory and vocal function two years postoperatively. After unilateral lateral cord fixation, breathing was good or sufficient in 73.6% of cases and insufficient in 26.4% of cases. The voice was normal or dysphonic in 86% of cases while aphonic in 14% of cases. Among the causes of bilateral vocal cord paralysis, primary strumectomies and operations for recurrent goiter were predominant (95%). All patients were tracheotomized before or after the operation. Two years postoperatively, incidental tracheal stenosis was noted in 73% of all patients. This was insignificant to moderate in 63.5% of cases and severe in 9.5% of the cases.

Adult↗