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PubMed1979

Local invasion by laryngeal carcinoma--the importance of focal (metaplastic) ossification within laryngeal cartilage.

Patterns of cartilage invasion by squamous carcinoma were examined in 34 consecutive laryngectomy specimens with particular reference to selective involvement of ossified cartilage. Direct infiltration of the laryngeal framework was demonstrated in 17 cases--16 (out of 17) transglottic carcinomas and in a simgle example of a combined glottic and infraglottic tumour. The susceptibility of ossified laryngeal cartilage to tumour invasion was confirmed, and morphological studies ahve clarified the underlying mechanisms. Invasion is a largely indirect process dominated by local bone destruction by osteoclasts, operating in front of the advancing tumour. One established, carcinoma cells infiltrate and erode bone alone, and the osteoclasts disappear. Reasons for the particular susceptibility of ossified laryngeal cartilage to tumour invasion are discussed and attention is drawn to the role of the tumour-associated osteoclast activating factors such as postaglandins. Therapeutic implications of cartilage invasion are noted.

Adult↗
PubMed1989

Asymmetry of the laryngeal framework: a morphologic study of cadaver larynges.

Asymmetry of the laryngeal framework was investigated with 50 excised human larynges, ten from newborns (five males, five females), 20 from adults in their 20s (ten males, ten females), and 20 from adults in their 50s (ten males, ten females). All adults were right-handed. The results are summarized as follows. 1) The laryngeal framework was asymmetric to a greater or lesser extent in all larynges. 2) The degree of asymmetry did not differ among different age groups or between sexes. 3) In newborns, there was no directional preponderance in asymmetry. 4) In older adults, there was a directional preponderance in asymmetry. The right thyroid lamina tended to tilt laterally whereas the left lamina showed a tendency to tilt medially. The right cricoarytenoid joint tended to be located slightly more laterally, posteriorly, and inferiorly than the left joint. The longitudinal axis of the thyroid cartilage was inclined to shift to the right posteriorly against the axis of the cricoid cartilage. The thyroid cartilage as a whole tended to tilt to the right against the cricoid cartilage. 5) There must be some compensatory mechanisms for the asymmetric framework to keep the vocal fold edges relatively symmetric.

Adult↗
PubMed1982

Laryngeal keratosis preceding laryngeal carcinoma. A report of four cases.

Detailed descriptions of the laryngeal mucosal changes that precede squamous cell carcinoma are infrequent. The criteria for identification of epithelial changes that are considered "premalignant" vary widely among pathologists. Presented herein are the histological details and clinical findings of four patients with biopsy-proved laryngeal keratosis in whom laryngeal carcinoma subsequently developed over intervals ranging from ten months to six years. The epithelial changes are variable but generally consist of a thickened mucosa with prominent alterations in the pattern of maturation. These maturation abnormalities range from proliferation of immature "basal-like" cells with little or no surface keratinization (classic form of atypia or dysplasia) to markedly thickened mucosa with prominent keratinization, both on the surface and in individual cells in the deep portions of the mucosa. Multiple recurrence in two of the patients with mucosal thickening and extensive individual cell and surface keratinization suggest that not only this histopathologic change, but the propensity for recurrence, may both be indicators of premalignant epithelial change.

Aged↗
PubMed2006

Laryngeal actinomycosis accompanying laryngeal carcinoma: Report of two cases.

Actinomycosis is a systemic chronic bacterial infection caused by Actinomyces israelii, an anaerobic organism normally resident in the human mouth. It can involve any organ, but cervicofacial disease is the most common. Laryngeal involvement is rare and usually occurs secondary to the oral, cervical or mandibular disease. There are only a few cases of primary laryngeal actinomycosis (LA) in the literature. Actinomycosis can also be a complication of head and neck surgery. Here we present two cases of LA accompanying laryngeal carcinoma and discuss in the literature about this event.

Actinomycosis↗
PubMed2005

Unilateral recurrent laryngeal nerve neuropraxia following placement of a ProSeal laryngeal mask airway in a patient with CREST syndrome.

We report a severe unilateral recurrent laryngeal nerve neuropraxia following use of the ProSeal laryngeal mask airway (PLMA) in a 71-year-old female patient with CREST syndrome. She required amputation of the 5th phalanx of foot because of gangrene due to Raynaud's syndrome. Anesthesia was induced with propofol, and a size 3 PLMA was inserted. Anesthesia was maintained with sevoflurane and nitrous oxide for 2 h and the operation was performed uneventfully. On removal of PLMA, the cuff volume was measured to 40 ml. The patient did not complain of respiratory discomfort shortly after PLMA removal. However, the next day she developed dysphagia and hoarseness. Laryngoscopic examination revealed unilateral vocal cord paralysis. Cricothyrotomy was required because of suspected silent aspiration pneumonia. The pharyngolaryngeal complications improved with a mobile vocal cord but slight hoarseness after 2 months. We considered the patient's CREST syndrome with a potential of tissue ischemia, and the high intracuff pressure of the PLMA due to nitrous oxide influx, to be the cause of severe recurrent laryngeal nerve neuropraxia in this case.

Aged↗
PubMed1999

Recurrent laryngeal nerve injury caused by a laryngeal mask airway.

Although there have been few reports of serious complications with the laryngeal mask airway, we record a case of permanent unilateral vocal cord paralysis following the use of a laryngeal mask airway and review the literature describing injuries, not only to the recurrent laryngeal nerves but also to the hypoglossal and lingual nerves.

Adult↗
PubMed1995

Relation of recurrent laryngeal nerve compound action potential to laryngeal biomechanics.

This study was designed to investigate the compound action potential (CAP) of the recurrent laryngeal nerve (RLN) and to correlate this electrophysiologic signal to laryngeal biomechanics and phonatory function. Four adult mongrel canines were anesthetized. The RLN was isolated and stimulated, and recording electrodes were applied. The electromyographic (EMG) electrode was placed in the thyroarytenoid (TA) muscle. The RLN CAP and the EMG of the TA muscle were recorded and compared to the stimulation intensity, subglottic pressure (Psub), and each other. The CAP peak-to-peak and EMG peak-to-peak amplitudes demonstrated a sigmoidal relation to stimulus intensity and a linear relation to Psub and to each other. On the basis of these findings, the RLN CAP appears to be a reliable physiologic measure of laryngeal function.

Action Potentials↗
PubMed1998

Growth-inhibitory effect of tamoxifen and quercetin and presence of type II estrogen binding sites in human laryngeal cancer cell lines and primary laryngeal tumors.

Quercetin and tamoxifen, in a range of concentrations between 0.01 and 5 microM, exert a dose-dependent inhibition on the anchorage-dependent and anchorage-independent cell growth of Hep2 and CO-K3 laryngeal cancer cell lines. Cell cycle analysis revealed that the growth-inhibitory effect was associated with a block of the cells at the G2/M checkpoint of the cell cycle followed by DNA fragmentation. This suggests that the failure of cells to proceed through the G2/M checkpoint can be a trigger for apoptosis. The induction of apoptosis by quercetin and tamoxifen was confirmed immunocytochemically by the in situ nick end labeling (TUNEL) reaction. These compounds also exerted a dose-dependent growth-inhibitory effect on primary tumor cells, as assessed by colony-forming assay and bromodeoxyuridine labeling. Laryngeal cancer cell lines and primary tumor cells expressed Type II estrogen binding sites (Type II EBS) with binding characteristics similar to those of Type II EBS in other tumor cells. Since the affinities of quercetin and tamoxifen for Type II EBS were correlated with their growth-inhibitory potential while ipriflavone neither interacted with these sites nor inhibited cell growth, the possibility exists that the action of these compounds is mediated, at least in part, by the interaction with Type II EBS. In conclusion, our data indicate that quercetin and tamoxifen could be potentially useful in laryngeal cancer treatment.

Apoptosis↗
PubMed2004

[Laryngeal tube versus laryngeal mask airway in anaesthetised non-paralysed patientsA comparison of handling and postoperative morbidity].

BACKGROUND: The purpose of this study was to compare the classical laryngeal mask airway (LMA) with the laryngeal tube (LT) in anaesthetised non-paralysed patients. PATIENTS AND METHODS: A total of 100 patients scheduled for minor elective surgery were included. After standardised induction and maintenance of anaesthesia with propofol and remifentanil, patients were randomly allocated to receive either a LMA or LT; muscle relaxants were not applied. Selection of the appropriate size and the initial inflation volume were chosen according to the manufacturers instructions. Ease of insertion, initial intra-cuff pressure, oropharyngeal leak pressure at an intra-cuff pressure of 60 cm H(2)O and incidence and severity of complications during and after anaesthesia were compared. RESULTS: The LT was inserted significantly quicker than the LMA (35.1+/-15.9 s vs. 56.6+/-42.5 s; mean+/-SD). Insertion of the LT was successful within 1 attempt in 90% and within 2 or 3 attempts in another 4% of patients for the LT compared with 68% and 20% of patients for the LMA, respectively. For the LT the initial cuff pressure was significantly lower (75.1+/-16.2 cm H(2)O) and the oropharyngeal leak pressure after adjustment of the intra-cuff pressure to 60 cm H(2)O was significantly higher (27.2+/-6.9 mbar) compared with the LMA (109.5+/-25.7 cm H(2)O and 19.9+/-4.0 mbar, respectively). Incidence of postoperative laryngeal complications in the LT group (31%) was lower compared with the LMA group (54%). CONCLUSION: In anaesthetised non-paralysed patients the LT compares favourably to the LMA in terms of ease of insertion and postoperative morbidity.

Adult↗
PubMed2004

Functional electrical stimulation of laryngeal adductor muscle restores mobility of vocal fold and improves voice sounds in cats with unilateral laryngeal paralysis.

Functional electrical stimulation (FES) has been proposed as a potential treatment for restoring motor functions of denervated motor systems. We investigated whether FES of paralyzed laryngeal adductor muscles could restore adduction to the vocal folds. In addition, we studied the effect of stimulated vocal fold adduction on the intensity and overall quality of voice production. We recorded movement of the vocal fold, electromyographic activity of muscles recruited for vocalization, and sound production in unanesthetized decerebrate cats during FES of the paralyzed thyroarytenoid (TA) muscle. FES of the paralyzed TA muscle induced adduction of the vocal fold. Appropriate stimulus parameters for induction was 1.5-3.0 mA intensity pulses delivered at a frequency of 30-50 pulses per second (pps). FES of the paralyzed TA muscle prolonged phonation time and increased intensity of voice sounds during vocalization induced by electrical stimulation (0.2 ms, 20-50 microA, 50 pps) of the periaqueductal gray (PAG). The quality of voice sounds evaluated by sound spectrography was shown to improve during vocalization with FES. We conclude that FES of the paralyzed laryngeal adductor muscle was effective in restoring adduction of the vocal fold and improving voice sounds impaired by unilateral laryngeal paralysis.

Animals↗
PubMed2004

Laryngeal nerve function after total laryngeal transplantation.

The first successful composite human laryngeal transplantation was performed by a team led by the senior author on January 4, 1998. The recipient was a 40-year-old male who had sustained a crush injury to his larynx 20 years prior, rendering him aphonic. Multiple previous attempts for reconstruction at an outside hospital were unsuccessful. The donor was a 40-year-old male who had died from a ruptured cerebral aneurysm. The specifics of the procedure have been detailed elsewhere. Throughout the patient's postoperative course, serial fiberoptic evaluations and voice testing were performed to evaluate laryngeal reinnervation reflected in phonatory function. We herein report the results of these exams, as well as the results of electromyographic recordings of the laryngeal musculature 4 years posttransplantation.

Adult↗
PubMed1996

Recurrent laryngeal papillomatosis developing into laryngeal carcinoma with human papilloma virus (HPV) type 18: a case report.

We report a case of recurrent laryngeal papillomatosis which developed into laryngeal squamous cell carcinoma 11 years after the first diagnosis. Interestingly, we could identify HPV type 18 DNA in the carcinoma tissue using the polymerase chain reaction (PCR). Other known risk factors of irradiation, smoking, exposure to chemical agents, or a hereditary tendency to malignant tumours were not present in this case. Our finding suggests that HPV type 18 is another aetiological agent for laryngeal carcinoma.

Carcinoma, Squamous Cell↗
PubMed2002

A longitudinal study of the Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer questionnaire in patients treated for laryngeal cancer.

A prospective longitudinal study was performed to investigate the sensitivity to change over time of the Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer questionnaire (S-SECEL), addressing communication dysfunction in patients with laryngeal cancer. Twenty-six consecutive patients attending a weekly tumour conference over a period of one year at Sahlgrenska University Hospital were included in the study prior to start of treatment. The patients answered four questionnaire repeatedly in the course of one year: the S-SECEL, the European Organization for Research and Treatment of Cancer (EORTC), the Core Quality of Life Core Questionnaire (QLQ-C30) supplemented by the Head and Neck cancer questionnaire module (QLQ-H&N35), and the Hospital Anxiety and Depression (HAD) scale. In addition, performance status was assessed. The S-SECEL questionnaire was well accepted by the patients, and compliance was satisfactory with a cumulative response rate of 88% at one year, supporting its feasibility in clinical settings. Repeated measures with the S-SECEL over one year demonstrated a significant decrease in voice and speech dysfunction. The correlation pattern over time between the S-SECEL and the EORTC and HAD questionnaires lent support to the construct validity of the S-SECEL and indicated that the questionnaire was sensitive to clinical change. The changes in S-SECEL correlated most strongly with changes in the EORTC QLQ-H&N35 speech scale, moderately with changes in the QLQ-C30 role and emotional functioning and global QoL scales, while the weakest correlations were with changes in physical functioning. The S-SECEL was sensitive to changes in communication dysfunction, with convergent and discriminant validity of longitudinal assessments, and with relevance for the quality of life of patients with laryngeal cancer receiving different treatment modalities.

Adult↗
PubMed2000

The ProSeal laryngeal mask airway: A randomized, crossover study with the standard laryngeal mask airway in paralyzed, anesthetized patients.

BACKGROUND: The ProSeal laryngeal mask airway (PLMA) is a new laryngeal mask device with a modified cuff to improve seal and a drainage tube to provide a channel for regurgitated fluid and gastric tube placement. In the present randomized, crossover study, the authors tested the hypothesis that ease of insertion, airway sealing pressure, and fiberoptic position differ between the PLMA and the standard laryngeal mask airway (LMA). For the PLMA, we also assess ease of gastric tube placement and the efficacy of an introducer tool. METHODS: Sixty paralyzed, anesthetized adult patients were studied. Both devices (only size 4) were inserted into each patient in random order. Airway sealing pressure and fiberoptic position were determined during cuff inflation from 0 to 40 ml in 10-ml increments. Gastric tube insertion was attempted with the PLMA if there was no gas leak from the drainage tube. In 60 additional patients, ease of insertion for the PLMA was compared with and without an introducer. RESULTS: First-time success rates were higher (60 of 60 vs. 52 of 60; P = 0.003) and the effective airway time shorter (9 +/- 3 s vs20 +/- 18 s; P < 0.0001) for the LMA. There were no failed uses of either device within three attempts. Airway sealing pressure was 8-11 cm H2O higher for the PLMA at all cuff volumes (P < 0.00001) and was higher in females for both devices. Fiberoptic position was better with the LMA at all cuff volumes (P < 0.00001), but vocal cord visibility was similar (LMA, 59 of 60; PLMA, 56 of 60). For the PLMA, gastric tube placement was successful in 58 of 58 patients and took 9 +/- 5 s. First-time success rates were higher (59 of 60 vs53/60; P = 0.03) and the effective airway time shorter (15 +/- 13 s vs 23 +/- 18 s; P = 0.008) with the introducer. CONCLUSION: The PLMA is capable of achieving a more effective seal than the LMA and facilitates gastric tube placement, but it is more difficult to insert unless an introducer tool is used. When correctly positioned, the PLMA isolates the glottis from the upper esophagus with possible implications for airway protection.

Adult↗
PubMed1999

Effect of harvesting autogenous laryngeal cartilage for laryngotracheal reconstruction on laryngeal growth and support.

OBJECTIVE: Determine the effect of harvesting autogenous thyroid cartilage on subsequent laryngeal growth and stability in a kitten model. STUDY DESIGN: Prospective controlled trial in animals. METHODS: Seventeen kittens were divided into three groups. Group one (n = 5) included kittens that underwent a unilateral thyroid cartilage resection. Group two (n = 5) included kittens that underwent a bilateral cartilage resection. Group three (n = 7) comprised kittens that did not undergo any surgical procedure (controls). All animals underwent endoscopic examination followed by the surgical procedure designated for that group. Kittens were then assessed daily for 2.5 months. At the end of that period the now "adolescent" cats were examined endoscopically then euthanized. The larynx was removed for gross and histopathologic analysis. RESULTS: All kittens tolerated the surgical procedure without airway compromise. Subsequent endoscopic examination 2.5 months after surgery revealed normal vocal cord function. Measurements of the true vocal cord and aryepiglottic and subglottic diameter did not differ significantly (one-way analysis of variance, P = .05) with respect to the side or the group. Histopathologic evaluation of the laryngeal sections indicated a patent airway, stable and viable thyroid cartilage, and no evidence of cartilaginous regrowth. CONCLUSIONS: The removal of unilateral and bilateral superior thyroid alar cartilage can be performed in kittens without postoperative respiratory or wound problems. The harvesting of autogenous thyroid cartilage has no apparent effect on subsequent laryngeal growth and stability in a kitten model.

Animals↗
PubMed1994

Evaluation of the thoraco-laryngeal reflex ('slap test') as an indicator of laryngeal adductor myopathy in the horse.

A study was conducted over a 12 month period to assess the accuracy of the 'slap test' in the diagnosis of laryngeal adductor myopathy. The thoraco-laryngeal reflexes of 15 horses with no clinical signs of idiopathic laryngeal hemiplegia (ILH) were recorded using a video-endoscope. These 'slap test' responses were examined independently by 3 assessors. The horses were subsequently subjected to euthanasia and samples taken from the cricoarytenoideus lateralis (CAL) muscles for histopathological examination and assessment of denervation atrophy. Despite normal adductory responses, moderate to severe atrophy of the left CAL muscles was seen in 5 horses. The remaining horses had varying degrees of adductor myopathy, invariably worse in the left side of the larynx. The 'slap test' as performed in this study was therefore unable to differentiate between horses with moderate to severe muscle changes and those without, making it useless as a diagnostic test for adductor myopathy. The reason for the preservation in adductor function despite advanced histological atrophy of the muscle may lie in the degree of reinnervation found in the muscles.

Animals↗
PubMed2001

Laryngeal mask vs intubating laryngeal mask: insertion and ventilation by inexperienced resuscitators.

The laryngeal mask airway (LMA) has been shown to be useful in airway maintenance during resuscitation. The intubating laryngeal mask (ILM) is a modified LMA permitting both ventilation and rapid endotracheal intubation. We aimed to compare the LMA and the ILM with regard to ease of insertion and successful ventilation by inexperienced personnel. We have used anaesthetized, apnoeic, non-paralysed patients as a model to simulate resuscitation. Following standardized training, non-anaesthetic medical staff with no previous experience in laryngeal mask airway insertion (novices) inserted either the LMA or ILM in 55 patients following induction of anaesthesia. There were no differences between the two patient groups included in our study with regard to mean age and body mass index (BMI). The success rate for inserting the airway device and achieving a significant end-tidal CO2 recording within two minutes was 23/28 for the LMA (82.1%) and 22/27 for the ILM (81.5%). Reasons for failure included inability to insert the ILM past the teeth and insertion of the LMA upside down. There were no clinically relevant differences in the mean time to airway insertion and successful ventilation (62.6 vs 62 seconds) or expired tidal volume (781 vs 767 ml) for the LMA and ILM respectively. We conclude that the ILM is as easily inserted and effectively used as an LMA by novices and, because it allows the option offacilitating endotracheal intubation, may be the preferred device for maintaining an airway during resuscitation.

Adult↗