Early invasion of the thyroid gland in carcinoma of the glottis.
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Granular cell tumor is an unusual tumor of probably neuroectodermal histogenesis, originally reported by Abrikossoff (1926) as a myoblastoma. Of the about 1,200 reported cases since then, 50% are found in the head and neck. Of these, 10% have a laryngeal localization. An infrequent case report of glottic localization which was solved by chirurgical excision with free margins, is presented. The features of the laryngeal presentation, is reviewed and iconography with immunohistochemical techniques of their pathologic characteristics, is showed.
PURPOSE: The aim of this work was to describe the morphology of the reconstructed larynx after supracricoid horizontal laryngectomy with simultaneous cricohyopexy (CHP) or cricohyoepiglottopexy (CEHP) preserving one or both arytenoid cartilages, to study the protective and respiratory functions of the larynx, to perform phoniatric evaluation of phonation quality, to analyze voice and speech phonetic-acoustic parameters, and to search for correlations between reconstruction type and phonetic-acoustic characteristics of voice and speech. MATERIAL AND METHODS: The material comprised 58 patients (32 after CHP and 26 after CHEP). CONCLUSION: Oval shape of the neoglottis dominated. Swallowing was normal in 46% of patients and did not depend on reconstruction type. Decannulation was possible in 66% of patients. The results were inferior after CHEP with both arytenoid cartilages intact. Socially efficient speech was found in 74% of patients and the results were better with CHEP. The phonetic-acoustic structure of voice and resonant speech was considerably different from the phonetic-acoustic structure of voice and speech under physiologic conditions. These differences applied to segmental (formant structure frequencies, noise range), as well as suprasegmental voice features.
The arytenoidopexy operation has been performed in 15 cases of bilateral abductor paralysis of different causes. A tube on n. 6 for women and a tube of n. 6.5 for men has been used for the intratracheal general anesthesia without a tracheotomy. The microdissection of the arytenoid has been realised under the operation microscope. The fixation suture of the arytenoid has been passed with a special needle set prepared by the experimental studies on the laryngectomised pieces. The functional respiration result has been controlled by the pre and postoperative spirometry. The laryngeal spasm disappeared and very good respiratory functional results have been obtained in all cases. After a post-operative phoniatric reeducation, the voice was found to be good in most of the cases.
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The control of early glottic cancer is equally satisfactory with either surgical resection or radiation therapy; this last method gives the patient good functional results. During the period from 1/1978 to 12/1985, 73 patients with early glottic carcinoma (T1 N0 M0) were treated in the Institute of Radiotherapy L. Galvani, University of Bologna; 45 were stage T1a (tumour limited to one vocal cord) and 28 were stage T1b (tumour of both vocal cords or involving anterior commissure); radiation treatment utilised a 60Co machine and 5 x 5 cm fields; the median dose was 67.2 Gy (range 50-76) with conventional fractionation. Ten patients had local recurrence; the median time of recurrence was 13.4 months; 9/10 were treated by surgery and 2/10 died, so the overall control by radiotherapy with surgery in reserve was 100% in T1a tumours and 90.6% in T1b ones. The 5-years disease free survival rate was 93.1% in T1a tumours and 69% in T1b; lesions involving anterior commissure had the worst prognosis, independent of the dose and time-dose factor (3/10 recurrences in the group treated with TDF less than 110 and 4/18 recurrences in the group with TDF more than 110).
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