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PubMed1987

Supraglottitis in young adults.

Supraglottitis is a disorder with the potential for significant morbidity and mortality in adults. Of the 25 patients we reviewed, 18 were black, representing the largest series of black adults with this condition reported in the medical literature. The mean age for black men was 14 years younger than previously described adults with supraglottitis. The index of suspicion for supraglottitis should be high in young adults with odynophagia out of proportion to findings on oropharyngeal examination. Indirect laryngoscopy will confirm the diagnosis and allow prompt initiation of treatment. Early recognition and treatment will avoid complications.

Adult↗

PubMedDate not supplied

Radiotherapy for the clinically negative neck in supraglottic laryngeal cancer.

PURPOSE: The supraglottic larynx has rich lymphatic drainage, resulting in a high incidence of occult cervical metastases, and the optimal treatment of the clinically uninvolved neck in supraglottic laryngeal cancer remains controversial. Selected retrospective series report a greater than 20% regional failure after treatment by radiotherapy alone, and some investigators recommend routine prophylactic neck dissection. We report on our series of patients who received radiotherapy as sole treatment to the clinically negative neck, either to the bilateral neck for N0 disease or to the contralateral neck for ipsilateral lymphatic involvement. PATIENTS AND METHODS: Between 1971 and 1998, 150 patients with supraglottic laryngeal cancer received radiotherapy alone to the clinically negative neck. Fifty-two patients had ipsilateral lymph node metastases (N1 = 16, N2a = 12, N2b = 20, N3 = 4), and 98 patients had no clinical nodal involvement. The primary site (T1/T2 = 74, T3/T4 = 76) was treated with radiotherapy (N = 91) or laryngectomy plus radiotherapy (N = 59). Neck dissection was performed on the involved neck in 36/52 node-positive patients for either multiple involved nodes (N = 20) or size > 3 cm (N = 16). Radiotherapy was delivered in standard fractionation and field arrangement. The median dose to the clinically negative neck was 5000 cGy (range: 4860-6000 cGy). RESULTS: With a median follow-up of 48 months, the clinically negative neck was the first site of failure in 3.3% of patients. The contralateral neck remained disease free in all patients. Five failures occurred in the N0 neck, and the median time to recurrence was 12 months (range: 5-30 months). Salvage therapy was neck dissection for the N0 neck failures. The 5-year locoregional control, disease-specific survival, and overall survival were 69%, 74%, and 61%, respectively. DISCUSSION: Our data support the use of radiotherapy as a prophylactic treatment for the clinically negative neck. Tumor control in the clinically uninvolved cervical lymphatics is comparable to that in surgical series, suggesting that routine neck dissection may not be necessary. Prospective trials are necessary to further define the role of radiotherapy in this patient population.

Adult↗

PubMed1983

Enlargement of the supraglottal cavity and its relation to stop consonant voicing.

Measurements were made of saggital plane movements of the larynx, soft palate, and portions of the tongue, from a high-speed cinefluorographic film of utterances produced by one adult male speaker of American English. These measures were then used to approximate the temporal variations in supraglottal cavity volume during the closures of voiced and voiceless stop consonants. All data were subsequently related to a synchronous acoustic recording of the utterances. Instances of /p,t,k/ were always accompanied by silent closures, and sometimes accompanied by decreases in supraglottal volume. In contrast, instances of /b,d,g/ were always accompanied both by significant intervals of vocal fold vibration during closure, and relatively large increases in supraglottal volume. However, the magnitudes of volume increments during the voiced stops, and the means by which those increments were achieved, differed considerably across place of articulation and phonetic environment. These results are discussed in the context of a well-known model of the breath-stream control mechanism, and their relevance for a general theory of speech motor control is considered.

Cineradiography↗

PubMed2004

Supraglottic carcinoma treated with curative radiation therapy: identification of prognostic groups with MR imaging.

PURPOSE: To retrospectively assess the prognostic meaning of tumor characteristics depicted on pretreatment magnetic resonance (MR) images for local outcome in supraglottic squamous cell carcinoma treated with definitive radiation therapy. MATERIALS AND METHODS: Pretreatment MR images acquired in 84 patients with supraglottic carcinoma treated with curative radiation therapy were reviewed for tumor involvement of laryngeal sites including glottis, subglottis, pre-epiglottic space, laryngeal cartilages, and hypopharynx, and for extralaryngeal extension. The volume of each tumor was estimated, and mean tumor volume was calculated for the group of tumors in each T staging category. RESULTS: Results of univariate analysis showed MR imaging-determined primary tumor volume (P =.03), involvement of pre-epiglottic space (P =.008), abnormal signal intensity in thyroid cartilage (P =.04), and extralaryngeal extension beyond thyroid and/or cricoid cartilage (P =.02) to be significant predictors of local control rate. Results of multivariate analysis with the Cox regression model confirmed statistical significance for invasion of pre-epiglottic space (P =.004) and for abnormal signal intensities in thyroid cartilage adjacent to the anterior commissure (P =.04) and in cricoid cartilage (P =.01). Five-year local control rates were calculated from the regression coefficients of three independent MR imaging prognostic factors, and three prognostic groups were identified on the basis of these control rates. The 5-year local control rate in the high-risk group was 35%, significantly lower than the rates in the intermediate- and low-risk groups (60% and 89%, respectively; P =.002). CONCLUSION: MR imaging-determined pre-epiglottic space involvement and abnormal signal intensities in the thyroid cartilage adjacent to the anterior commissure and/or the cricoid cartilage are strong predictors of local outcome in supraglottic carcinoma treated with definitive radiation therapy.

Adult↗

PubMed1981

Differentiation of pyriform sinus cancer from supraglottic laryngeal cancer by computed tomography.

Nine pyriform sinus tumors and 16 supraglottic laryngeal lesions were studied by computed tomography. The pyriform sinus tumors had a much higher incidence of thyroid cartilage invasion (five of nine patients) and involved the posterolateral margins of the cartilage. Only two of 16 supraglottic tumors reached the thyroid cartilage, involving the midline or more inferior margins. The supraglottic tumors grew in a circumferential pattern, and when the pre-epiglottic space was involved, extension was bilateral. Lesions of the pyriform sinus more frequently showed unilateral involvement. Lymph node metastases were seen in an approximately equal proportion of patients in the two groups, and they correlated more with the size of the primary tumor than with its site of origin. Posteroinferior invasion of the space between the thyroid and cricoid cartilage was seen only with pyriform sinus lesions.

Carcinoma, Squamous Cell↗

PubMed2000

Contribution of supraglottal mechanoreceptor afferents to respiratory-related evoked potentials in humans.

We used the global field power (GFP) to estimate the magnitude and timing of activation of the somatosensory cortex by respiratory mechanoreceptor afferents in normal humans in response to brief, negative oral pressure pulses applied at the onset of inspiration. We compared responses before (test) and after insertion of a laryngeal mask airway (LMA) that prevented supraglottal airway receptors from sensing the applied stimulus. Evoked potential responses without supraglottic stimulation were smaller, with delayed or missing features, than those with all receptors stimulated. Supraglottic receptors contribute about one-half of the GFP summed over the 100 ms poststimulus, and subglottal receptors, including those in the larynx, provide a GFP response approximately 38% above baseline. The most obvious difference between test and LMA responses occurred at 55 ms on average, when the LMA GFP lacked activation features seen in the test condition. We conclude that mechanoreceptors above the larynx are responsible for a major portion of the midlatency afferent information arriving at the somatosensory cortex in response to applied pressure pulses.

Adult↗

PubMed2006

Comparison of the glottic closure reflex in traditional "open" versus endoscopic laser supraglottic laryngectomy.

OBJECTIVES: Cancer of the supraglottic larynx may be surgically treated with either traditional "open" supraglottic laryngectomy (OSL) or endoscopic laser supraglottic laryngectomy (ELSL). Pharyngeal dysphagia is a well-documented consequence of traditional OSL from which near-normal swallowing characteristically recovers 14 to 40 days after surgery. Conversely, ELSL results in the resumption of serviceable swallowing within 2 to 7 days after surgery. METHODS: A prospective assessment of the glottic closure reflex in 6 consecutive patients who had ELSL was performed by fiberoptic endoscopic evaluation of swallowing with sensory testing. RESULTS: All 6 patients with ELSL demonstrated an intact glottic closure reflex both before surgery and 48 to 72 hours after surgery. In contrast, 7 of 8 historical control patients who had OSL demonstrated a persistent absence of the glottic closure reflex 3 weeks to 12 years later. CONCLUSIONS: Although a number of clinical factors influence swallowing recovery, one important factor separating our patient groups was the preservation of the glottic closure reflex in patients who underwent endoscopic laser resection. Because the loss of the glottic closure response persists for years after traditional OSL, it is concluded that the sensory field deficit caused by superior laryngeal nerve section is largely not recoverable; however, compensatory mechanisms remain important in serviceable recovery, even if delayed after operation. Indeed, preservation of the glottic closure response appears to enhance swallowing recovery when equivalent compensatory mechanisms are used.

Adult↗

PubMedDate not supplied

Supraglottic laryngectomy: 30 years of experience.

A review of 467 cases of supraglottic laryngectomy operated during the last 30 years is presented. Cases have been subdivided into groups according to stage and TNM classification. By far the most numerous in this series were T2 cases. No cases prevailed over N+ by 4:1. Stage II cases represented about 60% of the total. Results are analyzed according to TNM and staging. The average overall 5-year cure rate is 75%. The influence of factors other than TNM and staging upon results is also considered. Supraglottic laryngectomy may be extended to include one arytenoid, the base of the tongue, or both, with approximately equal results. Practically all cases had en bloc bilateral functional or classic neck dissection for threatening or actual lymph node metastases. This may have contributed to a higher number of successes. Combined surgery and radiotherapy is occasionally indicated, but rarely improves the prognosis of severe cases. Site and type of recurrences are considered and their treatment and prognosis are discussed. On the basis of the present study the clinical value of supraglottic laryngectomy is further assessed.

Female↗

PubMedDate not supplied

Airway management of acute supraglottitis at the Children's Hospital, Boston: 1980-1985.

A controversy has existed in recent years regarding the ideal method of establishing and maintaining an airway in the pediatric patient with acute supraglottitis. Nasotracheal intubation has been used as the sole method of airway management of acute supraglottitis at The Children's Hospital, Boston, since 1970. This paper reviews our experience with 80 children with acute supraglottitis presenting at our institution during the years 1980 to 1985.

Acute Disease↗

PubMed1990

Supraglottic carcinoma: patterns of recurrence.

A retrospective review of 202 patients with supraglottic squamous cell carcinoma and at least 2 years of follow-up was performed. Surgery alone was used to treat 102 patients, and combined therapy in 100 patients. Local-regional failure occurred in 47 (23%) patients. Only 4 patients (2%) developed recurrence at the primary site. The neck was the most common site for recurrent disease (39/47 or 83%), which in 35 patients appeared in the undissected, contralateral side. The risk to the contralateral side of the neck in patients with midline (epiglottic) lesions was similar to that in those with unilateral (aryepiglottic fold) lesions. Supraglottic laryngectomy, when properly selected, did not compromise primary control in the larynx. Radiation therapy was ineffective in controlling metastasis to the contralateral side of the neck in 16 of 99 patients (16%). Therefore, routine bilateral neck dissection should be considered in the surgical treatment of supraglottic carcinoma for control of regional disease.

Adult↗

PubMed1998

Carbon dioxide laser microsurgery for early supraglottic carcinoma.

Forty-eight untreated patients with early supraglottic carcinoma (12 patients stage I and 36 patients stage II) had primary carbon dioxide laser microsurgery between 1979 and 1994 with the intent of complete tumor removal with preservation of functionally important structures of the larynx. Ninety-six percent of the patients were treated exclusively by surgery; 4% had laser microsurgery and postoperative radiotherapy. With a median follow-up of 55 months, the 5-year local control rate with the first treatment was 100% for pT1 cases and 89% for pT2 cases. The ultimate local control rate with voice preservation, including patients successfully salvaged after a local recurrence, was 97% for pT2 carcinomas. Five (10%) patients died of tumor (TNM)-related deaths. The 3-year recurrence-free rate and 3-year overall survival rate (Kaplan-Meier) were 87% and 85%; the 5-year recurrence-free rate and 5-year overall survival rate were 83% and 76%, respectively. The results achieved with transoral laser microsurgery in early supraglottic carcinoma are comparable to those of open supraglottic laryngectomy with respect to local control and survival. The functional results are superior, since clinically relevant aspiration did not occur.

Adult↗

PubMed1999

Preradiotherapy computed tomography as a predictor of local control in supraglottic carcinoma.

PURPOSE: To determine the utility of pretreatment computed tomography (CT) for predicting primary site control in patients with supraglottic squamous cell carcinoma (SCC) treated with definitive radiotherapy (RT). MATERIALS AND METHODS: Pretreatment CT studies in 63 patients were reviewed. Minimum length of follow-up was 2 years. Local recurrence and treatment complications resulting in permanent loss of laryngeal function were documented. Tumor volume was calculated using a computer digitizer, and pre-epiglottic space (PES) spread was estimated. The data were analyzed using a combination of Fisher's exact test, logistic regression modeling, and multivariate analyses. Five-year local control rates were calculated using the product-limit method. RESULTS: Local control rates were inversely and roughly linearly related to tumor volume, although there seemed to be a threshold volume at which primary site prognosis diminished. Local control was 89% in tumors less than 6 cm3 and 52% when volumes were > or =6 cm3 (P = .0012). The likelihood of maintaining laryngeal function also varied with tumor volume: 89% for tumors less than 6 cm3 and 40% for tumors > or =6 cm3 (P = .00004). Pre-epiglottic space involvement by tumor of > or =25% was associated with a reduced chance of saving the larynx (P = .0076). Multivariate analyses revealed that only tumor volume independently altered these end points. CONCLUSION: Pretreatment CT measurements of tumor volume permits stratification of patients with supraglottic SCC treated with RT alone (which allows preservation of laryngeal function) into groups in which local control is more likely and less likely. Pre-epiglottic space spread is not a contraindication to using RT as the primary treatment for supraglottic SCC.

Carcinoma, Squamous Cell↗

PubMed2006

Video assessment of supraglottic airway orientation through the perilaryngeal airway in pediatric patients.

The COBRA perilaryngeal airway (PLA) is a new supraglottic airway device available for use in children. We studied the orientation of the larynx as viewed through the PLA using video obtained with a fiberoptic bronchoscope in 45 infants and children. Laryngeal view was scored, and position of the grill bars of the PLA and the epiglottis was assessed. An acceptable airway was obtained in all subjects, but the laryngeal view was nearly or completely obstructed in 76.9% of the patients 10 kg and less, with the epiglottis folded over the glottic opening. This was uncommon in larger children. The grill bars of the PLA were closely opposed to the epiglottis and supraglottic structures in nearly all subjects. We conclude that 1) the PLA provides an acceptable airway in infants and children, but infolding of the epiglottis with obstruction of the view of the glottic opening is common in infants, 2) extra vigilance for airway obstruction in this age group is necessary, and 3) the PLA's close opposition to the supraglottic structures suggests that removal in a deeper plane of anesthesia might minimize laryngeal stimulation.

Adolescent↗

PubMed1990

Supracricoid laryngectomy with cricohyoidopexy: a partial laryngeal procedure for selected supraglottic and transglottic carcinomas.

The partial horizontal supracricoid laryngectomy with cricohyoidopexy consists of resection of the whole thyroid cartilage and paraglottic space, as well as the epiglottis and the whole pre-epiglottic space. The cricoid cartilage, the hyoid bone, and at least one arytenoid cartilage are spared. Sixty-eight patients with squamous cell carcinoma of the supraglottis who underwent this procedure during the period from 1974 through 1986 are presented. Conventional horizontal supraglottic laryngectomy was contraindicated in all cases. All but three patients (95.4%) recovered physiologic deglutition, and none required a permanent tracheostomy. The 3-year actuarial survival rate was 71.4%. No local recurrences were encountered. The indications for the procedure are carcinomas of the supraglottis that 1. involve the glottis and anterior commissure, 2. invade the ventricle, 3. present with a marked limitation of true vocal cord mobility (transglottic lesions), and 4. invade the thyroid cartilage. The procedure is presented as a useful alternative to radiation therapy, horizontal supraglottic laryngectomy, and total laryngectomy in select cases of supraglottic carcinoma.

Adult↗

PubMed1993

Prognostic value of histopathological parameters in 51 supraglottic squamous cell carcinomas.

The prognosis for supraglottic squamous cell carcinomas is difficult to establish. A study of 19 histopathological parameters (14 from the primary tumor and 5 from the lymph node metastases) was undertaken in 51 supraglottic epidermoid carcinomas. All patients were subjected to supraglottic horizontal laryngectomy with bilateral functional neck dissection and postoperative radiotherapy. A discriminant analysis was performed to relate the different histopathological variables to 5-year survival. Capsule rupture and the number of metastatic lymph nodes were the only two parameters significantly related to survival (P < .01). Histopathology (in particular, lymph node metastases) proved more effective in predicting patient evolution than TNM staging.

Adult↗

PubMed2001

Supraglottic tumour categories: 1987 and 1997 International Union Against Cancer classification.

PURPOSE: To verify the correlation to survival of 1987 and 1997 Union Internationale Contre le Cancer (UICC; International Union Against Cancer) supraglottic tumour categories. MATERIALS AND METHODS: Two hundred and sixty patients seen at the ENT Clinic at the University of Ferrara from 1970 to 1990 had a complete follow-up and met the criteria of enrolment in this study. Data were analyzed by means of survival analyses (Kaplan-Meier and Cox algorithms). RESULTS: Multivariate analysis (adjusted for number and patient's age) of 1997 UICC supraglottic tumour categories (T1 vs. T4) showed a significant correlation with the survival rate, whereas 1987 UICC categories did not reach any significant statistical value. CONCLUSION: The 1997 UICC tumour categories represent an improvement in supraglottic cancer classification.

Carcinoma, Squamous Cell↗

PubMed2001

Radiologic laryngeal parameters in acute supraglottitis in Korean adults.

Soft-tissue lateral neck radiography is important for diagnosing acute supraglottitis. This study aimed to determine the objective criteria for a diagnosis of acute supraglottitis from soft-tissue lateral neck radiographs in Korean adults. The parameters in 30 adult patients with acute supraglottitis were compared with those of age- and sex-matched normal 30 Korean adults. The mean of epiglottis width (EW) and aryepiglottic fold width (AEW) in the control group were 4.37 +/- 0.93 mm, 2.45 +/- 0.71 mm, respectively and in the patient group they were 15.87 +/- 3.60 mm, 6.4 +/- 2.55 mm, respectively. The sensitivity and specificity of an EW greater than 7 mm were 100%, and 100% respectively. The sensitivity and specificity of an AEW greater than 4.5 mm were 83%, and 100% respectively.

Acute Disease↗

PubMed1998

[Preoperative radiotherapy reduces cervical metastasis of supraglottic carcinoma: a prospective randomized trial in 201 patients].

OBJECTIVE: To evaluate the effectiveness of preoperative radiotherapy in the control of overall cervical lymph node metastasis from supraglottic carcinoma. METHODS: A prospective randomized study on 210 patients with supraglottic carcinoma was performed. Nine patients were lost from follow-up and therefore excluded. The analysis was based on the remained 201 patients including fifteen who did not complete the treatment protocol. Surgery alone(S) was carried out in 102 patients and radiotherapy(40 Gy) followed by surgery (R + S) in 99 patients. All the patients were followed up for more than three years. RESULTS: No statistically significant difference in survival rates between S and R + S groups was found by using the Kaplan-Meier analysis. However, relative risk of overall cervical recurrence had a trend of reduction for patients in R + S group, versus patients in S group. There was a statistically significant reduction of lymph node metastasis in R + S group compared to S group in stage I-III(P = 0.0198) while in stage IV no such difference was observed. Patients with stage I-III disease who did not receive preoperative radiation were 1.766 times more likely to develop neck recurrence compared to patients who did. Among all the factors, only TNM stage and histological nodal status were found to be independent risk factors for regional control. Contralateral neck failure occurred more frequently in patients with advanced lesion(P = 0.020) and in patients without preoperative radiation(P = 0.018). CONCLUSION: There may be a trend towards improved control of cervical lymph node metastasis with preoperative radiation of 40 Gy dose in patients with supraglottic cancer in stage I-III of the disease.

Combined Modality Therapy↗