Hypofractionated (2.75 Gy per fraction) versus Conventionally Fractionated Primary Radiotherapy for T2N0M0 Carcinoma of the Glottis

Abstract Introduction Radiotherapy provides excellent outcome in early stage glottic cancer; however, the optimal radiotherapy dose fractionation remains unknown. Objective To investigate the outcome of patients with T2N0M0 treated with either hypofractionated (HypoFxn) or conventionally fractionated radical (ConFxn) radiotherapy. Methods According to our institutional protocol, patients with T2N0M0 glottic cancer can be treated either with ConfFxn or HypoFxn radiotherapy, as per clinician's and patient's choice, following shared decision making discussing the advantages and disadvantages of both modalities. A total of 77 patients with T2N0M0 squamous cell carcinoma of glottis treated with either HypoFxn 55Gy in 20 fractions (n = 19) or ConFxn 63 to 65Gy in 30 fractions (n = 58) were included. Results With median follow-up of 3.4 years, there was no significant difference in disease-free survival (median: HypoFxn = 65.2 months, and ConFxn = 75.3 months; p = 0.874), local recurrence free survival rates (median: HypoFxn = 78.8 months vs. ConFxn = 81.2 months; p = 0.274), and overall survival (median: HypoFxn = 65.9 months vs. ConFxn = 67.7 months; p = 0.532). Elective neck irradiation was given to 43 patients, all in the ConFxn group, and this was associated with poorer local control (p = 0.027). The use of radiotherapy modality, three-dimensional conformal radiotherapy (3DRT) versus intensity modulated radiotherapy (IMRT), was not a prognostic factor (p = 0.36). In the HypoFxn group, grade III acute dysphagia requiring nasogastric tube was 16%, compared with 25% in the ConFxn group (p = 0.446). Conclusion HypoFxn radiotherapy provides a comparable treatment outcome with acceptable toxicity. The addition of prophylactic irradiation of the neck lymph nodes has no impact on regional control.

The consensus among experts on the diagnosis and treatment of pediatric vocal cord paralysis / 临床耳鼻咽喉头颈外科杂志

Pediatric vocal ford paralysis is a vocal cord movement disorder caused by damage to the pediatric laryngeal motor nerves.It is mainly characterized by voice, breathing,and swallowing difficulties,and in severe cases,it can lead to choking in affected children. Currently, the diagnosis and treatment of this condition pose a significant challenge for pediatric otolaryngologists, as the goal is to minimize damage to the vocal folds and laryngeal framework.In order to standardize the diagnosis and treatment of pediatric vocal cord paralysis, the Pediatric Otolaryngology Committee of the Chinese Medical Association,in collaboration with multiple children's medical centers nationwide, have formulated this consensus document.

Construction of three image recognition models of manikin′s glottis using visual laryngoscopy based on deep-learning algorithm / 中华麻醉学杂志

Objective:To construct three image recognition models of manikin′s glottis using visual laryngoscopy based on deep-learning algorithm.Methods:The tracheal intubation manikin′s epiglottis was visualized using a videolaryngoscope, and then epiglottis was elevated to expose the glottis and acquire glottic images. A total of 149 images were obtained from various angles and orientations and randomly divided into training set and test set, and the annotation of image data was completed. Three glottal image recognition models of CenterNet, YOLOv3 and YOLOv4 were developed. The training set was used to complete the training of the models, and finally the test set was used to evaluate the model performance.Results:CenterNet, YOLOv3 and YOLOv4 three models were successfully constructed, the mean average precision of CenterNet, YOLOv3 and YOLOv4 was 92.33%, 89.52% and 89.02% respectively, the recall rates were 87.50%, 90.00% and 90.00% respectively, the precision rates reached 97.22%, 94.74% and 94.74% respectively, and the accuracy rates were 90.91%, 85.11% and 88.89% respectively. All three algorithms demonstrated an identical F1 score of 91.00%.Conclusions:The CenterNet, YOLOv3 and YOLOv4 models are successfully constructed, and three recognition models can accurately identify the glottis in the image, with the CenterNet model demonstrating the highest recognition precision.

Clinical Predictors of Postintubation Bilateral Vocal Fold Immobility

Abstract Introduction Iatrogenic bilateral vocal fold immobility (BVFI) often arises from posterior glottic stenosis (PGS) after endotracheal intubation, whereby posterior commissure mucosal disruption leads to fibrosis and ankylosis of the cricoarytenoid joints. Sequelae can be devastating, resulting in dyspnea, stridor, and death due to asphyxiation. Objectives We sought to review features associated with PGS to better understand how to prevent this condition. A secondary aim is to analyze factors correlating to tracheostomy dependence. Methods Charts from January 2010 to November 2020 were retrospectively reviewed, and adult patients with the diagnosis of BVFI after intubation were included. Data on comorbidities, duration of intubation, laryngoscopy, and decannulation status was analyzed. Results Out of the 68 patients included in the present study, 60.3% were male, and the mean duration of intubation 14.3 ± 8.5 days. A total of 94% of the patients were intubated for at least 7 days, diabetic, and/or obese. Although association with prolonged intubation >7 days was not significant (p = 0.064), complete BVFI on fiberoptic exam (n = 47) was significantly associated with tracheostomy dependence both in the entire cohort (p = 0.036) and in the 56 patients with tracheostomy (p = 0.0086). Patients without cardiovascular disease (CVD) were less likely to be tracheostomy dependent compared with those with CVD (odds ratio [OR]: 0.23 [0.053-0.79]; p = 0.028). Conclusions We identified duration of intubation, DM, and obesity as potential risk factors for PGS. Complete immobility and CVD were significantly associated with tracheostomy dependence. Our findings may have important implications for earlier tracheostomy in high-risk intubated patients, as well as for closer monitoring of disease progression and earlier intervention in those predisposed to tracheostomy dependence.

Revisiting the Concept of Non- and Minimally Invasive Interventions in Early Glottic Cancer - Part II: Single Therapy Should be Favored over the Combination of Transoral Laser Microsurgery and Radiotherapy, Regarding the Postinterventional Voice Quality

Abstract Introduction Early glottic cancer (EGC) is associated with a high cure rate. Hence, patients and physicians also focus on the impact of the proposed treatment on the speaking function of the preserved larynx. Objectives The present study assessed the impact of single-modality treatment (transoral laser microsurgery [TLM], or radiotherapy) or combination therapy for EGC on post-interventional voicing and explored factors which might explain the related perceptions. Methods A total of 108 patients filled in the voice handicap index 10 questionnaire, 1 and 2 years postinterventionally. Non-parametric tests were used for the respective statistical analyses. Results Sixty-four patients were treated with TLM, 15 with radiotherapy, and 29 with both modalities. Transoral microsurgery and radiotherapy were associated with post-interventional dysphonia, which attenuated between the first and second postinter-vention year (p = 0.000). No association between sociodemographic parameters and the attenuation of postinterventional dysphonia was identified for either treatment modality. Transoral microsurgery and radiotherapy resulted in comparable postin-terventional voicing, in the first (p = 0.940) and second (p = 0.196) postintervention years. The addition of TLM to radiotherapy resulted in worse voice quality in the second, compared with the first postintervention year (p = 0.000), demonstrating a detrimental effect on speech intelligibility in noise (p = 0.000). Conclusion Single therapy should be favored over the combination of TLM and radiotherapy for EGC in terms of retaining better postinterventional voice quality. Postinterventional dysphonia should be taken into account, during preinterventional counseling, as it may exert leverage on the quality of patients' lives. Patients and physicians should acknowledge the optimal time of voice function return, which seems to be extending up to two years posttreatment.

Características clinicoepidemiológicas de pacientes con cáncer de laringe / Clinical epidemiological characteristics of patients with larynx cancer

Introducción: La laringe es la localización más común de los tumores malignos de cabeza y cuello no cutáneos. Objetivo: Caracterizar a los afectados por lesiones malignas de laringe. Métodos: Se realizó un estudio descriptivo, transversal y retrospectivo de 242 pacientes con carcinoma de laringe atendidos en el Hospital Oncológico Docente Provincial Conrado Benítez García de Santiago de Cuba, desde enero de 2013 hasta diciembre de 2015. Resultados: La mayoría de los pacientes eran hombres (88,8 %), con una relación de 8:1 respecto al sexo femenino, y la edad media fue de 65 años. Así mismo, el tabaquismo estuvo presente en 204 pacientes (84,3 %) y los tumores glóticos resultaron ser los más frecuentes, con 168 afectados, de los cuales 89,3 % presentó como primer síntoma la disfonía, seguida en orden del aumento de volumen cervical como manifestación principal del cáncer de supraglotis (26,6 %) y de subglotis (60,0 %). El estadio predominante al momento del diagnóstico fue el I (35,5 %). Conclusiones: En la actualidad los tumores malignos de laringe resultan un importante problema de salud por la tendencia ascendente en el número de pacientes a nivel mundial.

Introduction: The larynx is the most common localization of non cutaneous head and neck malignancies. Objective: To characterize those affected patients due to larynx malignancies. Methods: A descriptive, cross-sectional and retrospective study of 242 patients with larynx carcinoma was carried out, they were assisted in Conrado Benítez García Provincial Teaching Cancer Hospital in Santiago de Cuba, from January, 2013 to December, 2015. Results: Most of the patients were men (88.8 %), with an 8:1 ratio regarding the female sex, and mean age was of 65 years. Likewise, nicotine addiction was present in 204 patients (84.3 %) and glottic tumors were the most frequent, with 168 affected, of which 89.3% presented dysphonia as first symptom, followed in order by the increase of cervical volume as main manifestation of the supraglottis (26.6 %) and subglottis (60.0 %) cancer. The predominant stage at the moment of the diagnosis was the I (35.5 %). Conclusions: At the present time larynx malignancies are an important health problem for the upward tendency in the number of patients worldwide.

Intensity-modulated radiotherapy for stage I glottic cancer: a short-term outcomes compared with three-dimensional conformal radiotherapy

PURPOSE: To investigate the differences in treatment outcomes between two radiation techniques, intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT).MATERIALS AND METHODS: We retrospectively analyzed 160 (IMRT = 23, 3DCRT = 137) patients with stage I glottic cancer treated from January 2005 through December 2016. The IMRT was performed with TomoTherapy (16 patients), volumetric-modulated arc therapy (6 patients), and step-and-shoot technique (1 patient), respectively. The 3DCRT was performed with bilateral parallel opposing fields. The median follow-up duration was 30 months (range, 31 to 42 months) in the IMRT group and 65 months (range, 20 to 143 months) in the 3DCRT group.RESULTS: The 5-year overall survival and 3-year local control rates of the 160 patients were 95.7% and 91.4%, respectively. There was no significant difference in 3-year local control rates between the IMRT and 3DCRT groups (94.4% vs. 91.0%; p = 0.587). Thirteen of 137 patients in the 3DCRT group had recurrences. In the IMRT group, one patient had a recurrence at the true vocal cord. Patients treated with IMRT had less grade 2 skin reaction than the 3DCRT group, but this had no statistical significance (4.3% vs. 21.2%; p = 0.080).CONCLUSION: IMRT had comparable outcomes with 3DCRT, and a trend of less acute skin reaction in stage I glottic cancer patients

The value of acoustic parameters in the voice therapy for patients with unilateral vocal cord paralysis / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the value of acoustic parameters in the voice therapy for patients with unilateral vocal cord paralysis (UVCP).@*Methods@#From May 2015 to April 2018, 51 patients with UVCP and 59 healthy controls in Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, were involved in this research retrospectively. The UVCP patients were diagnosed with stroboscopic laryngoscopy. The minimum glottal area (MGA) was calculated by KIPS software when the people were pronouncing/i:/. The fundamental frequency (F0), Jitter, Shimmer and NHR were detected by CSL4500 multiple acoustic voice analyzer.@*Results@#MGA of UVCP patients was much higher than that of healthy control (male: 433.68±64.52 vs. 294.41±51.82, t=9.23, P=0.000; female: 498.80±73.42 vs. 302.03±76.54, t=13.21, P=0.000), which meaned vocal cord insufficiency.After voice therapy, MGA reduced significantly (male: 288.48±55.09, female: 258.22±57.17, t=24.41 and 31.22, P=0.000 vs. pre-therapy). MGA of untreated patients decreased in varying degrees. Compared with the voice therapy group, the MGA decreased in a significantly lower extent (24.25±22.91 vs. 188.31±54.37, t=8.97, P=0.000). The F0, Jitter, Shimmer and NHR raised significantly in UVCP patients group (P=0.000 vs. healthy control group), and they were reduced by voice therapy (all P<0.05). Each of the four acoustic parameters was relative with MGA, r=0.551, 0.867, 0.853 and 0.875 in turn, P=0.001, 0.000, 0.000, and 0.000.@*Conclusion@#MGA and acoustic parameters can reflect the acoustic features of UVCP patients, which are useful tools in the UVCP assessment and voice therapy.

Effect of radiofrequency ablation of low temperature plasma knife in the treatment of 32 cases of early glottal carcinoma / 中国基层医药

Objective@#To investigate the effect and recurrence rate of radiofrequency ablation of low temperature plasma knife in the treatment of patients with early glottal carcinoma.@*Methods@#A total of 64 cases of early glottic carcinoma in the People's Hospital of Shanxi Province from February 2012 to January 2016 were divided into observation group and control group according to the different treatment schemes, with 32 cases in each group.The observation group was treated with radiofrequency ablation of low temperature plasma knife, and the control group was performed with routine larynx cleft surgery.The surgical related indicators and postoperative complications of the two groups were recorded.The phonetic changes (amplitude perturbation, fundamental frequency perturbation and harmonic noise ratio) before and 6 months after operation of two groups were compared.After 2 years of follow-up, the recovery of vocal mucosa in the two groups after 1 year of operation and the recurrence rate of 6 months, 1 year and 2 years after operation of the two groups were statistically recorded.@*Results@#The intraoperative blood loss in the observation group was less than that in the control group(P<0.05), and the operative time and hospital stay observation time in the observation group were shorter than those in the control group(all P<0.05). The incidence rate of postoperative complications in the observation group [9.38% (3/32)] was lower than that in the control group[31.25%(10/32)], and the smoothness rate of the vocal cords at 1 year after operation in the observation group [90.63% (29/32)] was higher than that in the control group[62.50%(20/32)], the difference were statistically significant(χ2=4.730, 7.053, all P<0.05). There were no statistically significant differences in amplitude perturbation, fundamental frequency perturbation and harmonic noise ratio between the two groups(all P>0.05). After operation, the amplitude perturbation and the fundamental frequency perturbation in the observation group were lower than those of the control group, and the harmonic noise ratio was higher than that of the control group, the difference were statistically significant (t=18.618, 4.258, 2.579, all P<0.05). In the observation group, the recurrence rates at 6 months, 1 year and 2 years after operation were lower than those in the control group(χ2=4.598, 6.335, 4.730, all P<0.05).@*Conclusion@#Radiofrequency ablation of low temperature plasma knife in the treatment of patients with early glottal carcinoma can significantly reduce the intraoperative blood loss, shorten the operation time and observation time of postoperative hospital stay, and significantly reduce the incidence of postoperative complications and recurrence rate.It can also improve the patients' voice, and promote the recovery of vocal cord mucosal smooth.Besides, it has remarkable effect, and it has important significance in clinical treatment.

Effect of radiofrequency ablation of low temperature plasma knife in the treatment of 32 cases of early glottal carcinoma / 中国基层医药

Objective To investigate the effect and recurrence rate of radiofrequency ablation of low temperature plasma knife in the treatment of patients with early glottal carcinoma.Methods A total of 64 cases of early glottic carcinoma in the People＇s Hospital of Shanxi Province from February 2012 to January 2016 were divided into observation group and control group according to the different treatment schemes ,with 32 cases in each group.The observation group was treated with radiofrequency ablation of low temperature plasma knife ,and the control group was performed with routine larynx cleft surgery.The surgical related indicators and postoperative complications of the two groups were recorded.The phonetic changes (amplitude perturbation,fundamental frequency perturbation and harmonic noise ratio ) before and 6 months after operation of two groups were compared.After 2 years of follow －up,the recovery of vocal mucosa in the two groups after 1 year of operation and the recurrence rate of 6 months,1 year and 2 years after operation of the two groups were statistically recorded.Results The intraoperative blood loss in the observation group was less than that in the control group (P＜0.05),and the operative time and hospital stay observation time in the observation group were shorter than those in the control group ( all P＜0.05).The incidence rate of postoperative complications in the observation group [9.38%(3／32)] was lower than that in the control group [31.25%(10／32)],and the smoothness rate of the vocal cords at 1 year after operation in the observation group [90.63%(29／32)] was higher than that in the control group [62.50%(20／32)],the difference were statistically significant (χ2 ＝4.730,7.053,all P＜0.05).There were no statistically significant differences in amplitude perturbation ,fundamental frequency perturbation and harmonic noise ratio between the two groups (all P＞0.05).After operation,the amplitude perturbation and the fundamental frequency perturbation in the observation group were lower than those of the control group,and the harmonic noise ratio was higher than that of the control group , the difference were statistically significant (t＝18.618,4.258,2.579,all P＜0.05).In the observation group,the recurrence rates at 6 months, 1 year and 2 years after operation were lower than those in the control group ( χ2 ＝4.598,6.335,4.730,all P＜0.05).Conclusion Radiofrequency ablation of low temperature plasma knife in the treatment of patients with early glottal carcinoma can significantly reduce the intraoperative blood loss ,shorten the operation time and observation time of postoperative hospital stay ,and significantly reduce the incidence of postoperative complications and recurrence rate.It can also improve the patients＇voice,and promote the recovery of vocal cord mucosal smooth.Besides,it has remarkable effect,and it has important significance in clinical treatment.

Effect of CO2 laser assisted laryngoscope on glottic carcinoma / 中国医师杂志

Objective To prospectively investigate laryngoscopy-assisted CO2 laser in the treatment of glottic laryngeal carcinoma.Methods 97 patients with early glottic laryngeal carcinoma in our hospital were selected and divided into control group (n =48) and observation group (n =49) according to random number table.The control group was treated with partial laryngectomy and the observation group was treated with laryngoscopy-assisted CO2 laser.The clinical efficacy,serum level of α1-acid glycoprotein (α1-AG) and ceruloplasmin (CER) after 10 min of the surgery and changes of the indicators of voice function [fundamental frequency jitter (jitter),the longest sound time (MPT),sound pressure level (SPL)] were observed and compared between the two groups,and the incidence of complications and quality of life (QOL) scores were statistically compared.Results The total remission rate in the observation group was 79.59％ (39/49),which was higher than that in the control group 56.25％ (27/48),with statistically significant difference (x2 =6.075,P =0.014).The levels of serum α1-AG and CER in the observation group 10 min after surgery were lower than those in the control group,with statistically significant difference (t =2.641,P =0.010,t =31.242,P =0.000).From 2 weeks after surgery to 3 months after surgery,SPL and MPT of two groups decreased first and then increased;Jitter increased first and then decreased,and the changing amplitude in the observation group was smaller than that in the control group,with statistically significant difference (P ＜ 0.05).The incidence of complications in the observation group was 2.04％ (1/49),which was lower than that in the control group 16.67％ (8/48),with statistically significant difference (P ＜ 0.05);3 months after surgery,the QOL score of the observation group was higher than that of the control group,with statistically significant difference (P ＜ 0.05).Conclusions Supporting laryngoscope CO2 laser surgery can improve stress state and quality of life of early glottic laryngeal cancer patients,and the incidence of complications is low.It has little effect on voice function.

A Case of Neurofibroma of the Vocal Cord

Solitary neurofibroma of the glottis is extremely rare and accounts for only 0.1–1.5% of benign laryngeal tumors. Aryepiglottic fold is the most frequent involved site followed by arytenoids and ventricular folds. There have been few reports of neurofibroma of the true vocal cord. We report a case of neurofibroma which was deeply embedded in the vocal cord and misdiagnosed as muscle tension dysphonia with a review of literatures.

Hypofractionated radiotherapy for early glottic cancer: a retrospective interim analysis of a single institution

PURPOSE: To evaluate the results of hypofractionated radiotherapy (HFX) for early glottic cancer. MATERIALS AND METHODS: Eighty-five patients with cT1-2N0M0 squamous cell carcinoma of the glottis who had undergone HFX, performed using intensity-modulated radiotherapy (IMRT, n = 66) and three-dimensional conformal radiotherapy (3D CRT, n = 19) were analyzed. For all patients, radiotherapy was administered at 60.75 Gy in 27 fractions. Forty-three patients received a simultaneous integrated boost (SIB) of 2.3–2.5 Gy per tumor fraction. RESULTS: The median follow-up duration was 29.9 months (range, 5.5 to 76.5 months). All patients achieved complete remission at a median of 50 days after the end of radiotherapy (range, 14 to 206 days). The 5-year rates for locoregional recurrence-free survival was 88.1%, and the 5-year overall survival rate was 86.2%. T2 stage was a prognostic factor for locoregional recurrence-free survival after radiotherapy (p = 0.002). SIB for the tumor did not affect disease control and survival (p = 0.191 and p = 0.387, respectively). No patients experienced acute or chronic toxicities of ≥grade 3. IMRT significantly decreased the dose administered to the carotid artery as opposed to 3D CRT (V₃₅, p < 0.001; V₅₀, p < 0.001). CONCLUSIONS: Patients treated with HFX achieved acceptable locoregional disease control rates and overall survival rates compared with previous HFX studies. A fraction size of 2.25 Gy provided good disease control regardless of SIB administration.

Comparison of Treatment Outcomes for T3 Glottic Squamous Cell Carcinoma: A Meta-Analysis

OBJECTIVES: This study compared the survival outcomes, local control rate, and laryngeal preservation rate of various treatment strategies in the treatment of T3 squamous cell carcinoma of the glottis using proportional meta-analyses. METHODS: Twenty-five retrospective case-series studies were included in these analyses. Treatment strategies were classified as total laryngectomy (TL), open partial laryngectomy (PL), transoral laser microsurgery (TLM), chemo-radiation therapy (CRT), and radiation therapy (RT) alone. RESULTS: The overall survival rate and disease-specific survival rate among laryngeal preservation treatments did not differ from the overall survival rate of TL. However, the local control rate was lower with RT than TL and PL, and laryngeal preservation rates of TLM and CRT were higher than RT alone. CONCLUSION: Consideration of preservation of laryngeal function is necessary when treating T3 glottic squamous cell carcinoma. PL, TLM, and, CRT are considered more appropriate initial laryngeal preservation strategies if available.

Treatment of glottic cancer involving the anterior commissure by transoral CO2 laser surgery / 中华耳鼻咽喉头颈外科杂志

Objective@#To study the clinical outcome of transoral CO2 laser surgery for glottic cancer involving the anterior commissure.@*Methods@#Thirty-two cases of glottic cancer involving the anterior commissure treated by transoral CO2 laser surgery between March 2009 and December 2013 were retrospectively reviewed. Among these cases, 27 were T1bM0M0, 5 were T2N0M0. All cases were followed-up for more than 3 years.@*Results@#All the 32 cases were successfully treated. Perioperative complications included injuries in the soft palate mucosa(13/32, 40.63%), loose incisors(3/32, 9.38%) and subcutaneous emphysema in the neck(2/32, 6.25%). During the follow-up period, granulation was found in all cases. Three cases had local recurrence. Two patients treated by a secondary transoral CO2 laser surgery and the other case had total laryngectomy, all three cases were followed up for 5 years without recurrence. Two cases had regional recurrence but no primary site recurrence. One patient was treated by neck dissection, and followed up for 5 years without recurrence. The other patient died of supraclavicular and mediastinal lymph node metastasis and lung metastasis 40 months after operation. The overall 5-year survival rate was 90.6%. There was no significant difference in survival rate between T1bN0M0(92.6%) and T2N0M0(80.0%) (Log Rank χ2=0.788, P=0.375). The overall 5-year local regional control rate was 84.4%. In T1bN0M0 lesions, the 5-year local regional control rate was 92.6%, which was significantly higher than that in T2N0M0 lesions(40.0%) (Log Rank χ2=9.504, P=0.002).@*Conclusion@#With appropriate surgical indication, detailed preoperative evaluation, good surgical skill, transoral CO2 laser surgery may achieve satisfactory outcome in the treatment of glottic cancer involving the anterior commissure.

Double-lumen endobronchial intubation-related anatomical factors of respiratory tract in adult pa-tients: measurement of glottis and left main bronchus using computed tomography / 中华麻醉学杂志

Objective To investigate the double-lumen endobronchial intubation-related anatomical factors of respiratory tract in adult patients through measurement of the parameters of glottis and left main bronchus using computed tomography(CT). Methods A total of 206 patients of both sexes, aged 20-80 yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective surgery, were enrolled in this study.The cervical and thoracic CT images were evaluated.The anteroposterior glottic diame-ter(AP-GD), anteroposterior tracheal diameter(AP-TD), transverse tracheal diameter(Tr-TD), left and right main bronchus diameters(LBD and RBD)and length between glottis and carina(G-TL)were measured.Multiple linear regression analyses were performed to detect the correlations between obtained pa-rameters and between obtained parameters and height. Results AP-GD was(19±3)mm, AP-TD(20± 4)mm, Tr-TD(16.6±2.4)mm, LBD(12.3±2.0)mm, RBD(13.7±2.0)mm and G-TL(126± 11)mm.AP-GD, height, AP-TD and Tr-TD were moderately correlated with LBD(r was 0.522, 0.584, 0.648 and 0.606, respectively, P<0.05).AP-TD +Tr-TD+AP-GD+height served as the inde-pendent variable, the fitting curve was confirmed, and the results showed that AP-TD, Tr-TD and height were the affecting factors for LBD, and the degree of correlation with LBD was as follows from high to low:Tr-TD(b′=0.334), AP-TD(b′=0.323), height(b′=0.243). When AP-GD served as the independ-ent variable and curve fitting was performed, there was no significant difference(P>0.05). Conclusion Tr-TD and AP-GD should be considered besides double-lumen endobronchial intubation-related anatomical factors such as LBD and height in adult patients.

A Case of Glottic Mucoepidermoid Carcinoma Presenting as Submucosal Mass / 대한이비인후과학회지

Mucoepidermoid carcinoma (MEC) is the most common malignant tumor originated from salivary gland. However, it rarely occurs in the larynx, which is approximately less than 0.35% of all laryngeal neoplasm. In the literature, the laryngeal MEC often appears as submucosal mass with intact mucosa. As a result, most patients are diagnosed in the advanced stage due to difficulty of early detection. There is no standard treatment option because of the rarity of the disease and the prognosis varies by histological features. We recently encountered a 85-yearold male with progressive hoarseness, and he was finally diagnosed as high grade glottic MEC. We report this rare and unique case with a literature review.

Effect of Head Extension Angle to Glottis Exposure : A Simulation Evaluation Based on CT Reconstruction Images of Upper Airway / 医学研究杂志

Objective To investigate the effect of head extension angle to glottis exposure by using three-dimensional CT reconstruction sagittal plane images of upper airway.Methods There were 80 patients,aged 7-78 years old,who had been scanned by helical CT in the head and neck.Reconstructed images were obtained by AW4.4 workstation and the following parameter was measured:angle α(A0 group),the angle created by the upper central incisor and root of epiglottis(angular vertex) and midpoint of glottis.Reconstructed images were printed according to the actual size of human body in a ratio of 1∶ 1,then the images were cut off from the upper central incisor to root of epiglottis by a section of arcs.Increasing the degree of angle α by clockwise to hypothetically increase the angle of head extension.The glottis was exposed by using a paper-made laryngoscope(Macintosh) model,and the success rate of glottis exposure was recorded when the degree of angle α was respectively increased 10°(A10 group),20°(A20 group),and 30°(A30 group).Results Compared with A0 group,the success rate of glottis exposure increased significantly in A10 group,A20 group and A30 group.The success rate of glottis exposure in A20 group and A30 group was significantly higher than A10 group.Compared with A20 group,the success rate of glottis exposure obviously increased in A30 group.Conclusion Based on CT reconstruction images of upper airway,we can analog study the effect of head extension angle to glottis exposure.

Accuracy of ultrasonographic measurement of subglottic airway diameter in selecting cuffed endotracheal tube size for pediatric patients with congenital heart disease / 中华麻醉学杂志

Objective To evaluate the accuracy of ultrasonographic measurement of the subglottic airway diameter in selecting the cuffed endotracheal tube (ETT) size for the pediatric patients with congenital heart disease.Methods Sixty pediatric patients of both sexes with congenital heart disease,of American Society of Anesthesiologists physical status Ⅱ-Ⅳ,aged 1 month-7 yr,undergoing elective open heart surgery,were included in this study.The subglottic airway diameter was measured by bedside ultrasonography after induction of anesthesia.The outer diameter of the cuffed ETT was determined according to the subglottic airway diameter.The air leak test was performed after intubation to determine whether or not the ETT size selected based on ultrasonography was appropriate.When the difference between the inner diameter of the finally selected ETT and the result calculated by the Motoyama formula was less than 0.2 mm,the ETT size selected based on the Motoyama formula was considered appropriate.The agreement and correlation between the subglottic airway diameter measured by age-based formula and ultrasonography and the outer diameter of the actually selected ETT were analyzed using Bland-Altman plot and Passing-Bablok regression analysis.Results The accurate rate of the ETT selected based on the ultrasonic measurement and Motoyama formula were 80％ and 55％,respectively,and there was significant difference (P＜0.05).Conclusion Ultrasonographic measurement of the subglottic airway diameter produces higher accuracy than the classical Motoyama formula in selecting the cuffed ETT size for the pediatric patients with congenital heart disease.

Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.