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1.
Clin Nucl Med ; 49(5): 481-483, 2024 May 01.
Article in English | MEDLINE | ID: mdl-38389203

ABSTRACT

ABSTRACT: Prostate-specific membrane antigen (PSMA) PET/CT has revolutionized the imaging of prostate cancer. Historically, prostate cancer metastasis to thyroid and cricoid cartilages was thought to be exceedingly rare, with only a few reported cases in the literature. Prostate cancer metastasis to the laryngeal cartilages was detected in 4 of 221 patients who underwent imaging with 18 F-PSMA (Pylarify) or 68 Ga-PSMA (Illuccix) PET/CT for initial staging of high-risk prostate cancer or restaging evaluation in the setting of biochemical recurrence from April 2022 through October 2023. The increased sensitivity and specificity of PSMA PET/CT allow for the detection of previously occult metastatic disease.


Subject(s)
Genital Neoplasms, Female , Prostatic Neoplasms , Male , Female , Humans , Positron Emission Tomography Computed Tomography/methods , Prostate/pathology , Thyroid Gland/pathology , Cricoid Cartilage/diagnostic imaging , Cricoid Cartilage/pathology , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/pathology , Gallium Radioisotopes , Genital Neoplasms, Female/pathology , Prostate-Specific Antigen
2.
Adv Gerontol ; 36(2): 227-233, 2023.
Article in Russian | MEDLINE | ID: mdl-37356099

ABSTRACT

The paper presents the results of a histomorphometric study of age-related changes in hyaline cartilage tissue by the example of studying cricoid cartilage from 88 corpses of males of various ages. A comparative assessment of the parameters between the groups was carried out and the dynamics of age-related changes in the main ones was studied. As a result of the studies, the greatest correlation with age was recorded in the following indicators: length (r=0,88) and width (r=0,89) of the ossification zone, the area of bone (r=0,87), adipose (r=0,77) and reticular tissue (r=0,86), the number of chondroblasts (r=-0,7). It was found that the transformations of cricoid cartilage occurring with age are characterized by a decrease in the area of cartilage tissue, the average number of chondrocytes and chondroblasts also tends to decrease steadily with increasing age. Age-related bone tissue transformations are characterized by an increase in the area of bone tissue and the transformation of the tissue structure itself: the number of bone beams and their dimensional characteristics (length and width) change. The results of the study allow us to evaluate the age dynamics of quantitative markers of involution processes of hyaline cartilage tissue in men by the example of studying cricoid cartilage and supplement the existing ideas about the pathogenesis of age-associated cartilage diseases.


Subject(s)
Bone and Bones , Cricoid Cartilage , Male , Humans , Cricoid Cartilage/pathology , Chondrocytes
3.
Int J Pediatr Otorhinolaryngol ; 162: 111293, 2022 Nov.
Article in English | MEDLINE | ID: mdl-36044795

ABSTRACT

OBJECTIVES: It is thought that many infants have a prominent venous plexus of the postcricoid area. In the past this entity had occasionally been reported as a postcricoid hemangioma or even a postcricoid mass. The term postcricoid cushion is now gaining acceptance to describe the prominent venous plexus of the posterior cricoid area. Although it rarely causes symptoms, it should be considered when patients present with symptoms of obstruction. Differentiating between normal variant postcricoid prominent venous plexuses, hemangiomas, and vascular malformations can be difficult and cannot be confirmed without immunohistochemistry. The objective of this systematic review is to describe current practices, clinical symptoms, management and outcomes of pediatric postcricoid lesions including postcricoid cushion. METHODS: A systemic review of the literature was done using the PRISMA (Preferred Reporting Items for Systemic Reviews and Meta-Analyses) guidelines to investigate postcricoid lesions. The following terms: Postcricoid, Postcricoid lesions, Postcricoid mass, Posterior cricoid, Pressure-dependent postcricoid mass, postcricoid prolapse, postcricoid hemangiomas, postcricoid vascular malformations, and postcricoid cushion were searched in PubMed and Google Scholar. Articles that were within the inclusion criteria were reviewed. Demographics, past medical and birth histories, clinical symptoms, evaluations, biopsy results, treatments, and outcomes were included. For the purposes of this review, postcricoid cushions, pressure-dependent postcricoid mass, and postcricoid prolapse will be group under normal variant postcricoid cushion. RESULTS: 15 articles with 42 distinct cases were included in this systemic review. 21/42 of the patients were female, the age ranged from 2 days to 18 years, the median age was 6.5 months, and 39/42 of patients were under the age of 2 years. 17/42 patients were diagnosed "hemangiomas" in the papers with only 1 case confirming the diagnosis of hemangioma with immunohistochemistry. 7/42 were diagnosed vascular malformations with 3 cases confirming the diagnosis of with immunohistochemistry. 17/42 of cases were normal variant postcricoid cushions. Most commonly, patients had a history of laryngomalacia (14/33) followed by no other medical history (9/33). The most common clinical symptoms were stridor, dysphonia, or weak cry in 30/42, dysphagia in 20/42, sleep disordered breathing in 9/42, and regurgitation or aspiration in 9/42.8/38 of patients diagnosed with postcricoid cushion did not have visualization of the lesion until a Valsalva maneuver was performed. The most common management for "hemangiomas" was observation (8/17), for "vascular malformations" was laser therapy (3/7), and for normal variant postcricoid cushions was observation (8/17). The most common outcome was complete resolution (14/30) followed by improvement of symptoms (9/30), and residual complications (4/30) The median time to follow-up was 12 months. CONCLUSION: Due to the relatively new "discovery" of the normal variant postcricoid cushion, including postcricoid cushion, pressure-dependent postcricoid mass, and postcricoid prolapse, the majority of the literature are case reports. Although it is theorized that many children under the age of 2 have a prominent venous plexus, in some cases it could cause symptoms of obstruction. Because immunohistochemistry is rarely done and reported in the literature, many case reports may have misdiagnosed the postcricoid lesions. Also, in many cases visualizing the normal variant postcricoid cushion requires that the patients have increased intrathoracic pressure; therefore, if no postcricoid prominence is seen initially or when the patient is under general anesthesia and a postcricoid lesion is suspected, the patient should receive a Valsalva maneuver or be placed in Trendelenburg position. Most cases of normal variant postcricoid cushions can be managed with observation. Due to the rarity and novelty of the discovery, more research needs to be done on the management of symptomatic postcricoid lesions and differentiating between normal variants and pathological vascular lesions.


Subject(s)
Deglutition Disorders , Hemangioma , Laser Therapy , Child , Cricoid Cartilage/pathology , Deglutition Disorders/etiology , Female , Hemangioma/diagnosis , Hemangioma/therapy , Humans , Infant , Infant, Newborn , Laser Therapy/adverse effects , Male , Prolapse
4.
J Feline Med Surg ; 24(4): 373-380, 2022 04.
Article in English | MEDLINE | ID: mdl-34236002

ABSTRACT

OBJECTIVES: Partial laryngectomy is an organ-sparing surgical procedure for the removal of laryngeal masses which has not been described in cats. The aim of this study was to report on the surgical procedure and the short- and long-term clinical outcomes of cats that underwent partial laryngectomy. METHODS: Medical records were retrospectively collected over a 4-year period in two institutions. The following data were retrieved: signalment, history, clinical signs, diagnostic test results, surgical procedure, postoperative management, complications and outcome. RESULTS: Six cats underwent partial laryngectomy. The most common clinical signs in cats with laryngeal masses were stridor (n = 4) and dyspnoea (n = 4). In all cats, a full-thickness portion of one or several laryngeal cartilages was resected, including thyroid cartilage alone (n = 2), thyroid cartilage and arytenoid (n = 2), and arytenoid cartilage and epiglottis (n = 2). The resected laryngeal masses were reported to be lymphoma (n = 3), carcinoma (n = 1), laryngeal cyst (n = 1) and inflammatory laryngeal disease (n = 1). All cats survived the surgical intervention of partial laryngectomy. Four cats showed varying degrees of respiratory distress in the short-term postoperative period. A temporary tracheostomy tube was placed in two cats. No other postoperative complications were noted in the short- or long-term. Four cats were still alive at the time of writing. These cats survived at least 252 days. CONCLUSIONS AND RELEVANCE: In a small number of cases, our results show that successful long-term outcomes after partial laryngectomy are achievable, with longer survival times than previously reported. Therefore, partial laryngectomy should be considered as a viable treatment option in cats with laryngeal masses.


Subject(s)
Carcinoma, Squamous Cell , Cat Diseases , Laryngeal Neoplasms , Animals , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/veterinary , Cat Diseases/surgery , Cats , Cricoid Cartilage/pathology , Cricoid Cartilage/surgery , Laryngeal Neoplasms/surgery , Laryngeal Neoplasms/veterinary , Laryngectomy/methods , Laryngectomy/veterinary , Retrospective Studies , Treatment Outcome
5.
Laryngoscope ; 132(1): 169-176, 2022 01.
Article in English | MEDLINE | ID: mdl-34291467

ABSTRACT

OBJECTIVES/HYPOTHESIS: Laryngeal chondrosarcomas are rare malignancies with a spectrum of presentations due to varying size, local extension, and biological behavior. Moreover, these neoplasms have differing effects on respiration, phonation, and deglutition. Consequently, it is valuable to assess endoscopic and transcervical treatment strategies. STUDY DESIGN: Retrospective case series. METHODS: A retrospective review was done from 2001 to 2020; 25 patients were identified with laryngeal chondrosarcomas. Their tumor pathology and treatment were analyzed. RESULTS: All 25 chondrosarcomas were in the posterior cricoid and arose in proximity to at least one cricoarytenoid joint: 23 of 25 grade I-II (low-mid), one of 25 grade II-III (mid-high), and one of 25 grade III (high). Some tumor was left in 23 of 25 to preserve cricoarytenoid-joint function. There were no known disease-specific deaths (~8-year median follow-up). Final surgical treatment in 24 of 25 was: 13 of 25 transcervical partial laryngectomy, 7 of 25 transoral-endoscopic removal, 4 of 25 total laryngectomy, and 1 of 25 observation. CONCLUSIONS: In this series, unresected intercurrent disease with laryngeal chondrosarcomas was not life-threatening. Therefore, disease was typically left in the posterior cricoid region to preserve mobility of at least one cricoarytenoid joint. This philosophy employed an ultra-function-sparing conservation approach that preserved and/or restored optimal voice, airway patency and swallowing. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:169-176, 2022.


Subject(s)
Chondrosarcoma/surgery , Laryngeal Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Chondrosarcoma/pathology , Cricoid Cartilage/pathology , Cricoid Cartilage/surgery , Female , Humans , Laryngeal Neoplasms/pathology , Laryngectomy/methods , Larynx/pathology , Larynx/surgery , Male , Middle Aged , Retrospective Studies
7.
Laryngoscope ; 131(5): 967-974, 2021 05.
Article in English | MEDLINE | ID: mdl-32557663

ABSTRACT

OBJECTIVES: Laryngotracheal stenosis (LTS) is a fibrotic condition of the upper airway. Recent evidence suggests dysregulated host immunity plays a role in LTS development and progression. The programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) axis, targeted by paradigm-shifting immunotherapies for cancer treatment, has also recently been implicated in the pathogenesis of fibrotic pulmonary disease. However, a role for the PD-1/PD-L1 axis in the proximal airway fibrosis seen in LTS patients has not been explored. STUDY DESIGN: Controlled ex vivo study. METHODS: Expression of PD-1, PD-L1, CD4, and CD8 were evaluated using immunohistochemical staining of cricotracheal resection specimens from postintubation iatrogenic laryngotracheal stenosis (iLTS), idiopathic subglottic stenosis (iSGS) patients, and normal controls derived from rapid autopsy (n = 8 per group). Fibroblasts derived from iLTS scar were also treated with transforming growth factor beta 1 (TGFß1) and analyzed for PD-L1 expression by quantitative real-time polymerase chain reaction (n = 6). RESULTS: iLTS specimens exhibited increased expression of PD-1, PD-L1, and CD4 (all P < .0167) compared to controls, whereas iSGS specimens exhibited increased expression of PD-1 and CD4 (P < .0167) compared to controls. PD-1, PD-L1, and CD4 showed periepithelial patterns of expression in both disease cohorts. TGFß1 treatment of iLTS fibroblasts increased expression of PD-L1 (the cognate ligand for PD-1). CONCLUSION: Expression of both PD-1 and its ligand PD-L1 are significantly greater in patients with iLTS compared to controls, and PD-1 expression is also elevated in patients with iSGS. Given published evidence implicating the PD-1/PD-L1 axis in pulmonary fibrosis, this suggests a possible role for checkpoint inhibitors targeting the PD-1/PD-L1 axis for the treatment of LTS. LEVEL OF EVIDENCE: N/A Laryngoscope, 131:967-974, 2021.


Subject(s)
B7-H1 Antigen/metabolism , Laryngostenosis/immunology , Programmed Cell Death 1 Receptor/metabolism , Tracheal Stenosis/immunology , B7-H1 Antigen/analysis , Biopsy , Case-Control Studies , Cells, Cultured , Cricoid Cartilage/immunology , Cricoid Cartilage/pathology , Cricoid Cartilage/surgery , Female , Fibroblasts , Fibrosis , Humans , Immunohistochemistry , Laryngostenosis/pathology , Laryngostenosis/surgery , Male , Middle Aged , Primary Cell Culture , Programmed Cell Death 1 Receptor/analysis , Trachea/immunology , Trachea/pathology , Trachea/surgery , Tracheal Stenosis/pathology , Tracheal Stenosis/surgery , Tracheostomy
9.
Pan Afr Med J ; 36: 74, 2020.
Article in English | MEDLINE | ID: mdl-32774633

ABSTRACT

Cricoarytenoid joint arthritis is most frequently reported in Rheumatoid Arthritis and in other systemic diseases such as Sjogren's syndrome, Systemic Lupus Erythematosus, Ankylosing Arthritis, Juvenile Chronic Arthritis, and autoimmune hepatitis but it has not been reported in dermatomyositis. In this paper, we report the case of a 43 years-old woman treated for dermatomyositis who presented with hoarseness and severe odynophagia. The laryngoscopy revealed the presence of an extensive white swelling of the left cricoarytenoid joint with reduced mobility of the left vocal cord, consistent with left cricoarytenoid joint arthritis, which has not previously been described in dermatomyositis to our knowledge. Treatment with high doses of prednisone produced a complete resolution of the laryngeal symptoms.


Subject(s)
Arthritis/etiology , Arytenoid Cartilage/pathology , Cricoid Cartilage/pathology , Dermatomyositis/complications , Adult , Arthritis/drug therapy , Arthritis/pathology , Dermatomyositis/drug therapy , Female , Glucocorticoids/administration & dosage , Humans , Laryngoscopy , Prednisone/administration & dosage
10.
Radiol Med ; 125(12): 1301-1310, 2020 Dec.
Article in English | MEDLINE | ID: mdl-32415474

ABSTRACT

OBJECTIVES: To evaluate thyroid, arytenoid, and cricoid cartilage invasion on computed tomography (CT) imaging in patients undergoing total laryngectomy for both primary and recurrent laryngeal carcinoma. Secondary endpoint was to compare laryngeal cartilage invasion between primary and recurrent tumours. METHODS: Pre-treatment CT of 40 patients who had undergone total laryngectomy was retrospectively evaluated and compared with histology. Focal erosions of thyroid cartilage were accounted for neoplastic invasion of the inner cortex. Full-thickness thyroid cartilage invasion was defined as a tumour-like tissue replacing thyroid cartilage or extended in extra-laryngeal soft tissues. Sclerosis and erosion of arytenoid and cricoid cartilages were assessed as signs of neoplastic invasion. RESULTS: CT erosion showed perfect agreement for thyroid inner cortex and cricoid cartilage invasion and almost perfect agreement (87%) for arytenoid cartilage invasion. For tumours in contact with thyroid cartilages, the absence of CT erosion underestimated inner cortex infiltration. CT showed perfect agreement in predicting full-thickness thyroid cartilage invasion only in the case of extra-laryngeal neoplastic extension. Arytenoid sclerosis showed poor correlation with neoplastic invasion. For primary tumours, CT demonstrated good (inner cortex 75%; full-thickness 85%), substantial (67.5%), and perfect (100%) accuracy in thyroid, arytenoid, and cricoid cartilage invasion, respectively. No CT differences were observed between primary and recurrent laryngeal tumours. CONCLUSION: Tumour-like tissue extension in the extra-laryngeal soft tissues was accurate in predicting thyroid cartilage full-thickness invasion. Erosions of arytenoid, cricoid, and thyroid cartilages' inner cortex on CT were highly indicative of neoplastic infiltration. No CT difference in cartilage infiltration between primary and recurrent tumours was observed.


Subject(s)
Laryngeal Cartilages/diagnostic imaging , Laryngeal Neoplasms/diagnostic imaging , Multidetector Computed Tomography/methods , Neoplasm Recurrence, Local/diagnostic imaging , Aged , Aged, 80 and over , Arytenoid Cartilage/diagnostic imaging , Arytenoid Cartilage/pathology , Contrast Media/administration & dosage , Cricoid Cartilage/diagnostic imaging , Cricoid Cartilage/pathology , Female , Humans , Iohexol/administration & dosage , Iohexol/analogs & derivatives , Laryngeal Cartilages/pathology , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/surgery , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Recurrence, Local/pathology , Retrospective Studies , Sensitivity and Specificity , Thyroid Cartilage/diagnostic imaging , Thyroid Cartilage/pathology
11.
Ann Otol Rhinol Laryngol ; 129(7): 662-668, 2020 Jul.
Article in English | MEDLINE | ID: mdl-32070112

ABSTRACT

OBJECTIVE: Cricoid chondronecrosis is a rare entity that has significant consequences for patients. Reports of its occurrence are scattered in the literature and currently there is no comprehensive review to help guide providers. METHODS: A case report from our institution is presented. A review of available literature is then provided with assessment of risk factors, signs and symptoms at presentation, laryngeal exam findings, radiologic findings, and surgical techniques. RESULTS: Twenty-four cases of cricoid chondronecrosis were reviewed from the literature. Patient age ranged from 8 months to 76 years. A history of endotracheal intubation for various reasons was present in all but two cases, and duration of intubation ranged from 6 hours to 28 days. Patients presented with airway compromise in all but two cases-one asymptomatic patient with prior tracheostomy and another with dysphagia after radiation. Dysphonia (n = 6) and dysphagia (n = 3) were less commonly present. Subglottic stenosis (n = 19) was the most common exam finding followed by vocal fold impairment (n = 11). When CT scan findings were reported, fragmentation of the cartilage and/or hypodensity of the central lamina were described in all but one case. Interventions ranged from observation on antibiotics and steroids to surgical therapies including tracheostomy, dilation, and posterior cricoid split, with or without stent placement. CONCLUSIONS: Cricoid chondronecrosis is a serious, rare entity that can occur even after a short period of endotracheal intubation. Providers must have a high level of suspicion in patients that present with upper airway dyspnea with a history of prior intubation. LEVEL OF EVIDENCE: Level 4.


Subject(s)
Cartilage Diseases/diagnosis , Cricoid Cartilage/diagnostic imaging , Haemophilus Infections/diagnosis , Laryngostenosis/diagnosis , Streptococcal Infections/diagnosis , Tracheostomy , Adult , Alcoholism/complications , Anti-Bacterial Agents/therapeutic use , Cartilage Diseases/complications , Cartilage Diseases/pathology , Cartilage Diseases/therapy , Cricoid Cartilage/pathology , Depression/complications , Dyspnea/etiology , Haemophilus Infections/complications , Haemophilus Infections/therapy , Humans , Intubation, Intratracheal , Laryngoscopy , Laryngostenosis/etiology , Male , Necrosis , Otorhinolaryngologic Surgical Procedures , Respiratory Sounds/etiology , Streptococcal Infections/complications , Streptococcal Infections/therapy , Vocal Cord Paralysis/diagnosis , Vocal Cord Paralysis/etiology
14.
Laryngoscope ; 130(7): 1634-1639, 2020 07.
Article in English | MEDLINE | ID: mdl-31498456

ABSTRACT

OBJECTIVES/HYPOTHESIS: Identify predictors of decannulation failure after cricotracheal resection (CTR) and thyrotracheal anastomosis (TTA) in patients with subglottic stenosis (SGS). STUDY DESIGN: Retrospective cohort study. METHODS: Charts of patients undergoing CTR and TTA for SGS at the University Health Network, Toronto, Ontario, Canada between 1988 and 2017 were reviewed. Patient, pathology, treatment, and outcome data were collected. The end points for statistical analysis were development of restenosis and permanent tracheostomy. RESULTS: One hundred fourteen patients (n = 114) were eligible for inclusion in this review. The mean age at primary resection was 46.9 years, 95 (83%) were females, and 19 (17%) were males. The rate of restenosis and permanent tracheostomy was 13% and 5%, respectively. Sixty-two patients (54%) underwent a CTR and TTA, and 52 patients (46%) underwent a CTR, laryngofissure, and TTA. Traumatic stenosis (odds ratio [OR] = 10.3, P = .017), longer T-tube duration (OR = 1.2, P = .011), combined glottic/subglottic stenosis (OR = 10.47, P = .010), start of the stenosis at the vocal cords (OR = 6.6, P = .029), postoperative minor complications (OR = 13.6, P = .028), and need for repeat surgery (OR = 44.1, P < .001) were associated with an increased risk of requiring permanent tracheostomy. CONCLUSIONS: CTR and TTA are excellent surgical approaches for adult patients with subglottic stenosis. In this study, 5% of patients required permanent tracheostomy. Factors predicting treatment failure include traumatic stenosis, longer T-tube duration, combined glottic/subglottic stenosis, start of stenosis at the level of vocal cords, postoperative minor complications, and need for repeat surgery. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:1634-1639, 2020.


Subject(s)
Cricoid Cartilage/surgery , Laryngectomy/statistics & numerical data , Laryngostenosis/surgery , Tracheal Stenosis/surgery , Tracheostomy/statistics & numerical data , Adult , Anastomosis, Surgical , Catheterization/statistics & numerical data , Cricoid Cartilage/pathology , Female , Glottis/pathology , Humans , Laryngectomy/methods , Laryngostenosis/pathology , Male , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Recurrence , Reoperation/statistics & numerical data , Retrospective Studies , Thyroid Gland/surgery , Time Factors , Trachea/surgery , Tracheal Stenosis/pathology , Tracheostomy/methods , Treatment Failure
15.
Medicine (Baltimore) ; 98(7): e14412, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30762745

ABSTRACT

RATIONALE: posterior pharyngeal wall carcinomas located at the level of the cricoid cartilage is a rare occurrence. Surgical treatment is a dilemma owing to the retention of laryngeal function PATIENT CONCERNS:: A 56-year-old man underwent a "resection of left cervical tumor" at another hospital. Postoperative pathological report noted a left metastatic squamous cell carcinoma of the neck. Neck-enhanced computed tomography (CT) revealed thickening of the right posterior pharyngeal wall, and an image of soft tissue density was present on the posterior pharyngeal wall with a size of approximately 1.0 × 1.5 cm. DIAGNOSIS: Hypopharyngeal carcinoma (T1N2M0). INTERVENTIONS: We performed operation on a patient who suffered from posterior pharyngeal wall carcinomas at the level of the cricoid cartilage. The postoperative defects were repaired with posterior pharyngeal flaps. OUTCOMES: The patient with posterior pharyngeal flap after operation survived without necrosis, the neck wounds of patient healed in 1 stage, and the phonation, swallowing and respiratory function was good. LESSONS: The application of posterior pharyngeal flap to repair defects due to posterior pharyngeal wall carcinomas that were located at the level of the cricoid cartilage after resection is an effective reconstruction method that is easy to use and has excellent repair effects.


Subject(s)
Carcinoma, Squamous Cell/surgery , Cricoid Cartilage/surgery , Hypopharyngeal Neoplasms/surgery , Plastic Surgery Procedures/methods , Surgical Flaps , Carcinoma, Squamous Cell/pathology , Cricoid Cartilage/pathology , Humans , Hypopharyngeal Neoplasms/pathology , Male , Middle Aged , Neck/pathology , Neck/surgery , Pharynx/pathology , Pharynx/surgery
16.
Medicine (Baltimore) ; 98(4): e14199, 2019 Jan.
Article in English | MEDLINE | ID: mdl-30681591

ABSTRACT

RATIONALE: After total or near-total laryngectomy and resection of prelaryngeal skin, laryngeal defects and prelaryngeal skin defects often remain a great challenge for head and neck surgeons when considering simultaneous reconstruction of. In this case report, a free bipaddled anterolateral thigh (ALT) was used for such defects reconstruction. PATIENT CONCERNS: For this 50-year-old male patient whose recurrent tumor invaded the cricoid cartilage and the prelaryngeal skin, supracricoid partial laryngectomy with a cricohyoidepiglottopexy would no longer be an option. However, the patient had a strong requirement of preserving lung-power speech, making total laryngectomy and chemoradiotherapy not acceptable. DIAGNOSIS: Pathologic result demonstrated well-differentiated squamous cell carcinoma. A PET-CT of the whole body showed extralaryngeal extension of the tumor invading the cricoids cartilage and prelaryngeal ribbon muscles and skin. Meanwhile, the video-laryngoscpy showed smooth laryngeal mucosa. INTERVENTIONS: A near-total laryngectomy and resection of prelaryngeal skin were performed. The resultant defects were reconstructed with a free bipaddled ALT flap. OUTCOMES: The patient is 18 months postsurgery with no locoregion tumor recurrence, taking oral feeds, partial lung-power speech and not decannulated. Laryngostenosis was shown by the videolaryngoscopy, MRI and CT scan. LESSONS: A free bipaddled ALT flap could be utilized for simultaneous reconstruction of large larynx and prelaryngeal skin defects, and allows partial laryngeal function preservation in selected local recurrent laryngeal cancer invading the cricoid cartilage and prelaryngeal skin.


Subject(s)
Cricoid Cartilage/surgery , Plastic Surgery Procedures/methods , Skin Transplantation/methods , Surgical Flaps/transplantation , Cricoid Cartilage/pathology , Humans , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/surgery , Larynx/surgery , Male , Middle Aged , Neck/surgery , Skin/pathology , Thigh
17.
Laryngoscope ; 129(11): 2588-2593, 2019 Nov.
Article in English | MEDLINE | ID: mdl-30671968

ABSTRACT

OBJECTIVES: The clinical significance of the interarytenoid mucosal height (IAMH) in pediatric dysphagia, ranging from normal anatomy to a laryngeal cleft, is unknown. This study seeks to evaluate a cohort of patients who underwent evaluation of their IAMH during microdirect laryngoscopy (MDL) for associations between IAMH and dysphagia as diagnosed on preoperative videofluoroscopic swallow study (VFSS). METHODS: A retrospective case series of 1,351 patients who underwent MDL between 2011 and 2016 were reviewed for intraoperative evaluation of IAMH using our interarytenoid assessment protocol. After exclusions, 182 patients were divided into three groups: 1) thickened diet: VFSS with recommendation for thickened liquids (n = 82 of 182; 45.1%), 2) normal diet: VFSS with allowance of thin liquids (n = 19 of 182; 10.4%), and 3) control: no VFSS performed (n = 81 of 182; 44.5%). RESULTS: There was no difference in IAMH between groups (P = 0.35). Power analysis was able to achieve > 80% power to detect an effect size of ≥ 0.5 (1-5 mucosal height scale). The majority of patients in each group had an IAMH above the false vocal folds (thickened diet: 57.3%, normal diet: 57.9%, control: 64.2%). There were similar percentages of patients in each group with an IAMH at or below the true vocal folds (thickened diet: 4.9%, normal diet: 5.3%, control: 6.1%). CONCLUSION: There was no significant association between IAMH and preoperative thickened liquid recommendation in this cohort. This data fails to support the hypothesis that the IAMH is an independent etiological factor for pediatric pharyngeal dysphagia. Further studies comparing IAMH with outcomes after feeding therapy and surgery may better clarify this relationship between anatomy and physiology. LEVEL OF EVIDENCE: 4. Laryngoscope, 129:2588-2593, 2019.


Subject(s)
Cricoid Cartilage/pathology , Deglutition Disorders/etiology , Deglutition Disorders/pathology , Laryngeal Mucosa/pathology , Photofluorography/statistics & numerical data , Body Height , Child , Child, Preschool , Congenital Abnormalities/etiology , Congenital Abnormalities/pathology , Cricoid Cartilage/diagnostic imaging , Deglutition Disorders/diagnostic imaging , Female , Humans , Laryngeal Mucosa/diagnostic imaging , Laryngoscopy/methods , Larynx/abnormalities , Larynx/pathology , Male , Microsurgery/methods , Preoperative Period , Retrospective Studies , Video Recording
18.
Arch Argent Pediatr ; 116(6): 418-425, 2018 12 01.
Article in English, Spanish | MEDLINE | ID: mdl-30457724

ABSTRACT

Subglottic stenosis is a congenital or acquired disease characterized by the narrowing of the airways, from the vocal cords to the lower border of the cricoid cartilage. It is one of the main causes of stridor and respiratory distress in children. More than 90 % of laryngeal stenoses are acquired due to prolonged endotracheal intubation. The pediatric management of subglottic stenosis is complex and may be affected by different factors that have an impact on the final outcome. Treatment may involve endoscopic procedures and/or open surgeries. Here we describe our experience in 35 patients with acquired subglottic stenosis who underwent endoscopic treatment with rigid dilation and identify the potential predictors of success of this technique.


La estenosis subglótica es una enfermedad congènita o adquirida caracterizada por el estrechamiento de la vía aérea desde las cuerdas vocales hasta el borde inferior del cartílago cricoides. Es una de las principales causas de estridor y dificultad respiratoria en los niños. Más del 90 % de las estenosis laríngeas son adquiridas debido a la intubación endotraqueal prolongada. El manejo de la estenosis subglótica en pediatría es complejo y puede ser influenciado por distintos factores que pueden afectar el resultado final. El tratamiento puede involucrar procedimientos endoscópicos y/o cirugías abiertas. Se describe nuestra experiencia con 35 pacientes con estenosis subglótica adquirida tratados endoscópicamente con dilatación rígida y se identifican potenciales factores predictores del éxito de esta técnica.


Subject(s)
Cricoid Cartilage/pathology , Intubation, Intratracheal/adverse effects , Laryngoscopy/methods , Laryngostenosis/therapy , Adolescent , Child , Child, Preschool , Dilatation , Female , Humans , Infant , Laryngostenosis/etiology , Male , Retrospective Studies , Treatment Outcome
19.
Ear Nose Throat J ; 97(8): 244-256, 2018 Aug.
Article in English | MEDLINE | ID: mdl-30138516

ABSTRACT

We conducted a retrospective chart review to compare four characteristics-cricoarytenoid joint ankylosis, narrowing, erosion, and density increases-in patients younger and older than 65 years. Our study population was made up of 100 patients, who were divided into two groups on the basis of age. The younger group (<65 yr) comprised 49 patients (27 men and 22 women), and the older group (≥65 yr) was made up of 51 patients (25 men and 26 women). Findings on computed tomography (CT) of the neck were used to determine whether each of the four characteristics was present or absent. Overall, we found only one statistically significant difference between the two groups: ankylosis was significantly more common in the older group (p = 0.036). When we looked further at the side of these anatomic changes, we found that the older group had significantly more right-sided and left-sided ankylosis than did the younger group (p = 0.026 for both), as well as significantly more left-sided narrowing (p = 0.028) (some patients had bilateral involvement). When we analyzed age as a continuous variable, older age was again associated with significantly more ankylosis (p = 0.047) and narrowing (p = 0.011). We conclude that CT can be useful for assessing radiologic changes in the cricoarytenoid joint in elderly patients during the workup of dysphonia and abnormal movement of the vocal folds.


Subject(s)
Aging/pathology , Cricoid Cartilage , Dysphonia , Age Factors , Aged , Arytenoid Cartilage/diagnostic imaging , Arytenoid Cartilage/pathology , Cricoid Cartilage/diagnostic imaging , Cricoid Cartilage/pathology , Dysphonia/diagnosis , Dysphonia/etiology , Female , Humans , Male , Tomography, X-Ray Computed/methods
20.
Eur Arch Otorhinolaryngol ; 275(7): 1671-1680, 2018 Jul.
Article in English | MEDLINE | ID: mdl-29713885

ABSTRACT

PURPOSE: The objective of the current systematic review with meta-analysis was to report the pooled survival outcomes of supracricoid partial laryngectomy in the setting of radiorecurrent laryngeal cancer to investigate if and when an organ-sparing surgical treatment is adequate. METHODS: The search included all original papers from 1990 to December 2017. The search terms included the following: cricohyoepiglottopexy; cricohyoidopexy; cricohyopexy; horizontal laryngectomy; and partial, subtotal, supracricoid, and supraglottic laryngectomy. Inclusion criteria were as follows: (1) data clearly distinguish results of partial laryngeal procedures; (2) clear description of tumor stage and selection criteria; (3) clear description or derivability of local control and survival rates. RESULTS: Eleven out of 270 papers were analyzed, and a total of 251 cases were included. Two-year LC, 3-year DFS, and 5-year OS were 92, 80, and 79%, respectively. Heterogenicity evaluated with the I2 parameter was 14, 0, 0%, respectively. The larynx preservation rate was 85.2%, the decannulation rate was 92.1%, and swallowing recovery was 96.5% (PEG dependence and the aspiration pneumonia rate were 3.5 and 6.4%, respectively). CONCLUSIONS: SCPL is oncologically sound, guaranteeing a high percentage of success. The homogeneity of data should encourage the use of SCPL as salvage treatment for recurrent LSCC.


Subject(s)
Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/surgery , Laryngectomy , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Cricoid Cartilage/pathology , Cricoid Cartilage/surgery , Humans , Laryngeal Neoplasms/mortality , Neoplasm Recurrence, Local/mortality , Salvage Therapy , Survival Rate , Treatment Outcome
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