Chondrosarcoma of the larynx.

A case of a low grade chondrosarcoma of the cricoid cartilage which had been diagnosed initially as a chondroma is presented. The tumour recurred twice after limited surgical resections. Total laryngectomy was inevitable due to near total involvement of the cricoid cartilage and subsequent histological examination revealed a low grade chondrosarcoma. We have discussed in brief, the diagnosis and treatment of chondrosarcomas of the larynx and support the view of conservative surgical management for low grade tumours as they are slow growing and metastases are infrequent. A total laryngectomy may be reserved for salvage or primarily when more than half of the cricoid cartilage needs to be resected. Histological grading reveals the biological behaviour of the tumour and CT scans help in planning the surgery. A regular follow-up is necessary for early detection of recurrences and metastases.

[Primary bronchogenic and pharyngo-laryngeal carcinomas (author's transl)]. / Cancers bronchiques primitifs et cancers pharyngo-laryngés.

The study of 112 case histories of lung cancers, both primary and secondary, has allowed the authors to determine as being of 5% the incidence of primary bronchogenic carcinoma associated with treated pharyngo-laryngeal cancer. One out of three such primaries was a solitary lung opacity. Bronchogenic primaries appeared be almost as frequent as lung, pleura and mediastine secondarie. They can be diagnosed at any moment of the treatment or follow-up of pharyngo-laryngeal cancer, and appear to occur later than pulmonary metastases. Their symptoms are more "bronchopulmonary" in nature. They are more frequently associated with endolarynx and chorda carcinomas. They are possibly more frequent in cases of smaller primaries without lymph-node involvement. Solitary lung opacities should be considered as independent primaries and constitute the best candidates for efficient pulmonary treatment. Treated pharyngo-laryngeal patients should undergo regularly spaced lung roentgenograms and frequent tracheal sputum cytology.

[Primary pharyngolaryngeal carcinoma, pulmonary metastases and carcinoma of the bronchus (author's transl)]. / Cancers pharyngo-laryngés, métastases pulmonaires et cancers bronchiques primitifs.

On the basis of 112 cases of pulmonary or mediastinal neoplasms observed during the treatment or follow-up of 952 carcinomas of the pharynx and larynx, the authors study in detail 45 cases of metastases. They draw the following conclusions:--metastases present clinically relatively early in the treated course of pharyngolaryngeal carcinomas: 85% before 18 months.--cannonball lesions are the commonest endo-thoracic clinical metastases: 6 out of 10.--carcinomas of the hypopharynx are at the origin of 2/3 of cannonball lesions (alpha less than or equal to 0.02) and 1/4 of mediastinal lymphadenopathies and pleural effusions.--endolaryngeal carcinomas are rarely at the origin of cannonball lesions and are associated almost exclusively with mediastinal lymphadenopathies and pleural effusions (alpha less than 0.001). The influence of the size of the primary tumour, of lymph node involvement, of capsular rupture and of failure to eliminate all malignant cells from the primary lesion are considered and discussed.

[Follow-up surgery for carcinoma of the tonsil (author's transl)]. / La chirurgie de rattrapage dans les épithéliomas de l'amygdale.

This study involves the frequency, techniques and results of follow-up surgery for carcinoma of the tonsil treated by transcutaneous radiotherapy. Local or lymph node failures affect 65% of patients treated by radiation. Follow-up surgery was used in 86% of these failures. After reviewing the various techniques and their oncological results, the authors discuss the best timing for follow-up surgery. They compar their results of surgery in the case of sub-total treatment, surgery for recurrences and routine surgery two months after the end of transcutaneous irradiation. The results are in favour of routine surgery. If it is accepted, since this point is open to discussion, that radiotherapy remains the appropriate initial, and sometimes adequate, treatment for carcinoma of the tonsil, the frequency of local and lymph node recurrences should lead to the indication, in certain cases, for complementary surgical therapy. This routine additional surgical treatment should be discussed in the context of the initial protocol of the treatment of a carcinoma of the tonsil.

[Parapharyngeal nerve tumors (10 recent cases)]. / Tumeurs nerveuses parapharyngées (10 nouveaux cas)

The authors describe ten cases of these rare tumours. They run through rapidly the histological and anatomical classifications. The cases consist of 8 schwannomas (one retropharyngeal schwannoma, two which had developed in the anterior sub-parotid space one of them a malignant schwannoma, the other two were two schwannomas of the sympathetic and three schwannomas of the X). A ganglioneuroma of the sympathetic and a paraganglioma of the X are also described. The authors draw attention to the clinical and anatomopathological distinction between the anterior and posterior sub-parotid spaces; to the need to treat tumours which develop there by surgery; to the different surgical techniques and methods of approach.

[Re-establishment of tracheal continuity by lowering the larynx after tracheal resection]. / Le rétablissement de la continuité trachéale par abaissement du larynx apreès résection trachéale

The authors describe a technique for re-establishing tracheal continuity after anastomotic resection of the cervical and cervico-thoracic trachea. Simply lowering the larynx cervically without an associated thoracic phase enables termino-terminal anastomosis of the trachea to be carried out after resection of more than 5 cm. In this article, the technique and the results obtained in 8 cases of pure tracheal stenosis are described in detail.

[Comparison of long-term carcinologic results between radical and conservative cervical surgery]. / Comparaison des résultats carcinologiques à long terme entre les évidements cervicaux radicaux et conservateurs

The aim of this research was to compare isolated ganglionic development in patients treated surgically for cancer of the larynx. This research included the cases of 232 patients operated on for laryngeal cancer and who underwent either total laryngectomy with or without conservation of the cricoid, or supra-glottal laryngectomy, or sub-glottal pharyngectomy. For the treatment of the ganglionic areas, there are six possibilities: --cobalt used in isolation; --uni- or bi-lateral cellulo-adenectomy; --uni- or bi-lateral curettage (a month apart); --curettage on one side, cellulo-adenectomy on the other. The results obtained were particularly significant as far as the N0 and regrouped N1 were concerned. The rate of ganglionic recurrence was 25 p. 100 for the N0 treated with cobalt and 6,5 p. 100 when surgery was carried out (cellulo-adenectomy or curettage). Also, curettage seems in N + cases to give better results : 26 p. 100 recurrence in cases of cellulo-adenectomy for N0-N1 and 4 p. 100 only in cases of curettage. These results appear to justify on the spot histological examination followed by curettage in N + cases.

[Translaryngeal microsurgical arytenoidectomy]. / Arytenoïdectomie microchirurgicale translaryngée

The authors describe a microsurgical procedure for translaryngeal arytenoidectomy in bilateral vocal cord paralysis and relate their clinical experience. They consider this approach as very valuable in as much as a rather minimal surgical procedure will create a good airway while conserving a satisfactory vocal function.