Dysphagia in Open Partial Horizontal Laryngectomy Type IIa: Quantitative Analysis of Videofluoroscopy using the ASPEKT Method.

Open Partial Horizontal Laryngectomy (OPHL) Type IIa surgery is a conservative surgical technique used in the treatment of laryngeal carcinomas. In this pilot study, we aimed to characterize swallowing function and physiology in a series of patients after OPHL Type IIa surgery through comparison to healthy reference values for quantitative measures for videofluoroscopy. We performed retrospective quantitative analysis of videofluoroscopy recordings of thin liquid swallows for a preliminary sample of 10 male patients. Each videofluoroscopy clip was rated in triplicate by trained blinded raters according to the ASPEKT Method (Analysis of Swallowing Physiology: Events, Kinematics and Timing). This preliminary sample of patients with previous OPHL surgery showed functional airway protection, with only 2 patients showing incomplete laryngeal vestibule closure (LVC) and associated airway invasion. However, the majority of patients (90%) showed prolonged latencies to LVC and upper esophageal sphincter (UES) opening. Prolonged durations of LVC and UES opening were also noted, but these were in the direction of compensation rather than impairment. Reduced pharyngeal area at rest was seen in 70% of the sample, and all patients showed poor pharyngeal constriction. Post-swallow residue was a prominent finding in ≥ 75% of these patients. In particular, reduced or absent constriction of the hypopharynx in the region of the pyriform sinuses was noted as a characteristic of swallowing in this sample. The data from these patients suggest that despite functional airway protection, severe swallowing dysfunction involving poor pharyngeal constriction and bolus clearance may be likely after OPHL surgery.

Cirugía transoral en cáncer de laringe estadificado T1-T2 / Transoral surgery in T1-T2 staged laryngeal cancer

Se realizó un estudio prospectivo y descriptivo, incluyendo 103 pacientes que fueron tratados por cáncer de laringe en etapa inicial (T1-T2) con cirugía transoral. De ellos, 55 se diagnosticaron en estadio T1, 16 en estadio T1-b y 32 en estadio T2. El control local inicial (CLI) en pacientes con tumores malignos de laringe estadificados T1 fue 91%, el control local con rescate (CLR) 96%, la preservación de la función de la laringe (PFL) 93% y la sobrevida específica 96%. En T1-b, el CLI fue 81%, el CLR 94%, la PFL 94% y la sobrevida específica 94%. En T2, el CLI fue 63%, el CLR 94%, la PFL 72% y la sobrevida específica 78%. La cirugía transoral en cáncer de laringe con T inicial tiene resultados oncológicos similares a otros tratamientos (cirugía externa o radioterapia), pero consideramos que es la mejor opción por su baja morbilidad, menor duración del tratamiento, y porque deja abiertas todas las posibilidades para tratar posibles recurrencias. (AU)

A prospective and descriptive study was conducted, including 103 patients who were treated for early stage laryngeal cancer (T1-T2) with transoral surgery. Of these, 55 were diagnosed in stage T1, 16 in stage T1-b and 32 in stage T2. The initial local control (CLI) in patients with malignant T1 laryngeal tumors was: 91%, local control with rescue (CLR) 96%, preservation of larynx function (PFL) 93% and specific survival 96%. In T1-b the CLI was 81%, the CLR 94%, the PFL 94% and the specific survival 94%. In T2 the CLI was 63%, the CLR 94%, the PFL 72% and the specific survival 78%. Transoral surgery in laryngeal cancer with initial T has oncological results similar to other treatments (external surgery or radiotherapy), but we consider that it is the best option because of its low morbidity, shorter duration of treatment, and because it leaves open all the possibilities to treat possible recurrences. (AU)

Comparison of long-term functional results between standard supracricoid laryngectomy and modified technique with sternohyoid muscle / Comparação de resultados funcionais a longo prazo entre laringectomia padrão supracricoide e técnica modificada com músculo esterno-hióideo

Abstract Introduction: Laryngeal cancer is the most common cancer of the upper respiratory tract. The main methods of treatment included surgery (partial laryngectomy and total laryngectomy) and radiation therapy. Laryngeal dysfunction is seen after both treatment modalities. Objective: The aim of the study is to compare postoperative functional results of the standard supracricoid partial laryngectomy technique and a modified supracricoid partial laryngectomy technique using the sternohyoid muscle. Methods: In total, 29 male patients (average years 58.20 ± 9.00 years; range 41-79 years) with laryngeal squamous cell carcinoma who underwent supra cricoid partial laryngectomy were included. The patients were divided into two groups in terms of the surgical techniques. In Group A, all patients underwent standard supracricoid partial laryngectomy technique between January 2007 and November 2011. In Group B, all patients underwent modified supracricoid partial laryngectomy between August 2010 and November 2011. Fiberoptic endoscopic evaluation of swallowing test, short version of the voice handicap index scores, and the MD Anderson dysphagia inventory, the time of oral feeding and the decanulation of the patients after surgery of each groups were compared. Results: The mean maximum phonation time was 8.68 ± 4.21 s in Group A and 15.24 ± 6.16 s in Group B (p > 0.05). The S/Z (s/s) ratio was 1.23 ± 0.35 in Group A and 1.08 ± 0.26 in Group B (p > 0.05); the voice handicap index averages were 9.86 ± 4.77 in Group A and 12.42 ± 12.54 in Group B (p > 0.05); the fiberoptic endoscopic evaluation of swallowing test averages were calculated as 12.73 ± 3.08 in Group A and 13.64 ± 1.49 in Group B (p > 0.05). In the MD Anderson dysphagia inventory, evaluation of swallowing, the emotional, physical, and functional scores were 29.21 ± 4.11, 32.21 ± 6.85, and 20.14 ± 2.17 in the Group B, and 29.20 ± 2.54, 32.4 ± 4.79, and 19 ± 1.92 in Group A, respectively. Conclusion: Although there is no statistical difference in functional outcome comparisons, if rules are adhered to in preoperative patient selection, modified supracricoid partial laryngectomy can be applied safely and meaningful gains can be achieved in functional outcomes.

Resumo Introdução: O câncer laríngeo é o câncer mais comum do trato respiratório superior. Os principais métodos de tratamento incluem cirurgia (laringectomia parcial e laringectomia total) e radioterapia. A disfunção laríngea é observada em ambas as modalidades de tratamento. Objetivos: Comparar os resultados funcionais pós-operatórios da técnica de laringectomia padrão supracricoide e a técnica de laringectomia supracricoide modificada com o uso do músculo esterno-hióideo. Método: Foram incluídos 29 pacientes do sexo masculino (média de 58,20 ± 9,00 anos, intervalo de 41 a 79) com carcinoma espinocelular de laringe submetidos à laringectomia supracricoide parcial. Os pacientes foram divididos em dois grupos em termos de técnicas cirúrgicas. Todos os pacientes do Grupo A foram submetidos à laringectomia padrão supracricoide entre janeiro de 2007 e novembro de 2011. No Grupo B, todos os pacientes foram submetidos à laringectomia supracricoide modificada entre agosto de 2010 e novembro de 2011. A avaliação endoscópica da deglutição por fibra ótica, os escores da versão curta do Voice Handicap Index e do MD Anderson Dysphagia Inventory, o tempo de alimentação oral e a decanulação dos pacientes foram comparados após a cirurgia em cada grupo. Resultados: A média do tempo máximo de fonação foi de 8,68 ± 4,21 segundos no Grupo A e 15,24 ± 6,16 segundos no Grupo B (p > 0,05). A razão S/Z (seg/seg) foi de 1,23 ± 0,35 no Grupo A e 1,08 ± 0,26 no Grupo B (p > 0,05); as médias do Voice Handicap Index foram 9,86 ± 4,77 no Grupo A e 12,42 ± 12,54 no Grupo B (p > 0,05); as médias da avaliação endoscópica da deglutição por fibra ótica foram calculadas como 12,73 ± 3,08 no Grupo A e 13,64 ± 1,49 no Grupo B (p > 0,05). Na avaliação da deglutição pelo MD Anderson Dysphagia Inventory, os escores emocional, físico e funcional foram 29,21 ± 4,11, 32,21 ± 6,85 e 20,14 ± 2,17 no Grupo B e 29,20 ± 2,54, 32,4 ± 4,79 e 19 ± 1,92 no Grupo A, respectivamente. Conclusão: Embora não haja diferença estatística nas comparações de resultados funcionais, se as regras forem respeitadas na seleção pré-operatória do paciente, a laringectomia supracricoide parcial modificada pode ser aplicada com segurança e ganhos significativos podem ser alcançados em termos de resultados funcionais.

Comparison of long-term functional results between standard supracricoid laryngectomy and modified technique with sternohyoid muscle.

INTRODUCTION: Laryngeal cancer is the most common cancer of the upper respiratory tract. The main methods of treatment included surgery (partial laryngectomy and total laryngectomy) and radiation therapy. Laryngeal dysfunction is seen after both treatment modalities. OBJECTIVE: The aim of the study is to compare postoperative functional results of the standard supracricoid partial laryngectomy technique and a modified supracricoid partial laryngectomy technique using the sternohyoid muscle. METHODS: In total, 29 male patients (average years 58.20±9.00 years; range 41-79 years) with laryngeal squamous cell carcinoma who underwent supra cricoid partial laryngectomy were included. The patients were divided into two groups in terms of the surgical techniques. In Group A, all patients underwent standard supracricoid partial laryngectomy technique between January 2007 and November 2011. In Group B, all patients underwent modified supracricoid partial laryngectomy between August 2010 and November 2011. Fiberoptic endoscopic evaluation of swallowing test, short version of the voice handicap index scores, and the MD Anderson dysphagia inventory, the time of oral feeding and the decanulation of the patients after surgery of each groups were compared. RESULTS: The mean maximum phonation time was 8.68±4.21s in Group A and 15.24±6.16s in Group B (p>0.05). The S/Z (s/s) ratio was 1.23±0.35 in Group A and 1.08±0.26 in Group B (p>0.05); the voice handicap index averages were 9.86±4.77 in Group A and 12.42±12.54 in Group B (p>0.05); the fiberoptic endoscopic evaluation of swallowing test averages were calculated as 12.73±3.08 in Group A and 13.64±1.49 in Group B (p>0.05). In the MD Anderson dysphagia inventory, evaluation of swallowing, the emotional, physical, and functional scores were 29.21±4.11, 32.21±6.85, and 20.14±2.17 in the Group B, and 29.20±2.54, 32.4±4.79, and 19±1.92 in Group A, respectively. CONCLUSION: Although there is no statistical difference in functional outcome comparisons, if rules are adhered to in preoperative patient selection, modified supracricoid partial laryngectomy can be applied safely and meaningful gains can be achieved in functional outcomes.

Papilomatosis laríngea: una causa poco frecuente de disfonía en el niño. Serie de casos / Laryngeal papillomatosis: A rare cause of dysphonia in the child. Case series

La papilomatosis laríngea juvenil es una enfermedad infrecuente causada por el virus del papiloma humano, principalmente, los tipos 6 y 11. Es el tumor laríngeo benigno más común en los niños. Debe pensarse, en esta patología, en todo niño con disfonía persistente y progresiva, acompañada o no de estridor y dificultad respiratoria. La laringoscopía flexible con anestesia local permite visualizar las típicas lesiones de características verrugosas. El diagnóstico se confirma mediante la anatomía patológica. El tratamiento existente es paliativo y consiste, principalmente, en la escisión quirúrgica de los papilomas para mantener la vía aérea sin obstrucción y mejorar la calidad de la voz, pero tiene una alta tasa de recidiva. Se presentan 20 pacientes con papilomatosis laríngea juvenil. Se describen las manifestaciones clínicas, el diagnóstico y el tratamiento de esta patología.

Juvenile laryngeal papillomatosis is an uncommon disease caused by human papilloma virus, mainly types 6 and 11. It is the most common benign laryngeal tumor in children. This condition should be suspected in any children with persistent and progressive dysphonia with or without stridor and respiratory distress. Flexible laryngoscopy under local anesthesia allows to visualize the typical wart-like lesions. The diagnosis is confirmed by pathological anatomy. Existing treatment is palliative and consists mainly of the surgical excision of the papillomas to maintain the airway without obstruction and to improve the quality of the voice, but it has a high rate of relapse. We present 20 patients with juvenile laryngeal papillomatosis. We describe the clinical manifestations, the diagnostic methods and the treatment of this pathology.

[Laryngeal papillomatosis: A rare cause of dysphonia in the child. Case series]. / Papilomatosis laríngea: una causa poco frecuente de disfonía en el niño. Serie de casos.

Juvenile laryngeal papillomatosis is an uncommon disease caused by human papilloma virus, mainly types 6 and 11. It is the most common benign laryngeal tumor in children. This condition should be suspected in any children with persistent and progressive dysphonia with or without stridor and respiratory distress. Flexible laryngoscopy under local anesthesia allows to visualize the typical wart-like lesions. The diagnosis is confirmed by pathological anatomy. Existing treatment is palliative and consists mainly of the surgical excision of the papillomas to maintain the airway without obstruction and to improve the quality of the voice, but it has a high rate of relapse. We present 20 patients with juvenile laryngeal papillomatosis. We describe the clinical manifestations, the diagnostic methods and the treatment of this pathology.

La papilomatosis laríngea juvenil es una enfermedad infrecuente causada por el virus del papiloma humano, principalmente, los tipos 6 y 11. Es el tumor laríngeo benigno más común en los niños. Debe pensarse, en esta patología, en todo niño con disfonía persistente y progresiva, acompañada o no de estridor y dificultad respiratoria. La laringoscopía flexible con anestesia local permite visualizar las típicas lesiones de características verrugosas. El diagnóstico se confirma mediante la anatomía patológica. El tratamiento existente es paliativo y consiste, principalmente, en la escisión quirúrgica de los papilomas para mantener la vía aérea sin obstrucción y mejorar la calidad de la voz, pero tiene una alta tasa de recidiva. Se presentan 20 pacientes con papilomatosis laríngea juvenil. Se describen las manifestaciones clínicas, el diagnóstico y el tratamiento de esta patología.

Perceptual and acoustic parameters of vocal nodules in children.

UNLABELLED: Vocal nodules constitute the major cause of dysphonia during childhood. Auditory-perceptual and acoustic vocal analyses have been used to differentiate vocal nodules from normal voice in children. PURPOSE: To study the value of auditory-perceptual and acoustic vocal analyses in assessments of children with nodules. DESIGN: Diagnostic test study. PATIENTS AND INTERVENTIONS: A comparative study was carried out including 100 children with videolaryngoscopic diagnosis of vocal nodules (nodule group-NG); and 100 children without vocal symptoms and with normal videolaryngoscopic exams (control group-CG). The age range of both groups was between 4 and 11 years. All children underwent auditory-perceptual vocal analyses (GRBASI scale); maximum phonation time and s/z ratio were calculated, and acoustic vocal analysis (MDVP software) were carried out. RESULTS: There was no difference in the values of maximum phonation time and s/z ratio between groups. Auditory-perceptual analysis indicated greater compromising of voice parameters for NG, compared to CG: G (79 versus 24), R (53 versus 3), B (67 versus 23) and S (35 versus 1). The values of acoustic parameters jitter, PPQ, shimmer, APQ, NHR and SPI were higher for NG for CG. The parameter f0 did not differ between groups. CONCLUSION: Compromising of auditory-perceptual (G, R, B and S) and acoustic vocal parameters (jitter, PPQ, shimmer, APQ, NHR and SPI) was greater for children with nodules than for those of the control group, which makes them important methods for assessing child dysphonia.

Immunohistochemical expression of cyclooxygenase-2 in patients with advanced cancer of the larynx who have undergone induction chemotherapy with the intention of preserving phonation.

INTRODUCTION: Cyclooxygenase-2 (COX2) is an enzyme that plays a role in different stages of the carcinogenic process and has prognostic and predictive values that have not yet been established. The objective of this study was to evaluate the role of COX2 overexpression in advanced squamous cell carcinoma of the larynx that has been treated with a phonation conservation protocol. MATERIALS AND METHODS: This study included a retrospective analysis of 59 patients with resectable tumours that were treated with chemotherapy (CT) and/or radiation therapy (RT). The expression levels of COX2, epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), and vascular endothelial growth factor receptor (VEGFR-2) in collected biopsy specimens were determined via immunohistochemistry. RESULTS: Forty-four percent of the included samples demonstrated overexpression of COX2. In the statistical analysis, COX2 overexpression did not correlate with other clinical or treatment efficacy prognostic factors; however, the median global survival (OS) of patients whose tumours expressed COX2 was 79 months, whereas COX2-negative patients had a median OS of only 38 months, although this finding did not reach statistical significance. The other analysed biological parameters did not demonstrate a significant relationship with COX2. CONCLUSIONS: COX2 overexpression was a common finding in our study. The results obtained did not reveal relationships with established prognostic categories; however, the difference in survival between patients with and without COX2 expression justifies the need for future prospective studies that utilise a larger patient sample size.

Structures constituting the sound source after the treatment of early glottic cancer.

INTRODUCTION: We indicate the exclusive radiation therapy as initial approach for T1a glottic tumors, and the frontolateral laryngectomy for the tumors staged as T1b and selected T2 glottic tumors. The videolaryngostroboscopy is a useful tool to analyze the laryngeal structural changes and compensatory motion after the therapeutic approach. OBJECTIVES: To evaluate the endolaryngeal structures of patients who participate in the vibratory sound source after the early glottic cancer treatment through the videolaryngostroboscopy. METHODS: It was a retrospective transversal study in which 20 patients who underwent exclusive radiation therapy and 25 patients who underwent frontolateral laryngectomy were analyzed by means of videolaryngostroboscopy. The radiation doses ranged from 5000 to 7020 cGy in the radiation therapy group. The mucosal wave and the vibratory source components were evaluated. RESULTS: All of the irradiated patients presented vibratory behavior, and hyperfunction was occasionally observed in four cases. The mucosal wave source was glottic in 18 cases and mixed in two cases. In the laryngectomy group, 10 supraglottic sources, 10 glottic sources, and five mixed sources were identified. Among the 10 cases of supraglottic source, eight patients presented global constriction and two patients presented medial constriction. Among the five cases of mixed source, two patients presented global constriction, one patient presented medial constriction, and one patient presented anteroposterior constriction. Regarding the number of anatomical structures presenting vibratory pattern, five patients had two structures, four patients had three structures, and one patient had four structures. CONCLUSION: Patients who underwent radiation therapy recruit less supraglottic structures as vibratory source than the patients undergoing vertical laryngectomy.

Evaluación de la deglución en pacientes con cáncer precoz de laringe tratados con cirugía o radioterapia / Swallowing assessment in early laryngeal cancer patients treated either with surgery or radiotherapy

Introducción: La deglución es un proceso neuromuscular complejo, que requiere de indemnidad anatómica y de una adecuada coordinación de varios órganos. El tratamiento del cáncer laríngeo puede ocasionar trastornos de la deglución. Tradicionalmente se ha reportado una mayor frecuencia de esta alteración con los tratamientos quirúrgicos, sin embargo no existe información adecuada sobre su incidencia en pacientes sometidos a radioterapia por cáncer laríngeo precoz. Objetivo: Comparar la frecuencia de alteraciones de deglución postratamiento en cáncer laríngeo precoz Material y método: El presente es un estudio transversal de dos grupos de pacientes con cáncer laríngeo precoz, unos tratados con cirugía parcial vertical (CP) y otros con radioterapia exclusiva (RT). A cada paciente se le realizó una evaluación otorrinolaringológica, nasofibroscópica y videofluoroscópica postratamiento. Las diferencias entre los grupos se compararon utilizando el test Xi cuadrado. Resultados: Ingresaron veinte pacientes por grupo, la mayoría de género masculino y de edades similares. Ambos grupos presentan una alta incidencia de síntomas aspirativos (55% en RT y 35% en CP) y alteraciones en nasofibroscopía y videofluoroscopía (35% en RTy 30% en CP). No hubo diferencias significativas entre ambos grupos. Discusión y conclusiones: Se demuestra una elevada incidencia de trastorno de la deglución en pacientes tratados por cáncer precoz de laringe, debiendo considerarse como una alteración frecuente en este grupo de pacientes, ya hayan sido tratados con RT o CP.

Introduction. Swallowing is a complex neuromuscular process that requires anatomical indemnity and an adequate coordination of several organs. Laryngeal cancer treatment may cause swallowing disorders. Traditionally, a high frequency of this type of disorder after surgery has been reponed, but no actual data concerning its incidence in patients undergoing radiotherapy for early laryngeal cancer has been published. Aim. To compare swallowing disorders frequency posterior to treatment in early laryngeal cancer patients. Material and Method. Two groups of early laryngeal cancer patients were transversally studied, one treated with vertical partial surgery (CP), and the other treated exclusively with radiotherapy. Each patient had otorhinolaryngological, nasofibroscopic and videofluoroscopic evaluations after treatment. Differences between groups were compared using the _-square test. Results. Twenty patients per group were entered in this study predominantly males of similar age. Both groups presented a high incidence of aspiration symptoms (55% in RT and 35% in CP). There were no significant differences between both groups. Discussion and Conclusion. A high incidence of swallowing disorders in patients treated for early laryngeal cancer was found. It should then be considered as a frequent alteration in this group of patients, either treated with RT or CP.

Tumores de cabeza y cuello / Head and neck tumors

Los tumores de cabeza y cuello corresponden a un heterogéneo grupo de enfermedades, destacando entre ellas el carcinoma epidermoide de laringe, faringe y cavidad oral, así como las neoplasias glandulares (tiroides y glándulas salivales). Constituyen una patología altamente desafiante, considerando la complejidad anatómica de la región cérvico-facial y las repercusiones funcionales y estéticas que pueden producir tanto la enfermedad como su tratamiento. Estos tumores se manifiestan clínicamente como masas palpables o por la producción de síntomas persistentes en la vía aéreo-digestiva superior. La imagenología y los estudios endoscópicos complementan la evaluación del paciente; la histopatología es esencial para determinar el diagnóstico definitivo. El manejo de los tumores de cabeza y cuello debe estar a cargo de equipos multidisciplinarios, siendo la cirugía y la radioterapia los pilares del tratamiento. El pronóstico de esta enfermedad está determinado, principalmente, por el tipo histológico y el estadio tumoral.

[Swallowing after chemotherapy and radiotherapy for laryngeal and hypopharyngeal carcinomas]. / Deglutição após quimioterapia e radioterapia simultânea para carcinomas de laringe e hipofaringe.

UNLABELLED: The main goals of the larynx preservation protocol are eradication of cancer and preservation of a functional larynx with maintenance of respiration, phonation and swallowing. Few studies, however have addressed functional outcomes. OBJECTIVE: Functional evaluation of oropharyngeal swallowing in patients enrolled in a larynx preservation protocol at the Hospital do Câncer AC Camargo. METHODS: Evaluation of swallowing was performed by videofluoroscopy in 31 patients, focusing on: oropharyngeal motility disorders, stasis, laryngeal penetration, aspiration and severity of dysphagia. RESULTS: Swallowing analysis: 5 patients showed inefficient bolus preparation, 14 had changes in the bolus propulsion; 23 patients had a reduced laryngeal elevation, 26 presented with stasis in the vallecula and 14 with stasis in hypopharynx. Nine patients presented silent aspiration. We detected functional swallowing in 11 patients; mild dysphagia in 7; mild/moderate in 7; moderate in 3 and severe dysphagia in 3. CONCLUSION: Larynx preservation results in changes of swallowing, ranging in their majority from discrete to moderate. Some patients, however, developed severe dysphagia, and oral feeding was not possible.

Deglutição após quimioterapia e radioterapia simultânea para carcinomas de laringe e hipofaringe / Swallowing after chemotherapy and radiotherapy for laryngeal and hypopharyngeal carcinomas

OBJETIVO: Avaliar a deglutição orofaríngea de pacientes submetidos a protocolo de preservação de laringe no Hospital do Câncer AC Camargo. MÉTODOS: De 43 pacientes com carcinoma epidermóide de laringe e hipofaringe tratados com quimioterapia semanal (paclitaxel 30 mg/m² e cisplatina 20 mg/m²) concomitante à radioterapia externa fracionada (180 cGy/dia, dose total 7040 cGy), foram avaliados 31 pacientes. A avaliação consistiu de videofluoroscopia. Os resultados foram classificados de acordo com alterações de motilidade orofaríngea, estases, aspiração e severidade da disfagia. RESULTADOS: alterações de fase preparatória e oral: estase em cavidade oral (58 por cento) e aumento do tempo de trânsito oral (32,3 por cento); fase faríngea: estase em valécula (83,9 por cento), redução da elevação laríngea (74,2 por cento), atraso no início da deglutição faríngea (51,6 por cento) e estase em hipofaringe (45,2 por cento). A deglutição funcional foi observada em 35,5 por cento dos pacientes, 54,8 por cento tinham disfagias discretas ou moderadas e 9,6 por cento disfagias severas. CONCLUSÃO: A associação de quimioterapia e radioterapia para preservação laríngea resulta em alterações da deglutição, na maior parte discretas a moderadas. Alguns pacientes, entretanto, evoluem com disfagia severa, em que a alimentação por via oral não é possível.

Voice and swallowing in patients enrolled in a larynx preservation trial.

BACKGROUND: The main goals of larynx preservation protocols are preservation of a functional larynx with intact voice and maintenance of normal deglutition. However, few studies have addressed functional outcomes. OBJECTIVES: To evaluate voice and swallowing in patients enrolled in a larynx preservation protocol. DESIGN AND SETTING: Acoustic analysis of 15 patients and videofluoroscopic evaluation of 14 patients who underwent chemoradiotherapy in an attempt to preserve the larynx. PATIENTS: Forty-three patients with larynx or hypopharynx squamous cell carcinomas were treated with weekly paclitaxel (30 mg/m2) and cisplatin (20 mg/m2) concurrent to radiotherapy (180-rad/d fraction [1.8 Gy] to 7040 rad [70.4 Gy]). Voice was analyzed perceptually and acoustically in 15 patients. Videofluoroscopic evaluation of swallowing was performed in 14 patients, focusing on oropharyngeal motility disorders, stasis, laryngeal penetration, aspiration, and dysphagia severity. RESULTS: Vocal analysis produced normal results in 1 patient, mild dysphonia in 4, moderate dysphonia in 6, and severe dysphonia in 4. The mean fundamental frequency for acoustic analysis was 131.4 Hz for men and 109.8 Hz for women. Acoustic measures of perturbation and noise were above the reference limits, indicating changes in the voice signal. Swallowing analysis showed inefficient bolus preparation in 13 patients and changes in the bolus propulsion in 12. Stasis was observed in all areas of the oropharynx. Five patients had reduction in laryngeal elevation, and 12 had stasis in the hypopharynx. Five patients presented with silent aspiration. We detected functional swallowing in 3 patients, mild dysphagia in 7, mild or moderate dysphagia in 2, and severe dysphagia in 2. CONCLUSIONS: Laryngeal preservation resulted in voice and swallowing abnormalities, but they tend to be mild to moderate, allowing intelligible communication and efficient swallowing in most patients.

Tumor de células granulares maligno de laringe: informe de un caso y revisión de la literatura / Granular cell neoplasm of the larynx: a case report and literature review

El tumor de células granulares es usualmente benigno que se origina en diferentes sitios anatómicos como son piel, tejido celular subcutáneo y partes blandas del cuerpo. Se ha discutido mucho acerca del origen embriológico y se ha comentado que podría ser muscular; sin embargo, los estudios actuales inclinan la balanza a que el origen celular del tumor de células granulares es neural, lo cual, desde el punto de vista histológico, ha generado confusión con otras neoplasias. El margen de edad en la que se presenta es muy amplio, desde algunos meses de vida hasta la ancianidad. Se han formulado criterios histológicos que ayudan a diferenciar los tumores de células granulares en tres tipos, benigno, atípico y maligno. Esta división es de acuerdo a seis parámetros: necrosis, células tumorales alargadas, núcleo vesicular con gran nucléolo, aumento en el número de mitosis(más de dos por campo de alto poder), radio núcleo citoplasma aumentado, pleomorfismo. Otro aspecto que ayuda a determinar la malignidad de un tumor de células granulares es la presencia o no de metástasis. Se han hecho estudios de inmunohistoquímica para ayudar a diferenciar el estado patológico de estos tumores. La medición de P53, Ki67 y su positividad indica la presencia de tumores más agresivos. La citometría de flujo, midiendo la ploidía celular puede también ayudar a orientar la conducta de estos tumores, aunque no es 100 por ciento seguro. El tumor de células granulares se puede confundir con otras neoplasias que también tienen células granulares como son algunos sarcomas de partes blandas; sin embargo, el principal diagnóstico diferencial es con melanoma maligno y con tumor de la vaina nerviosa periférico maligno, ya que éstos tienen origen neural. Aquí el uso de inmunohistoquímica es esencial para el diagnóstico diferencial. El tumor de células granulares malignas es una neoplasia sumamente rara, sólo han sido publicados 43 casos en todo el mundo. Es aún más rara la presencia de tumores de células granulares malignas de localización laríngea, ya que únicamente existe registrado un caso, publicado en 1958. En este artículo nosotros reportamos el segundo tumor maligno de células granulares de localización laríngea consignado en la literatura mundial, en una mujer de 50 años oriunda de Panamá. El tratamiento de estos tumores es quirúrgico con base en una excisión amplia con márgenes libres dependiendo de su localización. La quimioterapia y radioterapia no juegan ningún papel hasta la fecha

Survival and functional results of Pearson's near-total laryngectomy for larynx and pyriform sinus carcinoma.

BACKGROUND: Current treatment for most T3 and T4 transglottic and pyriform sinus carcinomas is total laryngectomy or total laryngectomy with partial pharyngectomy. Voice rehabilitation usually requires the use of a tracheoesophageal puncture (TEP). Pearson's near-total laryngectomy (NTL) is an option for voice preservation in selected cases with no invasion of the interarythenoid space and limited invasion of the subglottis. The purpose of this study is to report the functional and survival results of 42 consecutive patients who underwent NTL from 1988 to 1995. Patients and Methods The patients were 40 men and two women, with a median age of 58 years. All patients had squamous cell carcinoma. There were 37 larynx and five pyriform sinus tumors. T3 stage tumor represented 85.7% of the cases. RESULTS: There were complications in 13 patients (28.9%). Vocal quality was considered good in 83.3% of the cases. To date, eight patients presented tumor recurrences: two local, two in the neck, and four distant. The 5-year actuarial overall survival rates were of 81.7% in larynx carcinoma and 66.6% in pyriform sinus carcinoma. CONCLUSIONS: In selected transglottic and pyriform sinus carcinomas, NTL can be carried out with acceptable morbidity and a high potential of voice preservation and tumor control.

Cancer of the larynx: correlation of clinical characteristics, site of origin, stage, histology and diagnostic delay.

The authors studied the records of 108 cases of cancer of the larynx registered at the Department of Otolaryngology--Clinics Hospital--Faculty of Medicine of University of São Paulo, from 1985 to 1995. Dysphonia was the most common symptom observed (85.2%), independently of the site of the tumor. Dysphagia, dyspnea and weight loss had a similar incidence (32.4%; 34.3%; and 29.6%, respectively), with dysphagia more frequent in tumors which affected the supraglottis and dyspnea in glottic and subglottic tumors. As to staging, 45.8% presented at stage IV at the first consultation, and only 13.5% at stage I. No association was observed between tumor size (according to the TNM classification), presence of lymph node involvement, and delay, in diagnosis, taking the period between the beginning of symptoms and the first consultation at the hospital. In relation to the presenting symptom those with dysphonia sought medical help later. There was no correlation between histological invasion and tumor stage. It was concluded that the stage at presentation of tumors of the larynx is possibly more related to intrinsic differences in the tumor's aggressiveness and in host characteristics than to the diagnostic delay, and that it is necessary to warn the population about symptoms which may suggest the presence of cancer of the larynx.