-
Cancer Imaging : the Official... Oct 2023Accuracy of head and neck MRI (HN-MRI) in predicting tumor invasion of laryngeal site/subsites in patients with laryngeal cancer prior to laryngectomy is poorly...
BACKGROUND
Accuracy of head and neck MRI (HN-MRI) in predicting tumor invasion of laryngeal site/subsites in patients with laryngeal cancer prior to laryngectomy is poorly evaluated in the literature. Therefore, we aim to evaluate the diagnostic value of HN-MRI in accurate pre-operative estimation of tumor invasion to laryngeal subsites in patients with laryngeal cancer.
METHODS
Patients with laryngeal cancer who underwent HN-MRI for cancer staging and underwent total laryngectomy between 2008 and 2021 were included. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of HN-MRI in predicting tumor invasion of laryngeal subsites were calculated based on concordance between the HN-MRI and histopathological results.
RESULTS
One hundred and thirty-seven patients underwent total laryngectomy [primary: 82/137(60%), salvage 55/137(40%)]. The utilization of HN-MRI resulted in the downstaging of 16/137 (11.6%) patients and the upstaging of 8/137 (5.8%) patients. For the whole cohort, there was a significant discordance between HN-MRI and histopathology for T-category; out of 116 cT4a disease, 102(87.9%) were confirmed to have pT4a disease, and out of 17 cT3 disease, 9(52.9%) were confirmed to have pT3 disease, p < 0.001. The MRI overall diagnostic accuracy of predicting tumor invasion was 91%, 92%, 82%, 87%, 72%, 76%, 65% and 68% for base of tongue, arytenoid, vocal cord, posterior commissure, pre-epiglottic space, cricoid cartilage, inner thyroid cortex, and subglottis, respectively.
CONCLUSIONS
In patients with laryngeal cancer undergoing total laryngectomy, HN-MRI demonstrates promising accuracy in predicting tumor invasion of specific laryngeal subsites (e.g., base of tongue). Our findings showed the potential of HN-MRI as a valuable tool for pre-operative planning and treatment decision-making in this patient population.
Topics: Humans; Laryngeal Neoplasms; Neoplasm Invasiveness; Magnetic Resonance Imaging; Neoplasm Staging; Laryngectomy; Retrospective Studies
PubMed: 37858162
DOI: 10.1186/s40644-023-00618-y -
Otolaryngology--head and Neck Surgery :... Jan 2019To characterize the phenotype and function of fibroblasts derived from airway scar in idiopathic subglottic stenosis (iSGS) and to explore scar fibroblast response to... (Comparative Study)
Comparative Study
OBJECTIVE
To characterize the phenotype and function of fibroblasts derived from airway scar in idiopathic subglottic stenosis (iSGS) and to explore scar fibroblast response to interleukin 17A (IL-17A).
STUDY DESIGN
Basic science.
SETTING
Laboratory.
SUBJECTS AND METHODS
Primary fibroblast cell lines from iSGS subjects, idiopathic pulmonary fibrosis subjects, and normal control airways were utilized for analysis. Protein, molecular, and flow cytometric techniques were applied in vitro to assess the phenotype and functional response of disease fibroblasts to IL-17A.
RESULTS
Mechanistically, IL-17A drives iSGS scar fibroblast proliferation ( P < .01), synergizes with transforming growth factor ß1 to promote extracellular matrix production (collagen and fibronectin; P = .04), and directly stimulates scar fibroblasts to produce chemokines (chemokine ligand 2) and cytokines (IL-6 and granulocyte-macrophage colony-stimulating factor) critical to the recruitment and differentiation of myeloid cells ( P < .01). Glucocorticoids abrogated IL-17A-dependent iSGS scar fibroblast production of granulocyte-macrophage colony-stimulating factor ( P = .02).
CONCLUSION
IL-17A directly drives iSGS scar fibroblast proliferation, synergizes with transforming growth factor ß1 to promote extracellular matrix production, and amplifies local inflammatory signaling. Glucocorticoids appear to partially abrogate fibroblast-dependent inflammatory signaling. These results offer mechanistic support for future translational study of clinical reagents for manipulation of the IL-17A pathway in iSGS patients.
Topics: Biopsy, Needle; Case-Control Studies; Cell Proliferation; Cells, Cultured; Cicatrix; Cytokines; Enzyme-Linked Immunosorbent Assay; Female; Fibroblasts; Fibrosis; Flow Cytometry; Humans; Immunohistochemistry; Interleukin-17; Laryngostenosis; Male; Polymerase Chain Reaction; Reference Values; Sensitivity and Specificity; Signal Transduction
PubMed: 30322354
DOI: 10.1177/0194599818803584 -
Ear, Nose, & Throat Journal Mar 2022
PubMed: 35324324
DOI: 10.1177/01455613221086528 -
Ear, Nose, & Throat Journal Jun 2022The hemangioma is the most common vascular tumor, involving the head and neck in 60% of cases. It is rare in the larynx. In children, hemangiomas are more frequent on... (Review)
Review
INTRODUCTION
The hemangioma is the most common vascular tumor, involving the head and neck in 60% of cases. It is rare in the larynx. In children, hemangiomas are more frequent on the subglottis, whereas in adults the most common site is the supraglottis. Laryngeal hemangioma with cavernous features isolated to the free edge of the vocal fold is a very rare clinical finding. We present 2 cases of glottic hemangioma. Both patients reported severe hoarseness.
CASES
In the first patient, an extensive blue-purple mass was seen on the right vocal cord. The patient was posted for microlaryngeal surgery with carbon dioxide (CO) laser. Second patient had a large, smooth, flesh-colored polypoid mass emanating from the left vocal cord. The patient was posted for microlaryngeal surgery. After 2 months, both patients showed a considerable voice improvement.
DISCUSSION
Vocal cord hemangiomas are very rare, and they usually cause problem in the voice of the patient. A vascular lesion that may mimic a hemangioma may sometimes result from an organizing hematoma following a hemorrhage on the vocal cords due to voice abuse. Laryngeal hemangiomas also need to be distinguished pathologically from polypoidal vascular granulation tissue that may be produced by laryngeal biopsy, intubation, or trauma. Indirect endoscopy is enough to diagnosis. No active treatment is advised for adult laryngeal hemangiomas unless the lesions are symptomatic or show a tendency to involve other parts. There is no uniformly accepted treatment of head and neck hemangiomas. Surgical excision with laser CO microlaryngoscopic techniques gives satisfactory results.
Topics: Adult; Carbon Dioxide; Child; Hemangioma; Humans; Laryngeal Neoplasms; Lasers, Gas; Vocal Cords
PubMed: 32921178
DOI: 10.1177/0145561320952191 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Dec 2020To study the anatomical distribution and tumor extent of juvenile laryngeal papilloma(JLP), and to sum up the similarity and difference in distribution between...
To study the anatomical distribution and tumor extent of juvenile laryngeal papilloma(JLP), and to sum up the similarity and difference in distribution between initiatial and recurrent tumor. Data of 65 patients with JLP who were admitted to the Ear Institute, School of Medicine, Shanghai Jiao Tong University from January 2011 to December 2018 were retrospectively analyzed. The RRP tumor assessment method proposed by Derkay et al. was referred to, in which larynx was divided in to 11 anatomical sites. 2.9±1.3 Laryngeal anatomical sites were involved in patients with initial tumor, while that was 3.1±1.5 in patients with recurrent tumor. The most common sites were true vocal fords, anterior commissure and false vocal fords in both group; and the least ones were subglottis, posterior glottis and ary-epiglottic fold. However, subglottis(=0.038) and trachea(=0.007) were more likely to be involved in recurrent tumor, with statistical differences. There were differences in distribution of JLP between initial and recurrent tumor, which might be the result of suitable areas for HPV survival or micro-lesion of residual tumor.
Topics: China; Humans; Laryngeal Neoplasms; Larynx; Papillomavirus Infections; Respiratory Tract Infections; Retrospective Studies
PubMed: 33254341
DOI: 10.13201/j.issn.2096-7993.2020.12.008 -
The Laryngoscope Jan 2017Current imaging modalities lack the necessary resolution to diagnose subglottic stenosis. The aim of this study was to use optical coherence tomography (OCT) to evaluate...
OBJECTIVES/HYPOTHESIS
Current imaging modalities lack the necessary resolution to diagnose subglottic stenosis. The aim of this study was to use optical coherence tomography (OCT) to evaluate nascent subglottic mucosal injury and characterize mucosal thickness and structural changes using texture analysis in a simulated intubation rabbit model.
STUDY DESIGN
Prospective animal study in rabbits.
METHODS
Three-centimeter-long sections of endotracheal tubes (ETT) were endoscopically placed in the subglottis and proximal trachea of New Zealand White rabbits (n = 10) and secured via suture. OCT imaging and conventional endoscopic video was performed just prior to ETT segment placement (day 0), immediately after tube removal (day 7), and 1 week later (day 14). OCT images were analyzed for airway wall thickness and textural properties.
RESULTS
Endoscopy and histology of intubated rabbits showed a range of normal to edematous tissue, which correlated with OCT images. The mean airway mucosal wall thickness measured using OCT was 336.4 μm (day 0), 391.3 μm (day 7), and 420.4 μm (day 14), with significant differences between day 0 and day 14 (P = .002). Significance was found for correlation and homogeneity texture features across all time points (P < .05).
CONCLUSIONS
OCT is a minimally invasive endoscopic imaging modality capable of monitoring progression of subglottic mucosal injury. This study is the first to evaluate mucosal injury during simulated intubation using serial OCT imaging and texture analysis. OCT and texture analysis have the potential for early detection of subglottic mucosal injury, which could lead to better management of the neonatal airway and limit the progression to stenosis.
LEVEL OF EVIDENCE
NA Laryngoscope, 127:64-69, 2017.
Topics: Animals; Disease Models, Animal; Image Interpretation, Computer-Assisted; Intubation, Intratracheal; Laryngoscopy; Laryngostenosis; Prospective Studies; Rabbits; Tomography, Optical Coherence
PubMed: 27559721
DOI: 10.1002/lary.26241 -
BMJ Case Reports Feb 2021Chondrosarcoma of the larynx is rare accounting for approximately 1% of laryngeal cancers; clear cell subtype is a rare variant. Given the low risk of occult nodal...
Chondrosarcoma of the larynx is rare accounting for approximately 1% of laryngeal cancers; clear cell subtype is a rare variant. Given the low risk of occult nodal disease, they present a unique opportunity to maximise tissue preservation in order to optimise both recovery and long-term functional outcomes. We present a case of laryngeal clear cell chondrosarcoma causing critical airway obstruction. An emergency tracheostomy was performed and mapping biopsies were taken. The tumour originated from the cricoid and extended into both arytenoid superstructures precluding cricotracheal resection. A modified narrow-field laryngectomy was performed, preserving all pharyngeal mucosa and neurovascularly intact infrahyoids. Organ preservation surgery is preferred in the management of laryngeal chondrosarcoma. If laryngectomy is required, the surgeon must ensure that all uninvolved, functional tissue is preserved carefully to improve swallow and voice outcomes postoperatively. We describe a novel technique used to achieve this outcome.
Topics: Airway Obstruction; Arytenoid Cartilage; Biopsy; Chondrosarcoma; Cricoid Cartilage; Humans; Laryngeal Neoplasms; Laryngectomy; Magnetic Resonance Imaging; Male; Middle Aged; Tomography, X-Ray Computed; Tracheostomy
PubMed: 33563684
DOI: 10.1136/bcr-2020-236044 -
Ear, Nose, & Throat Journal Sep 2021We aimed to comprehensively investigate different upper airway segments in adults, determine the predictors of the size of each segment, and identify an appropriate...
OBJECTIVES
We aimed to comprehensively investigate different upper airway segments in adults, determine the predictors of the size of each segment, and identify an appropriate endotracheal tube (ETT) size chart.
STUDY DESIGN
Retrospective chart review.
SETTING
Tertiary care center.
MATERIALS AND METHODS
The data for patients aged >18 years who underwent neck computed tomography were screened. Patients with existing tumors, trauma, or any pathology that can alter the normal airway anatomy and those with intubation, tracheostomy, or nasogastric tubes were excluded. Computed tomography software was used to measure the anteroposterior diameter (APD), transverse diameter (TD), and cross-sectional area (CSA) at the glottic, proximal subglottic, distal subglottic, and tracheal levels. Multiple regression analysis was used to identify the predictors of the airway size.
RESULTS
One hundred patients were reviewed. The TD was consistently smaller than or equal to the APD at each level in all but 3 patients. The mean CSA and TD (170 mm and 11.3 mm, respectively) of the glottis indicated that the glottis was most often the narrowest level, followed by the proximal subglottis where the mean CSA and TD were 192.1 mm and 12.7 mm, respectively. Moreover, the mean APD was the smallest at the level of the trachea (20.1 mm). Multiple regression analysis confirmed that height and sex were the predominant predictors of measurements for the 4 airway segments. In addition, age was associated with the TD and CSA of the distal subglottic and tracheal segments, respectively.
CONCLUSION
One-third of our participants exhibited a proximal subglottic diameter that was equal to or smaller than the glottic diameter. Our findings also suggested that the height and sex of the patients are important variables for the selection of an appropriate ETT size.
Topics: Adult; Body Height; Equipment Design; Female; Glottis; Humans; Intubation, Intratracheal; Male; Middle Aged; Multivariate Analysis; Retrospective Studies; Sex Factors; Tomography, X-Ray Computed; Trachea
PubMed: 31914813
DOI: 10.1177/0145561319900390 -
Journal of Visualized Experiments : JoVE Jan 2020Laryngotracheal stenosis (LTS) is a pathologic narrowing of the subglottis and trachea leading to extrathoracic obstruction and significant shortness of breath. LTS...
Laryngotracheal stenosis (LTS) is a pathologic narrowing of the subglottis and trachea leading to extrathoracic obstruction and significant shortness of breath. LTS results from mucosal injury from a foreign body in the trachea, leading to tissue damage and a local inflammatory response that goes awry, leading to the deposition of pathologic scar tissue. Treatment for LTS is surgical due to the lack of effective medical therapies. The purpose of this method is to construct a biocompatible stent that can be miniaturized to place into mice with LTS. We demonstrated that a PLLA-PCL (70% poly-L-lactide and 30% polycaprolactone) construct had optimal biomechanical strength, was biocompatible, practicable for an in vivo placement stent, and capable of eluting drug. This method provides a drug delivery system for testing various immunomodulatory agents to locally inhibit inflammation and reduce airway fibrosis. Manufacturing the stents takes 28-30 h and can be reproduced easily, allowing for experiments with large cohorts. Here we incorporated the drug rapamycin within the stent to test its effectiveness in reducing fibrosis and collagen deposition. Results revealed that PLLA-PCL tents showed reliable rapamycin release, were mechanically stable in physiological conditions, and were biocompatible, inducing little inflammatory response in the trachea. Further, the rapamycin-eluting PLLA-PCL stents reduced scar formation in the trachea in vivo.
Topics: Animals; Drug-Eluting Stents; Mice; Tracheal Stenosis
PubMed: 32065163
DOI: 10.3791/60483 -
Oxford Medical Case Reports May 2022Foreign body aspiration in children, specifically sharp and metallic type, imposes a serious morbidity and mortality risk if intervention is delayed. The bronchoscopic...
Foreign body aspiration in children, specifically sharp and metallic type, imposes a serious morbidity and mortality risk if intervention is delayed. The bronchoscopic removal of sharp metallic foreign bodies is technically challenging for the operating surgeon. We present a case of an 8-year-old girl who presented with an alleged history of aspiration of metallic, sharp and open safety pin 8 hours prior to presentation following which she developed throat pain and painful swallowing. X-ray of soft tissue neck showed a radio-opaque foreign body being lodged in the supraglottic area. She underwent emergency direct laryngoscopy-guided foreign body removal under general anesthesia. There was an open metallic sharp safety pin hinged over the inter-arytenoid region with its one end reaching sub-glottis and other end toward the hypopharynx. No post-operative complications occurred and patient was discharged on the third post-operative day.
PubMed: 35619679
DOI: 10.1093/omcr/omac044