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Experimental and Computational... 2023Laryngotracheal stenosis (LTS) is a type of airway narrowing that is frequently caused by intubation-related trauma. LTS can occur at one or multiple locations in the...
Laryngotracheal stenosis (LTS) is a type of airway narrowing that is frequently caused by intubation-related trauma. LTS can occur at one or multiple locations in the larynx and/or trachea. This study characterizes airflow dynamics and drug delivery in patients with multilevel stenosis. Two subjects with multilevel stenosis (S1 = glottis + trachea, S2 = glottis + subglottis) and one normal subject were retrospectively selected. Computed tomography scans were used to create subject-specific upper airway models. Computational fluid dynamics modeling was used to simulate airflow at inhalation pressures of 10, 25, and 40 Pa, and orally inhaled drug transport with particle velocities of 1, 5, and 10 m/s, and particle size range of 100 nm-40 µm. Subjects had increased airflow velocity and resistance at stenosis with decreased cross-sectional area (CSA): S1 had the smallest CSA at trachea (0.23 cm) and resistance = 0.3 Pa·s/mL; S2 had the smallest CSA at glottis (0.44 cm), and resistance = 0.16 Pa·s/mL. S1 maximal stenotic deposition was 4.15% at trachea; S2 maximal deposition was 2.28% at glottis. Particles of 11-20 µm had the greatest deposition, 13.25% (S1-trachea) and 7.81% (S2-subglottis). Results showed differences in airway resistance and drug delivery between subjects with LTS. Less than 4.2% of orally inhaled particles deposited at stenosis. Particle sizes with most stenotic deposition were 11-20 µm and may not represent typical particle sizes emitted by current-use inhalers.
PubMed: 37305073
DOI: 10.1007/s42757-022-0151-9 -
European Archives of... Sep 2016To study effectiveness of surgery and watchful waiting in localized laryngeal amyloidosis, retrospective case series. This retrospective study comprises all consecutive...
To study effectiveness of surgery and watchful waiting in localized laryngeal amyloidosis, retrospective case series. This retrospective study comprises all consecutive patients with localized laryngeal amyloidosis surgically treated in a tertiary hospital between 1994 and February 2016. Recurrence rate, revision surgery, progression to systemic amyloidosis, and changes in voice were monitored yearly. Eighteen patients were included. Seven women and eleven men had a median age 50 years (range 21-77 years) and median follow-up 6.4 years (2.4-17 years). Amyloid was located in subglottis (5), glottis (8), false vocal folds (8) and other supraglottic areas (5), in more than one laryngeal region (13) and bilaterally (12). Cold steel excision was used at the glottis; CO2 laser excision, sometimes assisted by microdebrider, at other laryngeal areas. Eleven patients needed revision surgery, ten within the first 4 years after surgical treatment. One patient needed his first revision surgery after 11 years. Five patients needed a second revision within 6 years after initial diagnosis. Two patients needed a third revision. Indications for first revision surgery were progression (8) with dysphonia (7), dyspnea (2), dysphagia (1), exclusion of malignancy (1), and aphonia (1). No patient developed systemic amyloidosis during follow-up. Although local progression of amyloid necessitates revision surgery once or twice in the first 4-6 years, progression slows down thereafter. Late progression, however, remains possible.
Topics: Adult; Aged; Amyloidosis; Female; Follow-Up Studies; Humans; Laryngeal Diseases; Male; Middle Aged; Recurrence; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 27156084
DOI: 10.1007/s00405-016-4061-y -
Ear, Nose, & Throat Journal May 2024
PubMed: 38727144
DOI: 10.1177/01455613241249265 -
Asian Pacific Journal of Cancer... Aug 2017Objective: To evaluate the clinicopathologic findings and treatment outcome in laryngectomized patients with laryngeal cancer and hypopharyngeal cancer. Materials and...
Objective: To evaluate the clinicopathologic findings and treatment outcome in laryngectomized patients with laryngeal cancer and hypopharyngeal cancer. Materials and Methods: The authors retrospectively reviewed the medical records of 212 patients who had been newly diagnosed and treated with laryngectomy between January 2000 and December 2010. The age, gender, clinical manifestations, associated predisposing condition, tumor WHO grade, AJCC tumor stage, maximum tumor size, anatomical involvement, type of surgery, postoperative sequelae, treatment and therapeutic outcome were analyzed. Results: The present study included laryngeal cancer (n = 155) and hypopharyngeal cancer (n = 57). The patients’ age ranged from 38 to 84 years, with the mean age of 62.08±9.67 years. The common clinical presentations were hoarseness (73.6%), cervical lymphadenopathy (35.8%), sorethroat (22.2%), and odynophagia (14.6%). The laryngeal cancer commonly involves true vocal cord (86.5%), anterior commissure (65.8%), false vocal cord (56.8%), laryngeal ventricle (53.5%), subglottis (47.1%), and paraglotic space (35.5%), respectively. Fifty-three percent of cases had stage IV cancer. The most common postoperative surgical sequela was hypothyroidism (77.8%). The overall 5-year survivals for laryngeal cancer and hypopharyngeal cancer were 55% and 9%, respectively. The 5-year survival for node-negative cases was 61.8% versus 17% for node-positive cases (p< 0.001). AJCC stage of laryngeal cancer and hypopharyngeal cancer was a significant predictor of 5-year survival (p< 0.001 and p = 0.004, respectively). Conclusions: The advanced AJCC stage, advanced T stage, advanced N stage, extracapsular tumor spread, and tumor invasion of false vocal cord, epiglottis, preepiglottic space, paraglottic space, thyroid cartilage, cricothyroid membrane were found to significantly augment the decrease of 5-year survival in laryngeal cancer. Only advanced AJCC stage was significantly associated with 5-year survival rate in hypopharyngeal cancer.
PubMed: 28843218
DOI: 10.22034/APJCP.2017.18.8.2035 -
Laryngoscope Investigative... Aug 2019Subglottic stenosis (SGS) is a serious, potentially life-threatening disorder that is difficult to treat due to significant recurrence rates. While conventional...
OBJECTIVE
Subglottic stenosis (SGS) is a serious, potentially life-threatening disorder that is difficult to treat due to significant recurrence rates. While conventional treatment of SGS relies heavily on serial endoscopic dilation procedures, this study aims to characterize the efficacy of incorporating subglottic corticosteroid injections in increasing surgery-free intervals (SFIs) for a cohort of patients at a university-based medical system.
STUDY DESIGN
Retrospective chart review.
METHODS
All SGS patients who underwent endoscopic dilation and at least one adjuvant office-based serial intralesional steroid injection (SILSI) were reviewed. Patients were excluded if they had synchronous airway lesions or stenosis outside of the subglottis. Charts were reviewed for demographic and treatment-specific data. The SFI was calculated for patients both prior to the initiation of SILSI and after. Groups were compared via Mann-Whitney test, with < .05 as the threshold for significance.
RESULTS
Thirteen patients met criteria, with mean age 50.1 ± 14.1 years and 7:6 female to male ratio. Eight of the thirteen (61.5%) had intubation-related stenosis, while 4/13 were idiopathic and 1/13 was due to Wegener's granulomatosis. Mean follow-up was 20.4 months. Patients underwent an average of 4.2 ± 2.2 postoperative injections, beginning 45.9 ± 19.0 days after surgery. The mean SFI prior to initiating SILSI was 288.6 ± 362.0 days; while after receiving SILSI, the mean interval was significantly longer (545.5 ± 152.7 days, = .0041).
CONCLUSIONS
We demonstrate that office-based corticosteroid injection for SGS was associated with a statistically significant improvement in the SFI and is a promising adjuvant approach. Future prospective studies should evaluate if the efficacy is reproducible on a large scale and if SILSI can and/or should be incorporated into the standard management paradigm for SGS treatment.
LEVEL OF EVIDENCE
4.
PubMed: 31453351
DOI: 10.1002/lio2.284 -
International Journal of Surgery Case... May 2021Leiomyosarcoma is a rare mesenchymal tumor that originates from smooth muscle cells. Head and neck LMSs represent only 3% of all leiomyosarcomas with less than 50 cases...
INTRODUCTION
Leiomyosarcoma is a rare mesenchymal tumor that originates from smooth muscle cells. Head and neck LMSs represent only 3% of all leiomyosarcomas with less than 50 cases of laryngeal LMS reported in the literature till now.
CASE PRESENTATION
We report a case of 50-year-old male presented at our ENT department for a chronic hoarseness. Clinical examination investigations found small submucosal lesion in the right vocal cord. Treatment consisted of CO2 Laser excision of the lesion. The evolution was marked by the appearance of a tumefaction in the left submandibular region and a severe dyspnea requiring an emergency tracheotomy. Paraclinical examination investigations found a supraglottis-glottis-subglottis tumor. A total laryngectomy with bilateral functional neck dissection was performed and the histopathological examination found a laryngeal leiomyosarcoma.
CONCLUSION
LMS of the larynx a very rare malignancy. The accurate diagnosis is histological. Surgery is the mainstay of treatment. Its prognosis is correlated to local recurrence and distant metastases.
PubMed: 33838483
DOI: 10.1016/j.ijscr.2021.105830 -
Risk factors for severity of juvenile-onset recurrent respiratory papillomatosis at first endoscopy.European Annals of Otorhinolaryngology,... Feb 2019The study objective was to determine risk factors for severity of juvenile-onset recurrent respiratory papillomatosis (RRP) at first endoscopic evaluation.
OBJECTIVE
The study objective was to determine risk factors for severity of juvenile-onset recurrent respiratory papillomatosis (RRP) at first endoscopic evaluation.
METHODS
Based on a review of all cases undergoing surgery for juvenile-onset RRP in two pediatric otolaryngology departments in the USA and France, the following severity risk factors were analyzed: number of laryngeal levels involved, extension to the subglottis, and bilateral involvement.
RESULTS
Thirty-two patients were included, with 571 endoscopic procedures. Number of endoscopies per patient varied according to initial extension: 30.67 procedures when all three levels were involved, 15.57 procedures when two and 14.08 procedures when only one (P=0.03). The odds ratio for risk of >14 procedures in 3-level involvement was 20.43 (P=0.047). Initial subglottic extension tended to be associated with more endoscopic procedures (23.67 vs 15.56, P=0.16).
CONCLUSIONS
RRP severity correlated with initial laryngeal extension of papillomatous lesions at first endoscopy. This finding allowed a short 3-item assessment scale to be created for routine use, complementary to Derkay's assessment scale.
Topics: Child; Child, Preschool; Coinfection; Endoscopy; Female; France; Humans; Iowa; Male; Papillomavirus Infections; Prognosis; Respiratory Tract Infections; Risk Factors; Severity of Illness Index
PubMed: 30503689
DOI: 10.1016/j.anorl.2018.11.007 -
Cureus Apr 2023Subglottic hemangiomas are rare in adulthood. The presence of the lesion in the subglottic region makes it even more unusual. Moreover, these lesions do not have a...
Subglottic hemangiomas are rare in adulthood. The presence of the lesion in the subglottic region makes it even more unusual. Moreover, these lesions do not have a typical course and involution changes as seen in the infantile forms. An elderly female initially came with a brief history of dyspnea and symptoms of upper respiratory tract infection. The patient also complained of a change of voice and noisy breathing, with a recent history of intubation following COVID-19 pneumonia and late-onset bronchial asthma. Flexible nasopharyngolaryngoscopy showed a mass below the vocal folds, which was seen to arise from the posterior subglottic region. The patient eventually underwent endoscopic excision of the lesion under general anesthesia and recovered well. Symptoms of hoarseness and stridor, along with a history of intubation, should raise a high index of suspicion for laryngeal diseases. A delay in the diagnosis of an obstructing lesion in the subglottis occurs in the presence of a confounding lung infection and overlap of clinical features with those of bronchial asthma. Surgical excision is required not only to alleviate obstructive symptoms but also to rule out malignancy.
PubMed: 37255907
DOI: 10.7759/cureus.38293 -
Journal of Cancer Research and... Aug 2023An 8-year-old child was admitted to our ENT department for a year because of a hoarse voice. An endoscopic examination displayed that a cystic, solid lesion can be seen... (Review)
Review
An 8-year-old child was admitted to our ENT department for a year because of a hoarse voice. An endoscopic examination displayed that a cystic, solid lesion can be seen in the right subglottis. The lesion was removed using a CO2 laser under general anesthesia. Postoperative histopathology confirmed granular cell tumor (GCT), S-100(+), vimentin (+), and SOX-10(+). GCT, also known as the Abrikossoff tumor, is a rare benign tumor that rarely occurs in the larynx, particularly in children. This case report emphasizes that considerable attention should be given to the differential diagnosis of the laryngeal granulosa cell tumor. Given the recurrence risk of GCT, long-term postoperative follow-up is necessary.
Topics: Female; Humans; Child; Granular Cell Tumor; Larynx; Anesthesia, General; Diagnosis, Differential; Ovarian Neoplasms
PubMed: 37675739
DOI: 10.4103/jcrt.jcrt_2096_22 -
Indian Journal of Surgical Oncology Jun 2015A frazzled man in his early thirties presented with a 4 year long history of frequent progressive airway obstruction. He had undergone two open laryngeal surgeries and...
A frazzled man in his early thirties presented with a 4 year long history of frequent progressive airway obstruction. He had undergone two open laryngeal surgeries and multiple endolaryngeal procedures for excision of a subglottic lesion which recurred. Each time the histopathology showed a different entity ranging from hemangioma and fibrihystiocytic lesion and spindle cell carcinoma. Finally the case was proven to be an intermediate grade sarcoma of neurogenic origin. He underwent widefield laryngectomy with placement of Provox-2 prosthesis followed by radiotherapy. Five years following surgery, he is progressing well. The case is being reported for its rarity and also for the histogenetic problems associated with this group of lesions. Authors found only one other case of laryngeal neurofibrosarcoma that was reported 29 years back [3].
PubMed: 26405416
DOI: 10.1007/s13193-014-0364-x