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Indian Journal of Otolaryngology and... Jun 2023The main purpose of this study is to evaluate and understand the clinical profile of patients presenting to an Indian tertiary care referral centre with Laryngotracheal...
The main purpose of this study is to evaluate and understand the clinical profile of patients presenting to an Indian tertiary care referral centre with Laryngotracheal Stenosis (LTS) and also to emphasise on the outcomes after treatment in these patients. This is a prospective observational study conducted at a tertiary care referral centre which included 18 patients diagnosed with LTS. All patients were evaluated clinically and radiologically to evaluate the degree of stenosis, site and length of the stenotic segment involved, intervened surgical procedure, intraoperative and postoperative complications following the procedure were all documented and taken into consideration. The data collected was analysed. The most common etiological cause of LTS was post intubation (77.8%). 61.5% among the 13 intubated patients had a history of intubation for more than 10 days. 83.3% of the cases had stenosis at the level of the subglottis and cervical trachea level. Post intubational airway stenosis is the most common cause of LTS. A precise assessment of the laryngotracheal complex is the cornerstone of LTS management. The choice of treatment depends on the location, severity, and length of stenosis, as well as on the patient's comorbidities, history of previous interventions, and on the expertise of the surgical team. Application of topical Mitomycin c during surgery reduces the incidence of granulations. Close postoperative follow up for a long time and the necessity of more than one intervention improves results and can spare patients the morbidity and mortality associated with acute airway obstruction.
PubMed: 37275098
DOI: 10.1007/s12070-023-03528-4 -
American Journal of Otolaryngology 2024To investigate the clinical characteristics, diagnosis and prognosis of patients with laryngeal tuberculosis (LTB) combined with respiratory tuberculosis.
PURPOSE
To investigate the clinical characteristics, diagnosis and prognosis of patients with laryngeal tuberculosis (LTB) combined with respiratory tuberculosis.
MATERIALS AND METHODS
A retrospective analysis was conducted on 134 patients who underwent endoscopy and were eventually diagnosed with LTB. The patients' demographic characteristics, clinical manifestations, endoscopic features, auxiliary examination, imaging examination and prognostic characteristics were analyzed.
RESULTS
LTB patients had a median age of 45.5 years (range from 12 to 87 years) and a median course of 3.0 months (range from 0.1 to 72 months). The patients' symptoms mainly presented as hoarseness (97.0 %), abnormal sensation of pharyngeal (49.3 %), cough and sputum (41.0 %), pharyngalgia (39.6 %), dysphagia (10.4 %) and dyspnea (8.2 %). The positive rate of tuberculous symptoms was 25.4 %. Endoscopic features showed that the lesions mainly involved the glottis (87.3 %), presenting as unilateral lesions (66.7 %), near-full-length involvement (88.0 %), with mucosal waves significantly reduced (86.3 %), followed by supraglottis (43.3 %), subglottis (24.6 %) and the pharynx (15.7 %). The lesions may present as granulomatous proliferation (66.4 %), ulceration (65.7 %) or swelling and exudation (51.5 %). A total of 75 patients (56.0 %) were finally diagnosed with combined pulmonary tuberculosis (PTB), with a positive chest X-ray rate of 25.6 % and a positive chest CT rate of 71.2 %. A total of 42 patients who received anti-tuberculosis treatment were followed up, and 73.8 % of patients had significant improvement in symptoms. The morphology of the pharyngeal and laryngeal mucosa returned to basically normal (59.4 %) or scar-like (34.4 %).
CONCLUSIONS
LTB is usually found in middle-aged men, and patients' symptoms are mainly hoarseness, abnormal sensation of pharyngeal, pharyngalgia, cough and sputum, and can be combined with tuberculous symptoms. These lesions mainly involve multiple subregions, mainly in the glottis, and can be combined with pharyngeal involvement. There were various types of lesions. Half of the patients were complicated with PTB, and chest CT was superior to X-ray in the detection of pulmonary lesions. After regular anti-tuberculosis treatment, the symptoms and morphology of the pharyngeal and laryngeal mucosa of most patients were significantly improved.
Topics: Middle Aged; Male; Humans; Infant; Child, Preschool; Child; Tuberculosis, Laryngeal; Hoarseness; Retrospective Studies; Tuberculosis, Pulmonary; Tuberculosis; Pharyngitis; Prognosis; Antitubercular Agents; Cough
PubMed: 37979215
DOI: 10.1016/j.amjoto.2023.104115 -
Indian Journal of Otolaryngology and... Dec 2022We herein report a rare coincidence and a possible association between laryngotracheal fungal infection and spindle cell carcinoma of the larynx (SpCC). A 79-year-old...
We herein report a rare coincidence and a possible association between laryngotracheal fungal infection and spindle cell carcinoma of the larynx (SpCC). A 79-year-old gentleman presented to the Emergency Department with manifestations of airway obstruction. Flexible nasendoscopy showed pooling of saliva around the larynx and his neck palpation did not show cervical lymphadenopathy. Further imaging showed bilateral transglottic mass mainly in the subglottis along with right pulmonary nodularity. Percutaneous tracheostomy, panendoscopy and biopsy of the laryngeal mass confirmed a diagnosis of SpCC. A few days later, he was admitted and aspergillus fumigatus was found in a biopsy of his tracheal tissue. To the best of our knowledge, the possible correlation between laryngotracheal aspergillosis and such a rare type of cancer larynx (SpCC) has not been highlighted in the literature.
PubMed: 36742790
DOI: 10.1007/s12070-021-02399-x -
Diagnostics (Basel, Switzerland) Apr 2022A 66-year-old man presented with a 2.8 cm lesion of the left vocal cord. On contrast-enhanced computed tomography scans, the tumor extended to the supraglottis,...
A 66-year-old man presented with a 2.8 cm lesion of the left vocal cord. On contrast-enhanced computed tomography scans, the tumor extended to the supraglottis, subglottis, paraglottic space and anterior commissure, causing partial obstruction of the laryngeal lumen. At another hospital, a fragmented incisional biopsy was diagnosed as a granular cell tumor, as to the S-100 immunohistochemical positivity. After excision, the tumor revealed to be an adult-type laryngeal rhabdomyoma. The typical cytoplasmic rod-like inclusions and cross striations were more evident in the second specimen. We confirmed the unusual S-100 immunohistochemical positivity (variable intensity, >90% of tumor cells). Muscle markers were not performed on the previous biopsy, resulting positive in our specimen (Desmin: strong, diffuse expression; Smooth Muscle Actin: strong staining in 10% of tumor cells). Melan-A, CD68, GFAP, pan-cytokeratins, CEA, calretinin and neurofilaments resulted negative. To our brief, systematic literature review, S-100 positivity (usually variable, often weak or patchy/focal) was globally found in 19/34 (56%) adult-type rhabdomyomas of the head and neck region. Especially on fragmented biopsy material, the differential diagnoses of laryngeal rhabdomyomas may include granular cell tumors, oncocytic tumors of the salivary glands or of different origin, and paragangliomas.
PubMed: 35453940
DOI: 10.3390/diagnostics12040892 -
Indian Journal of Otolaryngology and... Oct 2019Injury to the aerodigestive tract following external laryngeal trauma is rare. Reports of acquired laryngopharyngeal fistula are very few. We report a very rare...
Injury to the aerodigestive tract following external laryngeal trauma is rare. Reports of acquired laryngopharyngeal fistula are very few. We report a very rare presentation of penetrating neck trauma presenting with fracture of the cricoid cartilage, subglottic stenosis and pharyngosubglottic fistula. The term 'pharyngosubglottic fistula' is used here for the first time to describe a communication tract between hypopharynx and subglottis. The successful surgical management of this case is discussed.
PubMed: 31742017
DOI: 10.1007/s12070-018-1390-8 -
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 -
Ear, Nose, & Throat Journal Mar 2022
PubMed: 35324324
DOI: 10.1177/01455613221086528 -
Otolaryngology--head and Neck Surgery :... Mar 2020To describe proof of concept and pilot data for a cryotherapy application in the subglottis in a rabbit airway model. Four New Zealand white rabbits (3 experimental, 1...
To describe proof of concept and pilot data for a cryotherapy application in the subglottis in a rabbit airway model. Four New Zealand white rabbits (3 experimental, 1 control) underwent general anesthesia and laryngoscopy and bronchoscopy. Experimental animals had cryotherapy applied with a direct contact 1.9-mm cryoprobe. Animals were euthanized at days 0, 2, and 6 posttreatment. Histologic changes were assessed in the treated subglottic tissues. This preliminary work has demonstrated that, with early cryogenic injury in the subglottis, there is mild mucosal epithelial injury associated with submucosal edema, acute inflammatory infiltrate, and degeneration of venule endothelial cells. Mucosal epithelial repair and resolution of the inflammatory response appear to be relatively rapid. We hope that this may provide a foundation to further explore cryotherapy as a primary or adjuvant treatment option for pediatric subglottis stenosis.
Topics: Animals; Bronchoscopy; Cryotherapy; Disease Models, Animal; Glottis; Laryngostenosis; Pilot Projects; Proof of Concept Study; Rabbits; Wound Healing
PubMed: 31986977
DOI: 10.1177/0194599820902098 -
Cureus Nov 2019Objectives This study aimed to compare the results of a software calculation method (SCM) and the mathematical calculation method (MCM) in measuring the cross-sectional...
Objectives This study aimed to compare the results of a software calculation method (SCM) and the mathematical calculation method (MCM) in measuring the cross-sectional area (CSA) at four different upper airway segments. Methods The data from the retrospective chart reviews of patients older than 18 years who had undergone computed tomography (CT) of the neck at our tertiary care center between September 2014 and September 2018 were reviewed. Data of patients who were intubated, tracheostomized, had nasogastric tubes, tumors, craniofacial anomalies, trauma, or any pathology that may affect the normal airway anatomy were excluded. We measured the anteroposterior (APD) and transverse diameter (TD) utilizing the CT software. CSA was calculated using both the mathematical formula (MCM) and software (SCM) at the glottis, proximal subglottis, distal subglottis, and tracheal levels. A paired sample t-test was used to determine the significant difference between SCM and MCM at each level. Results The data of 100 patients (59% female) were reviewed. There was a significant difference between the SCM and MCM at all four levels. The mean differences between the SCM and MCM were -33.63 mm, -24.20 mm, 6.04 mm (p < 0.001) at the glottis, proximal subglottis, and trachea, respectively. The mean difference at the distal subglottis was -4.08 mm (p = 0.01). Conclusion Our study found a significant difference between the SCM and MCM in measuring the CSA of the four airway segments. Theoretically, the SCM is more accurate and precise than MCM in measuring CSA; however, we could not prove the superiority of either method.
PubMed: 31886046
DOI: 10.7759/cureus.6106 -
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