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The Laryngoscope Jul 2024Recent immunologic study of the adaptive immune repertoire in the subglottic airway demonstrated high-frequency T cell clones that do not overlap between individuals....
OBJECTIVES
Recent immunologic study of the adaptive immune repertoire in the subglottic airway demonstrated high-frequency T cell clones that do not overlap between individuals. However, the anatomic distribution and antigenic target of the T cell repertoire in the proximal airway mucosa remain unresolved.
METHODS
Single-cell RNA sequencing of matched scar and unaffected mucosa from idiopathic subglottic stenosis patients (iSGS, n = 32) was performed and compared with airway mucosa from healthy controls (n = 10). T cell receptor (TCR) sequences were interrogated via similarity network analysis to explore antigenic targets using the published algorithm: Grouping of Lymphocyte Interactions by Paratope Hotspots (GLIPH2).
RESULTS
The mucosal T cell repertoire in healthy control airways consisted of highly expressed T cell clones conserved across anatomic subsites (trachea, bronchi, bronchioles, and lung). In iSGS, high-frequency clones were equally represented in both scar and adjacent non-scar tissue. Significant differences in repertoire structure between iSGS scar and unaffected mucosa was observed, driven by unique low-frequency clones. GLIPH2 results suggest low-frequency clones share targets between multiple iSGS patients.
CONCLUSION
Healthy airway mucosa has a highly conserved T cell repertoire across multiple anatomic subsites. Similarly, iSGS patients have highly expressed T cell clones present in both scar and unaffected mucosa. iSGS airway scar possesses an abundance of less highly expanded clones with predicted antigen targets shared between patients. Interrogation of these shared motifs suggests abundant adaptive immunity to viral targets in iSGS airway scar. These results provide insight into disease pathogenesis and illuminate new treatment strategies in iSGS.
LEVEL OF EVIDENCE
NA Laryngoscope, 134:3245-3252, 2024.
Topics: Humans; Adaptive Immunity; Male; Female; Laryngostenosis; Middle Aged; T-Lymphocytes; Adult; Case-Control Studies; Receptors, Antigen, T-Cell; Respiratory Mucosa; Aged; Single-Cell Analysis
PubMed: 38450771
DOI: 10.1002/lary.31376 -
Indian Journal of Otolaryngology and... Feb 2024Total laryngectomy is the primary treatment for locally advanced laryngeal carcinomas. However, routine thyroid removal (total or hemithyroidectomy) during this...
Total laryngectomy is the primary treatment for locally advanced laryngeal carcinomas. However, routine thyroid removal (total or hemithyroidectomy) during this procedure is controversial, as the incidence of thyroid gland involvement varies and may lead to lifelong thyroid supplementation, increasing postoperative morbidity. The lack of a consensus on managing the thyroid gland in laryngeal carcinoma cases necessitates improved evaluation techniques, with radiology playing a crucial role in this aspect. Understanding the correlation between radiological factors and histopathological involvement of the thyroid gland can aid in formulating appropriate management strategies during total laryngectomy. To study the correlation of preoperative radiological factors with histopathological involvement of thyroid gland in laryngeal carcinomas. This was a retrospective study which included 57 patients who underwent total laryngectomy for squamous cell carcinoma of larynx. The pre-operative CT findings such as involvement of thyroid cartilage, cricoid cartilage, paraglottic space, anterior commissure, subglottis and thyroid gland along with transglottic extension of tumor were correlated with post-operative histopathological thyroid gland involvement. Cricoid cartilage erosion and thyroid gland involvement in CT scans individually exhibited positive likelihood ratios of 2.58 and 3.23, respectively, demonstrating a reasonable agreement with histopathological findings. The specificity of cricoid cartilage and thyroid gland involvement was also higher with values of 76.4% and 81%, respectively. Moreover, combining thyroid and cricoid cartilage erosion in CT scans as a predictive parameter for thyroid gland involvement resulted in a better likelihood ratio of 8.23 and a fair agreement with histopathological findings. We conclude that cricoid cartilage erosion and thyroid gland involvement in pre-operative CECT can be taken as a preoperative indicator for intraoperative decision on thyroidectomy.
PubMed: 38440602
DOI: 10.1007/s12070-023-04305-z -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Mar 2024Subglottic masses is very rare. The clinical data of five cases of subglottic mass in our hospital from 2017 to 2022 were summarized, and their clinical manifestations,...
Subglottic masses is very rare. The clinical data of five cases of subglottic mass in our hospital from 2017 to 2022 were summarized, and their clinical manifestations, auxiliary examination findings, treatment plan and pathological features were analyzed. Among the 5 patients, 1 case was subglottic pleomorphic adenoma, 1 case was subglottic granuloma, 1 case was subglottic breast cancer metastasis, 1 case was subglottic primary adenoid cystic carcinoma, and 1 case was immunoglobulin G4-related disease. No recurrence was observed in the patients so far. Subglottic mass is easy to be missed. Therefore, when the lesion is suspected in this area, the examination of ear, nose and throat should be carried out systematically to detect the lesion early and improve the prognosis.
Topics: Humans; Adenoma, Pleomorphic; Carcinoma, Adenoid Cystic; Immunoglobulin G4-Related Disease; Laryngeal Neoplasms; Neck
PubMed: 38433696
DOI: 10.13201/j.issn.2096-7993.2024.03.013 -
Pakistan Journal of Medical Sciences Jan 2024Shabbir Syndrome or commonly known as Laryngo-onycho-cutaneous syndrome (LOCS) is an autosomal recessively inherited syndrome, caused due to mutations in the laminin...
Shabbir Syndrome or commonly known as Laryngo-onycho-cutaneous syndrome (LOCS) is an autosomal recessively inherited syndrome, caused due to mutations in the laminin alpha-3 (LAMA3) gene. This syndrome affects the epidermal layer and results in granulation formation in the eyes, larynx, and nails. One of the most dreadful complications of this syndrome can be due to granulation formation in the larynx or sub-glottis region resulting in laryngeal stenosis and death. According to the latest (OMIM) classification, LOCS has been reclassified as a subtype of Junctional epidermolysis bullosa (JEB). But it is still considered a rare syndrome with limited cases reported worldwide. In this case report, we have discussed a case of a four year old, Pakistani boy, who presented with stridor, fragile skin, and granulation of nails, with no family history of LOCS.
PubMed: 38328664
DOI: 10.12669/pjms.40.2(ICON).9035 -
Head & Neck Mar 2024Locally advanced laryngeal cancers treatment often involves total laryngectomy, which some patients are unwilling to undergo, even if this choice reduces their survival...
Locally advanced laryngeal cancers treatment often involves total laryngectomy, which some patients are unwilling to undergo, even if this choice reduces their survival probability. Therefore, the objective of laryngeal oncologic surgery is not only to remove the tumor, but also to preserve the organ and its functions. To overcome these concerns, several partial laryngectomy techniques have been developed. This article describes the surgical technique and a case study of a 64-year-old male patient with locally advanced laryngeal squamous cell carcinoma who underwent vertical partial laryngectomy extending to the subglottis and hypopharynx using transoral robotic surgery (TORS) with a da Vinci Single Port surgical robot. The video and article provide a detailed description of the surgical technique, which resulted in successful tumor removal with excellent oncological and functional outcomes.
Topics: Male; Humans; Middle Aged; Robotics; Robotic Surgical Procedures; Laryngectomy; Hypopharynx; Laryngeal Neoplasms; Head and Neck Neoplasms; Treatment Outcome
PubMed: 38221740
DOI: 10.1002/hed.27634 -
Ear, Nose, & Throat Journal Dec 2023Dysphagia is common in idiopathic Parkinson's disease (IPD) and is associated with impairments in both swallowing safety and swallowing efficiency. The goals of this...
Dysphagia is common in idiopathic Parkinson's disease (IPD) and is associated with impairments in both swallowing safety and swallowing efficiency. The goals of this study were to define post-swallow residue patterns in people with IPD and describe pathophysiological endoscopic findings affecting residue accumulation. This was a prospective single-blinded cross-sectional cohort study of patients with the diagnosis of IPD recruited from a Movement Disorder Clinic. Clinical variables included patient age, cognitive function, and measures of disease severity, and laryngoscopic examinations with a flexible endoscopic evaluation of swallowing (FEES) were completed for each patient. Visual Analysis of Swallowing Efficiency and Safety (VASES) was used to analyze FEES. Post-swallow residue outcomes and non-residue endoscopic outcomes including the Bowing index, Penetration Aspiration Scale (PAS) score, premature leakage, and build-up phenomenon were evaluated. Multiple regression models were used to evaluate factors affecting the residue at different anatomic levels. Overall 53 patients completed the study. The multiple regression analyses showed a relation between (1) the presence of residue at the level of oropharynx and epiglottis with premature leakage, (2) the presence of residue at the level of the laryngeal vestibule and vocal folds with build-up phenomenon, and (3) the presence of residue at the level of the hypopharynx, laryngeal vestibule, and subglottis with airway invasion. Residue pattern during FEES is associated with specific swallow dysfunctions in IPD. Using residue localization and quantification may be a helpful tool in assessing the impact of targeted swallowing interventions in patients with IPD and dysphagia.
PubMed: 38050868
DOI: 10.1177/01455613231210976 -
Otolaryngologia Polska = the Polish... Sep 2023<br><b>Introduction:</b> Malignant minor salivary gland tumors are rare, accounting for fewer than 1% of all laryngeal cancers.</br>...
<br><b>Introduction:</b> Malignant minor salivary gland tumors are rare, accounting for fewer than 1% of all laryngeal cancers.</br> <br><b>Aim:</b> This study aims to share our experiences regarding clinical, radiological, pathological profiles and their management.</br> <br><b>Materials and methods:</b> The current study reviews 11 cases of malignant minor salivary gland tumors of the larynx treated surgically at our Institute between 2005 and 2019.</br> <br><b>Results:</b> The mean age of the patients was 54 years (range 38-75 years) with six females and five males in the series (1.2:1). Subglottis and trachea were the sites of origin in 54% of the cases, and hoarseness with dyspnea were the most common presenting symptoms. There were nine Adenoid cystic and two Mucoepidermoid carcinoma patients. Surgery was the primary mode of treatment.</br> <br><b>Conclusions:</b> Most of the larynx's malignant minor salivary gland tumors are submucosal in origin. The outcome and prognosis vary considerably based on the tumor's histology, grade, and stage.</br>.
Topics: Female; Male; Humans; Adult; Middle Aged; Aged; Adenoids; Hoarseness; Laryngeal Neoplasms; Larynx; Salivary Gland Neoplasms
PubMed: 38032326
DOI: 10.5604/01.3001.0053.4040 -
Seminars in Fetal & Neonatal Medicine Oct 2023Safe and effective management of the neonatal airway requires knowledge, teamwork, preparation and experience. At baseline, the neonatal airway can present significant... (Review)
Review
Safe and effective management of the neonatal airway requires knowledge, teamwork, preparation and experience. At baseline, the neonatal airway can present significant challenges to experienced neonatologists and paediatric anaesthesiologists, and increased difficulty can be due to anatomical abnormalities, physiological instability or increased situational stress. Neonatal airway obstruction is under recognised, and should be considered an emergency until the diagnosis and physiological implications are understood. When multiple types of difficulties are present or there are multiple levels of anatomical obstruction, the challenge increases exponentially. In these situations, preparation, multi-disciplinary teamwork and a consistent hospital-wide approach will help to reduce errors and morbidity.
Topics: Humans; Infant, Newborn; Airway Obstruction; Neonatology
PubMed: 38030433
DOI: 10.1016/j.siny.2023.101483 -
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