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Journal of Clinical Medicine Sep 2022Historically, surgery was the first-choice therapy for early, intermediate and advanced laryngeal squamous cell carcinoma (LSCC). Partial laryngeal surgery has evolved... (Review)
Review
Historically, surgery was the first-choice therapy for early, intermediate and advanced laryngeal squamous cell carcinoma (LSCC). Partial laryngeal surgery has evolved in recent decades and was influenced by many historic events and the development of new technologies. Partial laryngectomies may be performed by open, endoscopic or transoral robotic approaches. In this historic paper, we describe the evolution of open partial laryngectomy techniques, indications and surgical outcomes. Since the first partial laryngectomy in 1788, many U.S., U.K. and European surgeons, including Henry Sands, Jacob da Silva Solis-Cohen and Theodor Billroth, performed this surgical procedure under local anesthesia for tuberculosis, cancer or syphilis. Partial laryngectomy gained reputation in the medical community in 1888 due to the laryngeal cancer and death of the prince of Prussia, Frederick III. Frederick III's death represented the turning point in the history of partial laryngectomies, calling attention to the importance of semiotics, biopsy and early diagnosis in laryngeal cancers. Hemi-laryngectomy was indicated/proposed for lateral laryngeal tumors, while thyrotomy was indicated for cancers of the middle part of the vocal fold. The second landmark in the history of partial laryngectomies was the discovery of cocaine, novocaine and adrenaline and the related development of local anesthetic techniques, which, together with the epidemiological and hygienic advances of the 19th century, allowed for better perioperative outcomes. General anesthesia was introduced in the second part of the 20th century and further improved the surgical outcomes. The diagnosis of laryngeal cancer was improved with the development of X-rays and direct laryngoscopies. The 20th century was characterized by the development and improvement of vertical partial laryngectomy procedures and the development of horizontal partial laryngectomies for both supraglottic and glottic regions. The history and the evolution of these techniques are discussed in the present historical paper.
PubMed: 36142999
DOI: 10.3390/jcm11185352 -
The Laryngoscope Oct 2021There are currently no treatments available that restore dynamic laryngeal function after hemilaryngectomy. We have shown that dynamic function can be restored post...
OBJECTIVE/HYPOTHESIS
There are currently no treatments available that restore dynamic laryngeal function after hemilaryngectomy. We have shown that dynamic function can be restored post hemilaryngectomy in a rat model. Here, we report in a first of its kind, proof of concept study that this previously published technique is scalable to a porcine model.
STUDY DESIGN
Animal study.
METHODS
Muscle and fat biopsies were taken from three Yucatan minipigs. Muscle progenitor cells (MPCs) and adipose stem cells (ASCs) were isolated and cultured for 3 weeks. The minipigs underwent a left laterovertical partial laryngectomy sparing the left arytenoid cartilage and transecting the recurrent laryngeal nerve. Each layer was replaced with a tissue-engineered implant: 1) an acellular mucosal layer composed of densified Type I oligomeric collagen, 2) a skeletal muscle layer composed of autologous MPCs and aligned oligomeric collagen differentiated and induced to express motor endplates (MEE), and 3) a cartilage layer composed of autologous ASCs and densified oligomeric collagen differentiated to cartilage. Healing was monitored at 2 and 4 weeks post-op, and at the 8 week study endpoint.
RESULTS
Animals demonstrated appropriate weight gain, no aspiration events, and audible phonation. Video laryngoscopy showed progressive healing with vascularization and re-epithelialization present at 4 weeks. On histology, there was no immune reaction to the implants and there was complete integration into host tissue with nerve and vascular ingrowth.
CONCLUSIONS
This pilot study represents a first in which a transmural vertical partial laryngectomy was performed and successfully repaired with a customized, autologous stem cell-derived multi-layered tissue-engineered implant.
LEVEL OF EVIDENCE
NA Laryngoscope, 131:2277-2284, 2021.
Topics: Adipose Tissue; Animals; Cell Differentiation; Cells, Cultured; Deglutition; Disease Models, Animal; Humans; Laryngeal Cartilages; Laryngectomy; Laryngoplasty; Larynx; Mesenchymal Stem Cells; Motor Endplate; Muscle, Skeletal; Myoblasts; Phonation; Pilot Projects; Primary Cell Culture; Proof of Concept Study; Recurrent Laryngeal Nerve; Swine; Swine, Miniature; Tissue Engineering; Tissue Scaffolds
PubMed: 33247846
DOI: 10.1002/lary.29282 -
Applied Sciences (Basel, Switzerland) Aug 2021The purpose of this paper is to report on the first application of a recently developed transoral, dual-sensor pressure probe that directly measures intraglottal,...
The purpose of this paper is to report on the first application of a recently developed transoral, dual-sensor pressure probe that directly measures intraglottal, subglottal, and vocal fold collision pressures during phonation. Synchronous measurement of intraglottal and subglottal pressures was accomplished using two miniature pressure sensors mounted on the end of the probe and inserted transorally in a 78-year-old male who had previously undergone surgical removal of his right vocal fold for treatment of laryngeal cancer. The endoscopist used one hand to position the custom probe against the surgically medialized scar band that replaced the right vocal fold and used the other hand to position a transoral endoscope to record laryngeal high-speed videoendoscopy of the vibrating left vocal fold contacting the pressure probe. Visualization of the larynx during sustained phonation allowed the endoscopist to place the dual-sensor pressure probe such that the proximal sensor was positioned intraglottally and the distal sensor subglottally. The proximal pressure sensor was verified to be in the strike zone of vocal fold collision during phonation when the intraglottal pressure signal exhibited three characteristics: an impulsive peak at the start of the closed phase, rounded peak during the open phase, and minimum value around zero immediately preceding the impulsive peak of the subsequent phonatory cycle. Numerical voice production modeling was applied to validate model-based predictions of vocal fold collision pressure using kinematic vocal fold measures. The results successfully demonstrated feasibility of measurement of vocal fold collision pressure in an individual with a hemilaryngectomy, motivating ongoing data collection that is designed to aid in the development of vocal dose measures that incorporate vocal fold impact collision and stresses.
PubMed: 36210866
DOI: 10.3390/app11167256 -
Ear, Nose, & Throat Journal Feb 2023This study aims to investigate the clinical diagnosis and treatment characteristics of primary laryngeal neuroendocrine carcinoma.
OBJECTIVE
This study aims to investigate the clinical diagnosis and treatment characteristics of primary laryngeal neuroendocrine carcinoma.
PATIENTS AND METHODS
A retrospective analysis was performed for the data of 6 patients with primary laryngeal neuroendocrine carcinoma admitted to the Department of Otorhinolaryngology of Dalian Central Hospital from September 2015 to January 2022, all of whom were male patients. And laryngoscopy showed that 4 had a similar appearance to hemangioma, 1 had nodular hyperplasia, and 1 was papilloma-like. The site of onset was located on the laryngeal surface of the epiglottis in 3 cases, situated in the aryepiglottic fold in 2 cases, and the posterior ventricular zone in 1 case. Five patients underwent surgery, including 4 by transoral endoscopic cryogenic plasma radiofrequency mass resection; one underwent a cervical lymph node dissection and supraglottic horizontal hemilaryngectomy. The remaining 1 case was treated in another hospital after the pathological diagnosis was confirmed by biopsy. All patients had no cervical lymph node metastases and were not supplemented with chemoradiotherapy.
RESULTS
The postoperative pathological diagnosis of all 5 patients was neuroendocrine carcinoma. No cancer cells were seen at the margins and base. One patient was lost to follow-up after treatment in another hospitals and the rest were followed up for 6 months to 6 years. One patient had removed laryngeal tumor and epiglottis by a low-temperature plasma radiofrequency ablation, recurrence 1 year after surgery, and no recurrence for 5 years after supraglottic horizontal hemilaryngectomy combined with prophylactic cervical lymph node dissection, no recurrence for the other 4 patients after 6 months to 4 years of follow-up.
CONCLUSION
The common sites of laryngeal neuroendocrine carcinoma are the laryngeal surface of the epiglottis and the aryepiglottic fold. The appearance of the tumor is mainly similar to that of hemangioma. Moreover, a common pathological classification is atypical carcinoid tumors, where early detection and surgical treatment can achieve a good therapeutic effect.
PubMed: 36737058
DOI: 10.1177/01455613231155853 -
Journal of Clinical Medicine Sep 2022To investigate oncological and functional outcomes in patients treated with salvage partial laryngectomy (SPL) after failed radio/chemotherapy.
OBJECTIVE
To investigate oncological and functional outcomes in patients treated with salvage partial laryngectomy (SPL) after failed radio/chemotherapy.
STUDY DESIGN
Retrospective multicenter chart review.
METHODS
Medical records of patients treated with SPL from January 1998 to January 2018 in two University Medical centers were retrieved. The SPL included horizontal supraglottic laryngectomy, hemi-laryngectomy and crico-hyoido-epiglottopexy. The following outcomes were investigated: histopathological features; overall survival (OS); recurrence-free survival (RFS) local and regional controls; post-operative speech recovery; and the oral diet restart and decannulation.
RESULTS
The data of 20 patients with cT1-cT3 laryngeal cancer were collected. The mean follow-up of patients was 69.7 months. The mean hospital stay was 43.0 days (16-111). The following complications occurred in the immediate post-operative follow-up: neck fistula (N = 6), aspiration pneumonia (N = 5), and chondronecrosis (N = 2). Early or late total laryngectomy was carried out over the follow-up period for the following reasons: positive margins and local recurrence/progression (N = 7), chondronecrosis (N = 2) and non-functional larynx (N = 1). The restart of the oral diet was carried out in 12/15 (80%) SPL patients (five patients being excluded for totalization). All patients recovered speech, and decannulation was performed in 14 patients (93%). The 5-year OS and RFS were 50% and 56%, respectively. The 5-year local and regional control rates were 56% and 56%, respectively.
CONCLUSIONS
Partial laryngectomy is an alternative therapeutic approach to total laryngectomy in patients with a history of failed radiation.
PubMed: 36143058
DOI: 10.3390/jcm11185411 -
Ear, Nose, & Throat Journal Sep 2023Rhabdomyosarcoma (RMS) is a rare and aggressive cancerous tumor that arises from embryonal mesenchymal cells with skeletal muscle differentiation, and it is exceedingly...
Rhabdomyosarcoma (RMS) is a rare and aggressive cancerous tumor that arises from embryonal mesenchymal cells with skeletal muscle differentiation, and it is exceedingly rare that occurs specifically in the larynx. To date, only 22 instances of laryngeal pleomorphic RMSs have been documented in adults. Consequently, there is limited information available to assist healthcare professionals in effectively handling RMS in the larynx of adult patients. Here, we present an uncommon occurrence involving a 45-year-old man who experienced progressive hoarseness and received a diagnosis of pleomorphic RMS affecting the larynx. Pleomorphic RMS had been pathologically diagnosed after a vertical hemilaryngectomy. Following the surgical intervention, the patient underwent chemotherapy and radiation therapy. As of now, there have been no indications of tumor recurrence.
PubMed: 37715691
DOI: 10.1177/01455613231198986 -
Laryngoscope Investigative... Oct 2023Glottic tumors with infiltration of the anterior/posterior commissure, and lesions with subglottic, cricoid, or cricoarytenoid joint infiltration have been highly...
OBJECTIVES
Glottic tumors with infiltration of the anterior/posterior commissure, and lesions with subglottic, cricoid, or cricoarytenoid joint infiltration have been highly controversial in the past, from the perspective of oncological safety. Although conservation laryngeal resection options exist, most are limited by the extent of resection proscribed by the technique and the postoperative functional results. Oncologically speaking, extended vertical hemilaryngectomy is often the optimal solution. However, limited reconstruction methods often compel total laryngectomy.
METHODS
Eight patients with vocal fold malignancy, which infiltrated the anterior and sometimes the posterior commissure and with subglottic extension and resultant uni/bilateral vocal fold motion impairment, were treated by single stage extended vertical partial laryngectomy with rotational crico-thyrotracheopexy as a functional reconstruction of the laryngeal framework. Patients were evaluated with objective and subjective function tests.
RESULTS
Histologic examination demonstrated tumor-free margins in every case. Definitive decannulation was successful in all cases within 2 weeks. All patients had a stable and adequate airway during follow-up and reported socially acceptable voice. Oral feeding was possible in seven patients.
CONCLUSION
Rotational crico-thyrotracheopexy, as a single stage reconstruction technique, is based on well-vascularized, readily available, appropriately shaped local tissues, without significant donor site morbidity or need for long-term stenting to reconstruct large laryngeal defects after extended vertical hemilaryngectomy for advanced unilateral glottic tumors and is applicable even with supra/subglottic invasion or infiltration of the contralateral vocal fold. An adequate airway can be achieved with socially acceptable voice and safe swallowing without compromising oncologic reliability.
LEVEL OF EVIDENCE
4 (retrospective case series review).
PubMed: 37899879
DOI: 10.1002/lio2.1155 -
Genes Feb 2023Approximately 60% of patients with squamous cell carcinoma (LSCC) have regional occult metastatic disease/distant metastases at the time of diagnosis, putting them at...
UNLABELLED
Approximately 60% of patients with squamous cell carcinoma (LSCC) have regional occult metastatic disease/distant metastases at the time of diagnosis, putting them at higher risk for disease progression. Therefore, biomarkers are needed for early prognostic purpose. The aim of this study was to analyze the expression pattern of connexins (Cx) 37, 40 and 45, pannexin1 (Panx1) and vimentin in LSCC and correlate with tumor grade (G) and outcome.
METHODS
Thirty-four patients who underwent (hemi-)laryngectomy and regional lymphadenectomy due to LSCC from 2017 to 2018 in University Hospital Split, Croatia, were studied. Samples of tumor tissue and adjacent normal mucosa embedded in paraffin blocks were stained using the immunofluorescence method and were semi-quantitatively analyzed.
RESULTS
The expression of Cx37, Cx40, and Panx1 differed between cancer and adjacent normal mucosa and between histological grades, being the highest in well-differentiated (G1) cancer and low/absent in poorly differentiated (G3) cancer (all < 0.05). The expression of vimentin was the highest in G3 cancer. Expression of Cx45 was generally weak/absent, with no significant difference between cancer and the controls or between grades. Lower Panx1 and higher vimentin expression were found to be prognostic factors for regional metastatic disease. Lower Cx37 and 40 expressions were present in patients with disease recurrence after the three-year follow-up period.
CONCLUSION
Cx37 and Cx40, Panx1, and vimentin have the potential to be used as prognostic biomarkers for LSCC.
Topics: Humans; Squamous Cell Carcinoma of Head and Neck; Vimentin; Neoplasm Recurrence, Local; Connexins; Head and Neck Neoplasms; Nerve Tissue Proteins
PubMed: 36833374
DOI: 10.3390/genes14020446 -
BMC Surgery Jul 2020Laryngeal rhabdomyosarcomas (RMSs) mainly occurred in children, while were extremely rare in adults. Consequently, less information was available to guide clinicians to... (Review)
Review
BACKGROUND
Laryngeal rhabdomyosarcomas (RMSs) mainly occurred in children, while were extremely rare in adults. Consequently, less information was available to guide clinicians to manage adult RMSs in larynx.
CASE PRESENTATION
A 42-year-old man presented with a 2-year history of gradually worsening hoarseness. Then, he underwent a surgery with suspension laryngoscope with initially being diagnosed as vocal cord cyst. Unexpectedly, the lesion was proved to be embryonal rhabdomyosarcoma (ERMS), pathologically. Next, he underwent chemoradiotherapy, while the tumor relapsed 18 months after the last treatment. Subsequently, a vertical hemilaryngectomy and a right selective neck dissection was performed, and the chemotherapy according to the anticancer drug sensitivity in vitro was arranged. Until the last check-up 18 months after chemotherapy, the patient did not display clinical or radiological signs of local recurrence and metastases.
CONCLUSIONS
Misdiagnosis and missed diagnosis of laryngeal RMSs might appear when tumors presented as smooth protuberance. We reported the first case of laryngeal RMSs in an adult with the multidisciplinary strategy based on the chemosensitivity assay in vitro. Furthermore, a systematic review of the literature was also discussed, highlighting the initial diagnostic pitfalls and subsequent management problems that may occur with this uncommon tumor.
Topics: Adult; Chemoradiotherapy; Combined Modality Therapy; Diagnostic Errors; Female; Humans; Laryngeal Neoplasms; Laryngectomy; Larynx; Male; Neck Dissection; Neoplasm Recurrence, Local; Rhabdomyosarcoma, Embryonal
PubMed: 32736545
DOI: 10.1186/s12893-020-00831-7 -
Romanian Journal of Morphology and... 2016The CO2 laser surgery represents a treatment method of laryngeal bicordal and anterior commissure glottic cancer T1b, T2, N0. In Department of ENT, Timisoara, Romania,...
The CO2 laser surgery represents a treatment method of laryngeal bicordal and anterior commissure glottic cancer T1b, T2, N0. In Department of ENT, Timisoara, Romania, during 1.01.2001-31.12.2011 were analyzed 781 files from patients with laryngeal neoplasm. One hundred twenty-seven patients presented the tumor that involved both vocal cords and anterior commissure, stages T1b, T2 and T3. Therapeutic options included CO2 laser microsurgical excision for 55 (43.30%) patients, frontolateral hemilaryngectomy for 16 (12.59%) patients, total laryngectomy for 42 (33.07%) patients, radiotherapy for 10 (7.87%) patients, and four (3.14%) patients, initially, refused any treatment modality. Endoscopic laser CO2 microsurgery was the primary and solitary management for curative resection of the glottic cancer. All operations were performed under general anesthesia with orotracheal intubations. The mean follow-up was 58 months, with the range between 36 to 84 months. Suspended microlaryngoscopy with CO2 laser surgery has been performed in 43 (33.85%) patients staged T1bN0Mx and 12 (9.44%) patients staged T2N0Mx. In five (9.09%) patients, we encountered local recurrences. The endoscopic CO2 laser surgery is in our view the elective and preferable surgical method in laryngeal glottic cancer stage T1b and T2 for cure, with oncological and functional results superior to those of conventional surgical procedures.
Topics: Aged; Carcinoma, Squamous Cell; Fiber Optic Technology; Follow-Up Studies; Humans; Laryngeal Neoplasms; Laryngectomy; Laryngoscopy; Larynx; Lasers, Gas; Male; Middle Aged
PubMed: 27833963
DOI: No ID Found