CONTRIBUTION OF THE LARYNGOGRAM TO THE MANAGEMENT OF MALIGNANT LARYNGEAL TUMORS.

Abstract

The larynx has been the subject of x-ray investigation almost since the inception of radiography. Thyroid cartilage calcification in cadavers was studied as early as 1896 (1). The first major contribution to roentgen examination of the larynx was by Coutard (2), who reported on the value of the lateral soft-tissue film of the neck in tumor diagnosis and in following tumor response to radiotherapy. He described the normal radiographic anatomy and the principles of tumor interpretation, based on the static findings of a mass projecting into the air passages, distortion of laryngeal structures, and cartilage destruction. Frontal tomography of the larynx, described by Leborgne (3), was the next step of importance. In tomograms the laryngeal structures can be demonstrated free from the overshadowing cervical vertebrae, permitting more accurate localization of tumors and evaluation of the subglottic space. The value of these two radiographic methods has been emphasized repeatedly in the world literature (4–7). The use of multiple maneuvers and contrast material described by Powers et al. (8) is the most recent advance in larynx radiography or laryngography. This examination has proved highly accurate in determining the presence and extent of tumor (9). Since 1948, a larynx tumor survey consisting of a lateral soft-tissue film of the neck and frontal tomograms has been used in this institution (M. D. Anderson Hospital and Tumor Institute, Houston) in all cases of tumors of the larynx. The usefulness of this survey in over 500 cases has recently been reviewed (10). Since July 1961 laryngograms have also been obtained. It is the purpose of this paper to evaluate the respective usefulness of laryngography and the classical tumor survey in the diagnosis of laryngopharyngeal disease. The value of the laryngographic findings in the management and follow-up of patients will be emphasized. Approximately 130 cases which were studied by both methods form the basis of this report. Methodology The natural history of squamous-cell carcinomas of the larynx depends on the anatomic site of origin, and for this reason it is on this site that their classification in this institution is based. Even when the tumor has extended to involve several sites, an attempt to determine the original is made. The anatomic divisions of the classification are illustrated in Figure 1. The laryngogram and larynx tumor survey were reviewed separately without benefit of clinical information. In each case the presence or absence of tumor, its site of origin, clinical type, and extent were recorded. Accuracy and clinical significance of this information were then assessed from a review of hospital charts and pathologic specimens. Technic of Examinations The Larynx Tumor Survey: The lateral soft-tissue film is obtained during phona-tion, with the patient erect at 6 feet target-film distance.