Aryepiglottic Fold Research Articles

Comparison of laryngoscopic, glottal and vibratory parameters among Estill qualities – Case study

Estill Voice Training (EVT) is an effective educational system for developing and controlling distinct voice qualities used in contemporary commercial singing. EVT teaches six vocal qualities that differ at 13 levels. This study aims to investigate whether the distinct vocal qualities taught by EVT can be systematically differentiated based on laryngoscopic observations and vocal fold oscillation parameters. To investigate the differences in six EVT qualities, laryngeal dimensions and glottal area waveform parameters were measured in a single female subject who performed it in one-octave scale. Glottis Analysis Tools (GAT) were used to measure these parameters and phonovibrograms were obtained from the analysis. The resulting data were subjected to factor analysis to identify the systematic differences between EVT qualities. High-speed videolaryngoscopy analysis revealed a significant influence of vocal qualities on vocal fold oscillations. The factor analysis of the data identified three factors based on laryngeal dimension and four factors derived from GAT parameters. The first GAT factor was influenced by posterior adduction and distinguished belt quality from other qualities, suggesting a significant influence of the aryepiglottic sphincter. The second GAT factor contained parameters derived from glottal length and amplitude, suggesting a relationship not only with vocal registers but also with laryngeal height. The third GAT factor was best related to body-cover figure and phonation type (membranous medialization), while the fourth GAT factor was related to the amplitude-length-ratio. These findings suggest that vocal fold oscillations can be used to distinguish between Estill voice qualities.

Transoral Laser-Assisted Infrahyoid Supraglottic Laryngectomy for Selected Patients With Supraglottic Cancer.

Supraglottic laryngectomy has evolved from open to transoral endoscopic approaches with advancements in surgical techniques and instruments such as lasers, endoscopes, ultrasonic devices, and robotics. Transoral laser-assisted microsurgery has emerged as an effective treatment option, offering faster functional recovery and serving as an alternative to partial laryngectomy or non-surgical therapies. Traditional endoscopic supraglottic laryngectomy involves resection of both suprahyoid and infrahyoid supraglottic structures. However, in cases where the tumor is limited to the infrahyoid epiglottis, a new technique known as transoral laser-assisted infrahyoid supraglottic laryngectomy allows for tumor removal while preserving the suprahyoid epiglottis, aryepiglottic folds, and vallecula, ensuring optimal preservation of laryngopharyngeal function. This procedure enables patients to swiftly return to their daily routines with minimal complications. This article discusses the surgical technique, potential indications, and advantages and disadvantages of the new approach for infrahyoid epiglottic cancer.

Extent and Effect of Covering Laryngeal Structures with Synthetic Laryngeal Mucus via Two Different Administration Techniques

The first goal of this study was to investigate the coverage of laryngeal structures using two potential administration techniques for synthetic mucus: inhalation and lozenge ingestion. As a second research question, the study investigated the potential effects of these techniques on standardized voice assessment parameters. Fluorescein was added to throat lozenges and to an inhalation solution to visualize the coverage of laryngeal structures through blue light imaging. The study included 70 vocally healthy subjects. Fifty subjects underwent administration via lozenge ingestion and 20 subjects performed the inhalation process. For the first research question, the recordings from the blue light imaging system were categorized to compare the extent of coverage on individual laryngeal structures objectively. Secondly, a standardized voice evaluation protocol was performed before and after each administration to determine any measurable effects of typical voice parameters. The administration via inhalation demonstrated complete coverage of all laryngeal structures, including the vocal folds, ventricular folds, and arytenoid cartilages, as visualized by the fluorescent dye. In contrast, the application of the lozenge predominantly covered the pharynx and laryngeal surface toward the aryepiglottic fold, but not the inferior structures. All in all, the comparison before and after administration showed no clear effect, although a minor deterioration of the acoustic signal was noted in the shimmer and cepstral peak prominence after the inhalation. Our findings indicate that the inhalation process is a more effective technique for covering deeper laryngeal structures such as the vocal folds and ventricular folds with synthetic mucus. This knowledge enables further in vivo studies on the role of laryngeal mucus in phonation in general, and how it can be substituted or supplemented for patients with reduced glandular activity as well as for heavy voice users.

The airway management and treatment of newborns with micrognathia and laryngomalacia

Objective:To explore the perioperative airway management and treatment of newborns with micrognathia and laryngomalacia. Methods:From January to December 2022, a total of 6 newborns with micrognathia and laryngomalacia were included. Preoperative laryngoscopy revealed concomitant laryngomalacia. These micrognathia were diagnosed as Pierre Robin sequences. All patients had grade Ⅱ or higher symptoms of laryngeal obstruction and required oxygen therapy or non-invasive ventilatory support. All patients underwent simultaneous laryngomalacia surgery and mandibular distraction osteogenesis. The shortened aryepiglottic folds were ablated using a low-temperature plasma radiofrequency during the operation. Tracheal intubation was maintained for 3-5 days postoperatively. Polysomnography（PSG） and airway CT examination were performed before and 3 months after the surgery. Results:Among the 6 patients, 4 required oxygen therapy preoperatively and 2 required non-invasiveventilatory support. The mean age of patients was 40 days at surgery. The inferior alveolar nerve bundle was not damaged during the operation, and there were no signs of mandibular branch injury such as facial asymmetry after the surgery. Laryngomalacia presented as mixed type: type Ⅱ+ type Ⅲ. The maximum mandibular distraction distance was 20 mm, the minimum was 12 mm, and the mean was 16 mm. The posterior airway space increased from a preoperative average of 3.5 mm to a postoperative average of 9.5 mm. The AHI decreased from a mean of 5.65 to 0.85, and the lowest oxygen saturation increased from a mean of 78% to 95%. All patients were successfully extubated after the surgery, and symptoms of laryngeal obstruction such as hypoxia and feeding difficulties disappeared. Conclusion:Newborns with micrognathia and laryngomalacia have multi-planar airway obstruction. Simultaneous laryngomalacia surgery and mandibular distraction osteogenesis are safe and feasible, and can effectively alleviate symptoms of laryngeal obstruction such as hypoxia and feeding difficulties, while significantly improving the appearance of micrognathia.

A Novel Approach for the Treatment of Intractable Aspiration After Supracricoid Laryngectomy.

This manuscript aims to present a novel and successful intervention for intractable aspiration following a supracricoid laryngectomy (SCL) that may avoid the need for total laryngectomy in patients experiencing intractable aspiration after SCL. This report describes a novel approach to treat intractable aspiration and feeding tube-dependency due to an incomplete posterior apposition of the laryngeal surface of the epiglottis to the arytenoids after a SCL in a 67-year-old man. The right and left aryepiglottic folds and the median glossoepiglottic fold were denuded using a CO2 laser. Then, an arytenoepiglottopexy was completed by placing 4-0 Vicryl between the lateral aspect of the epiglottis and arytenoids; thus, approximating these structures. Two weeks after surgery, fiberoptic endoscopic evaluation of swallowing demonstrated improved closure of the larynx upon swallowing with great upgrading in the Penetration-Aspiration scale (PAS). PAS improved from a 6 to 2, corresponding to, transient penetration for moderately thick liquids and puree solids. He also demonstrated improved secretion management and airway protection. Following a 4-week course of intensive dysphagia therapy, a modified barium swallow revealed a significant improvement in airway protection, with a PAS score of 1 (no airway invasion). Chronic aspiration is a life-threatening condition that can severely reduce patients' quality of life. Despite the use of current therapeutic approaches, a subset of patients will remain plagued by persistent symptoms. We introduce an innovative, simple, and quick endoscopic technique that offers benefit in controlling aspiration after SCL. NA.

The modified Valsalva maneuver in hypopharynx CT scan

Objective:To analyze the significance and factors influencing of CT scan under the modified Valsalva maneuver. Methods:Clinical data of 52 patients with hypopharyngeal carcinoma diagnosed from August 2021 to December 2022 were collected, all patients had calm breathing CT scan and modified Valsalva maneuver CT scan. Compare the exposure effect of the aryepiglottic fold, interarytenoid fold, postcricoid area, piriform fossa apex, posterior hypopharyngeal wall, and glottis with each CT scanning method. The effects of age, neck circumference, neck length, BMI, tumor site, and T stage on the exposure effect were analyzed. Results:In 52 patients, 50 patients（96.15%） completed CT scan at once time. The exposure effect of the CT scan under modified Valsalva maneuver in the aryepiglottic fold, interarytenoid fold, postcricoid area, piriform fossa apex, posterior hypopharyngeal wall was significantly better than CT scan under calm breathing（Z=-4.002, -8.026, -8.349, -7.781, -8.608, all P<0.01）, while CT scan under modified Valsalva maneuver was significantly worse in glottis than CT scan under calm breathing（Z=-3.625, P<0.01）. In the modified Valsalva CT scan, age had no obvious effect on the exposure effect. The exposure effect was better with long neck length, smaller neck circumference, smaller BMI and smaller T stage. The exposure of postcricoid carcinoma was better than pyriform sinus carcinoma and posterior hypopharyngeal wall carcinoma. But differences were not all statistically significant. Conclusion:The anatomical structure of the hypopharynx was clearly under CT scan with modified Valsalva maneuver, which clinical application is simple, but the effect of glottis was worse. The influence of age, neck circumference, neck length, BMI, and tumor T stage on the exposure effect still needs further investigation.

Laryngeal Anaplastic Lymphoma Kinase-Positive B-cell Lymphoma: Case Report and Review.

Larynx is an uncommon extranodal site for non-Hodgkin lymphoma (NHL). Anaplastic lymphoma kinase (ALK)-positive B-cell lymphoma is a rare and aggressive form of NHL. A 19-year-old male presented to the ENT department with globus sensation, hoarseness, cervical lymphadenopathy and weight loss. A 70-degree rigid endoscopic examination of the larynx showed a vascular, irregular, submucosal mass arising from the right aryepiglottic fold causing near complete obstruction of the laryngeal airway. PET-CT showed hypermetabolic lesions in the supraglottis, cervical lymph nodes, cervical spine, ribs and abdominal lymph nodes. Biopsy was taken from the supraglottic mass as well as the enlarged cervical lymph nodes, which revealed ALK-positive large B-cell NHL. In this report, we present a rare case of ALK-positive large B-cell NHL of the larynx, discussing its clinical, radiological and pathological features. A limited review of literature is also presented. There is a need to develop a database for the description of lymphomas affecting the larynx and this case report adds to the existing knowledge of this rare entity.

Clinicopathological Study of Supraglottic Laryngeal Malignancies

Background: Laryngeal malignancy is the second most common malignancy in head neck region worldwide. Incidence of supraglottic carcinoma is more common in this country which interferes with most vital functions in the sufferers like voice, respiration and swallowing by virtue of its anatomical location, local infiltration and direct extension.&#x0D; Objectives: To find out the clinicopathological profile of supraglottic laryngeal malignancies of the patients attending in a tertiary level Hospital.&#x0D; Methods: A cross sectional study was conducted among seventy eight cases of supraglottic carcinoma who were histopathologically proven selected from the in-patient department of ENT and Head -Neck Surgery Dhaka Medical College Hospital, Dhaka during January 2020 to July 2021.&#x0D; Results: Among 78 cases in this study, male: female ratio 10.1:1 and mean age was 52.1 (± 4.6) years with the range from 40 to 78 years. Majority of the patients came from low socioeconomic condition (79.5%). Regarding habit 93.6% of cases were smoker and 59% are habituated in chewing betel nut and leaves, 3.8% were with chewing tobacco and alcohol 2.6%. Most of patients presented with more than one symptom and the commonest was change of voice (87.2%), which followed by dysphagia (78.2%), neck swelling (55.1%), irritable cough (32%) and dyspnoea (20.5%). A big portion of the patients (39.7%) had T2 lesion followed by T3 lesion (38.5%), T1 lesion (11.5%) and T4 lesion (10.3%) clinically. Clinical nodal involvement presented in 55.1% cases and there was no distance metastasis. 56 (71.8%) patients had exophytic growth and 22 (28.2%) patients had ulcerative growth. A large portion of the patients (65.4%) had growth in Aryepiglottic fold followed by False Cord (34.6%), arytenoid (29.5%) and Epiglottis (25.6%). On histopathological evaluation, Squamous cell carcinoma (SCC) was present in 85.8% cases, well differentiated (14.1%), moderately differentiated (53.8%), and poorly differentiated (17.9%). While Adenocarcinoma found in 7.7% cases and Non-Hodgkin Lymphoma present in 6.4% cases.&#x0D; Conclusion: Supraglottic carcinoma usually occurs in 5th decade with male predominancy in poor socio economic group. Smoking, chewing (tobacco and betel nut) habits and alcohol consumption have got strong relation in the causation of supraglottic carcinoma.More than half of the cases has nodal metastasis and predominant histological type was squamous cell carcinoma. &#x0D; Bangladesh J Otorhinolaryngol 2022; 28(2): 141-148

Frequency of Regional Metastasis in Supraglottic Carcinoma of Larynx

Background: Incidence of laryngeal cancer still high among the upper aerodigestive tract. 85–95% of these laryngeal cancer is squamous cell carcinoma. Locally advanced laryngeal cancer metastasize more. Supraglottic cancers have the highest prevalence of regional metastases among laryngeal cancers.&#x0D; Objectives: To evaluate the frequency of regional metastasis in supraglottic carcinoma of larynx.&#x0D; Methods: This cross-sectional study was conducted including 40 patients with supraglottic Carcinoma of Larynx over a period of six months from June to November 2014 in the ENT and Head Neck Surgery department of Rajshahi Medical College Hospital, Rajshahi. Those with glottic carcinoma, subglottic carcinoma, hypopharyngeal carcinoma, metastatic neck node without any primary site (Occult primary) were excluded from the study. FNAC from neck node was done in patients with palpable neck node.&#x0D; Results: Most of the patients 19 (47.5%) was in age group 50-60 years with mean age 54.5±13.2 years. Most of the patients present with more than one symptom &amp; the commonest presenting symptoms was cough and irritation 35(87.5%) followed by dysphagia 26(65%) and change of voice 24(60%). A good number of patients, 16(40%) was presented with neck swelling. Among 40 patients, 16(40%) had their regional lymph nodes involved. Level-II lymph nodes were involved in higher number of cases 10(62.5%). Nodes in early stage of involvement were found in most cases 9(56.5%). Homolateral involvement of nodes was found in most cases 13(81.3%).Most of the supraglottic growths 22(55.0%) was exophytic in appearance. The common site of supraglottic carcinoma in this study was aryepiglottic fold and arytenoids 20(50.0%). Among the patients, 31(77.5%) had T2 tumours. Amon them, 16(40%) were in stage-III followed by stage-II 10(25%).&#x0D; Conclusion: Regional metastasis is a very useful prognostic indicator. Supraglottis is rich in lymphatic drainage and a high proportion of these tumors spread to lymph nodes.&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(2): 180-185

DEATH DUE TO DELAYED COMPLICATION IN HANGING - A CASE REPORT

Hanging is one of the most common methods of painless suicide in India. Hanging is a form of asphyxia which is caused by the suspension of the body by a ligature encircling the neck, where the constricting force is the weight of the body. In most cases of hanging cases, the death of the individual occurs immediately or the usual average period is about 3 to 5 minutes. Causes of death in case of hanging are asphyxia, venous congestion, cerebral ischemia, carotid compression or fracture of vertebrae resulting in penetration into the spinal cord. In this article, the authors report a rare case of a 19-year-old male individual, who attempted suicide by hanging, survived for 7 days in ICU in an unconscious state and then died after the best efforts of the ICU team. Delayed death in hanging can be due to aspiration pneumonia, oedematous or haemorrhagic swelling of pharyngeal tissues or aryepiglottic folds, emphysema, infections, oedema of the larynx, lungs and brain pathology like an abscess, hypoxic encephalopathy, infarction and softening. In post-mortem examination, the doctor must remove the ligating material after carefully preserving the knot, and look for any marks of injury or struggle that may suggest the violence leading to strangulation. Prolonged resuscitative measures must be tried in all the victims of attempted hanging, and a guarded prognosis must be described.

Augmentation-lateralization for Unilateral Vocal Fold Palsy With Airway Obstruction: A New Concept in Laryngology.

This study presents an efficient, safe, effective, and novel technique of reconstructive transoral laser microsurgery (R-TLM) for the treatment of unilateral vocal fold paralysis (UVFP) with airway obstruction. It is based on the augmentation of the immobile and potentially flaccid and atrophic side while lateralizing the arytenoid and posterior part of the vocal fold, thus improving breathing without sacrificing phonation and commonly improving it. Retrospective cohort study through data from medical records and operative notes. Patients with UVFP with exertional dyspnea with or without dysphonia were included in this report. The vocal fold is augmented by harvesting the aryepiglottic fold soft tissues and the upper part of the arytenoid and placing them into the paraglottic space as a pedicled microflap, thus augmenting the anterior two thirds of the vocal fold while lateralizing the remaining arytenoid and posterior third of the vocal fold by an internal traction suture to improve airway. Postoperative breathing, phonation and swallowing were assessed. Twenty two cases are reported in the study. Follow-up evaluations ranged from 6 to 12 months. All cases showed successful and durable improvement of breathing and phonation. None required tracheostomy or gastrostomy pre- or postoperatively. Augmentation-lateralization is a novel, safe, and effective minimally invasive technique that allows airway improvement with good results on phonation in patients with challenging UVFP with airway obstruction.

Laryngeal Schwannoma Triggered Life-threatening Acute Airway Obstruction- A Rare Case Report with Review of Literature.

Schwannoma in larynx is a rare presentaion. Laryngeal schwannomas are characterstically slow growing benign tumour usually arising from false cord and aryepiglottic fold with globus sensation being the most common presentation. Seldom it can present as stridor which need immediate intervention for survival of the patient. We present a case of 53 year female who presented with stridor at emergency and emergency tracheostomy was done. This patient had a history of dysphagia to solid food, hoarseness of voice and symptoms of aspirations. 70 degree rigid endoscopy and CEMRI of neck was performed to see the extent of the laryngeal lesion causing stridor. Tumor was excised completely by external transcervical approach. Histopathological reports suggested this tumor as schwannoma. Large obstructive laryngeal schwannoma though a unusual presentation but with immediate tracheostomy, proper diagnostic work up and precise surgical approach can give excellent recovery and post operative outcome for the patient.

A Study on Quality of Life in Post-tracheostomised Patients.

Tracheostomy is a complex procedure which includes special care and attention with respect to the stoma and wound. But apart from surgical pitfalls certain qualities of life are also affected which needs due consideration for positive prognostic outcomes. To assess the quality of life in post tracheostomised patients. This study was a hospital based observational study conducted for a period of one year and included 97 patients. All patients underwent tracheostomy in ENT department and Central ICU. Nineteen post tracheostomy quality of life parameters were evaluated in 1st, 4th and 12th week interval. 83.51% were male belonging to 6th and 7th decade. Most of them were tracheostomised on emergency basis (90.72%) for malignant causes (82.47%) and 95.88% of them had it for temporary period of time. Aryepiglottic folds were the most common site of malignant lesion. In the 1st week post tracheostomy, all parameters were affected except taste, smell and aesthetic state whereas in the following weeks it was employment, anxiety and voice production which were the affected quality of life. Most people had upper airway malignant growth and due to late presentation, they had to be put under emergency tracheostomy. Thus, leading to less time in pre-operative counselling that is a must in improving post-operative period quality of life. Awareness is required for timely screening of patients from 5th decade onwards so that adequate and timely treatment can be provided.

Clinical Diagnosis and Treatment of Primary Laryngeal Neuroendocrine Carcinoma.

This study aims to investigate the clinical diagnosis and treatment characteristics of primary laryngeal neuroendocrine carcinoma. 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. 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 6months to 6years. One patient had removed laryngeal tumor and epiglottis by a low-temperature plasma radiofrequency ablation, recurrence 1year after surgery, and no recurrence for 5years after supraglottic horizontal hemilaryngectomy combined with prophylactic cervical lymph node dissection, no recurrence for the other 4patients after 6months to 4years of follow-up. 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.

Chronic Qat Chewing Effects on Nasopharynx, Oropharynx, and Laryngopharynx

Background Qat (also known as Khat, Kat, Miraa) is a green plant Catha edulis planted mainly in East and South Africa, and The Arabian Peninsula. It is widely and traditionally consumed by people in some regions. It has general effects on different systems such as cardiovascular and nervous system. Local effects were mainly described in the oral cavity such as periodontitis and white keratotic lesions. Scarce studies proved its relationship with cancer development. To date, there is a literature gap in reporting other local manifestations. In this study, the authors discuss additional local manifestations noted with chronic qat chewing. Aim In this study, the pharyngeal effects of chronic qat consumption were described. Material and methods This study is a retrospective study retrieved from an Ear, Nose, and Throat clinic records. All patients attending the clinic with history of chronic qat chewing more than 10 years were included in the study. Patients’ complaints were analyzed for the presence of voice change, stridor, and dysphagia. Nasopharyngeal and laryngeal endoscopy were used to assess the velopharynx, oropharynx, epiglottis, aryepiglottic folds, and pyriform sinuses. Results This study included 22 patients. Most patients presented with muffled voice and stridor on exertion. More than half of the cases developed velopharyngeal stenosis. All cases had uvular edema and associated deformity of the posterior pillar and the laryngeal structure were described. Conclusion Changes in the nasopharynx, oropharynx, larynx, and hypopharynx were noted in patients with chronic qat consumption.

Assessment of Laryngeal Sensory Function using a Tactile Aesthesiometer in Healthy Adults.

Laryngeal sensory function in healthy adults was assessed through the delivery of tactile stimuli using Cheung-Bearelly monofilaments. 37 healthy adults were recruited with 340 tactile stimuli analyzed. Four calibrated tactile stimuli were delivered to three laryngeal sites: false vocal fold (FVF), aryepiglottic fold (AEF), and lateral pyriform sinus (LPS). Primary outcome was the elicitation of laryngeal adductor reflex (LAR). Secondary outcomes were gag, patient-reported laryngeal sensation (PRLS), and perceptual strength. Analysis was performed with mixed effects logistic regression modeling. Positive LAR was observed in 35.7%, 70.2%, and 91.2% of stimuli at LPS, AEF, and FVF respectively. LAR rates were significantly associated with laryngopharyngeal subsite (p< 0.001), tactile force (p= 0.001), age (p= 0.022) and sex (p= 0.022). LAR, gag, PRLS, and perceptual strength significantly increased as a more medial laryngeal subsite was stimulated and as stimulus force increased. Each of the ten years of age increase was associated with 19% reduction in odds of LAR (aOR=0.81, 95% CI [0.68, 0.97]; p= 0.022). Male gender was associated with a 55% reduction in odds of LAR (aOR=0.45, 95% CI [0.23, 0.89]; p= 0.022). LAR elicitation capability decreases in the male gender, aging, and a more lateral subsite. This study provides insight into the pathophysiology of hypo- and hyper-sensitive laryngeal disorders and is paramount to making accurate diagnostic assessments and finding novel treatment options for various laryngological disorders. Laryngoscope, 133:2525-2532, 2023.

Edema of the larynx - an emergency caused by angina Ludovici

Introduction. Laryngeal edema is a rare complication of angina Ludovici. Infections of this region are mostly of dentogenic origin, less often caused by tonsillitis or other infections in the pharynx. We present a case of a patient with laryngeal edema and dyspnea caused by a lower jaw tooth infection and an ipsilateral submandibular abscess. Case outline. The clinical picture of our patient progressed rapidly ? from toothache, painful swelling of the floor of the oral cavity, submandibular and submental regions, bilaterally, all the way to lifethreatening dyspnea. A flexible nasopharyngolaryngoscopy was performed. Swelling of the base of the tongue on the left side was observed, along with pronounced edema of the aryepiglottic fold on the same side, which narrowed the breathing space. Since the breathing space was significantly reduced, the patient was urgently hospitalized. The surgical treatment was carried out in the form of an external incision and drainage of the abscess collection of the left submandibular region, with the use of oxygen support and parenteral therapy, in accordance with the recommendations from the available medical literature. Constant monitoring of saturation levels indicated a significant improvement after just a few hours of medicamentous therapy. Conclusion. The goal of our work is to point out a very rare but serious complication, laryngeal edema, which can lead to airway obstruction even in the first few days of the development of the infection, and endanger the life of the patient.

Laryngopharyngeal Lesion Appeared in a Patient With Eosinophilic Esophagitis

Question: A 52-year-old woman with eosinophilic esophagitis (EoE) stable on the potassium-competitive acid blocker vonoprazan (VPZ) was presented with a cobblestone-like lesion lying between the hypopharynx and the aryepiglottic fold (Figure A). The lesion was found on esophagogastroduodenoscopy (EGD) performed to examine her newly developed mild hemoptysis. The pharynx and larynx were intact 4 months earlier (Figure B). Chest radiography and sputum test for tuberculosis were negative. Her medical condition included dyslipidemia and urticaria. She did not drink alcohol or smoke cigarettes. For further assessment, she was referred to an otorhinolaryngologist, and subsequently the lesion was biopsied with the use of laryngoscopy under general anesthesia. Histologic evaluation found nuclear enlargement with spongiosis in the epithelium cells (Figure C) and remarkable infiltration of inflammatory cells in the subepithelial layer (Figure D). There was insignificant eosinophilia in the biopsies. p53 immunohistochemical staining showed a few positive epithelial cells (Figure E). In addition, enhanced computed tomography found no lymphadenopathy in the neck. On the basis of the findings, the lesion was diagnosed as possible low-grade dysplasia. From then on, she had been closely monitored, in which both the pharyngo-laryngeal lesion and EoE had not changed for 1 year until both conditions exacerbated with newly developed hoarseness. Esophageal biopsy showed increase in intraepithelial eosinophil counts up to 46 per high-power field (Figure F). For deterioration of EoE, topical corticosteroid (200 μg oral fluticasone twice per day) was added to VPZ. Her symptoms gradually improved, and 2 months later a follow-up EGD found significant improvement in not only EoE but also the pharyngo-laryngeal lesion (Figure G). This unexpected response to the treatment led to histologic reassessment of the lesion.

Neoadjuvant Chemotherapy and Endoscopic Resection for Hypopharyngeal Cancer

A 79-year-old man was diagnosed with a cT2 hypopharyngeal cancer and cT2 esophageal cancer by upper gastrointestinal endoscopy. Computed tomography showed swelling of the thoracic paratracheal lymph nodes (cN1 for esophageal cancer). He first underwent neoadjuvant chemotherapy for esophageal cancer (2 courses of cisplatin 80 mg/m2/d on Day 1 and fluorouracil 800 mg/m2/d on Days 1–5) followed by esophagectomy with lymphadenectomy and reconstruction of the gastric tube. Before chemotherapy, the hypopharyngeal cancer extended from the aryepiglottic fold to the posterior cricoid region and right piriform sinus (Figure A).

Anaesthesia and laryngomalacia - A case report

Laryngomalacia is one of the commonest causes of congenital stridor in neonates. The treatment depends on the severity of the stridor. We present a case of 12 day old neonate with a history of stridor who was diagnosed to have laryngomalacia on clinical examination and confirmed by flexible fibreoptic bronchoscopy. The neonate underwent excision of excessive aryepiglottic fold under general endotracheal anaesthesia with controlled ventilation as the definitive surgery.