Laryngeal Region Research Articles

The subglottic involvement is an independent risk factor for recurrence of laryngeal amyloidosis.

To analyze the risk factors for recurrence of laryngeal amyloidosis (LA). The clinical data of patients with LA admitted in the Otolaryngology Head and Neck Surgery Department of the Second Affiliated Hospital of Xi'an Jiaotong University from August 2009 to June 2022 were analyzed retrospectively; then, the risk factors for recurrence and their impacts on the recurrence time were also analyzed. Of the 44 patients with LA, the majority (38 cases, 86.4%) only involved one anatomical region and the others (6 cases, 13.6%) involved two laryngeal regions concurrently. Overall, the glottic region was the most commonly affected area (28 cases, 63.6%), followed by the supraglottic region (16 cases, 36.4%) and subglottic region (6 cases, 13.6%). In addition, all the lesions were categorized as isolated nodule (31.8%), submucosal localized deposition (52.3%), and submucosal diffuse deposition (15.9%) according to their morphologies under electronic laryngoscope. Finally, six patients (13.6%) had recurrence after operation with a median recurrence time of 24.5months, and subglottic involvement was confirmed to be an independent risk factor for recurrence of LA by univariate and multivariate logistic regression analyses (P < 0.05). Meanwhile, the patients with subglottic involvement presented as submucosal diffuse deposition had a considerable shorter recurrence time (t = 5.759, P = 0.005). The subglottic involvement is an independent risk factor for recurrence of LA.

Self-Reported Stress, Trauma, and Prevalence of Laryngoresponders in the General Population.

It has been proposed that some individuals are "laryngoresponders" (LRs) in that their stress manifests in the laryngeal region and laryngeal functions (e.g., voice and breathing). Preliminary data support the notion that LRs might differ from nonlaryngoresponders (NLRs) in their self-reported past trauma and recent stress. The purpose of this study was to establish the point prevalence of self-identified LRs in the general population. Using a web-based questionnaire, participants reported up to 13 stress-vulnerable bodily regions and described symptom nature and severity for each region. At the end of the questionnaire, they were explicitly prompted to report whether their laryngeal region or its functions were affected by stress. Participants were categorized a posteriori as Unprompted LRs, Prompted LRs, Inconsistent LRs, or NLRs. We compared LR and NLR groups on the Perceived Stress Scale (PSS-10) and the Childhood Trauma Questionnaire (CTQ-SF). We also redistributed the survey to a subset of participants to establish grouping reliability. A total of 1,217 adults responded to the survey, and 995 provided complete data sets. Of those, 15.7% were classified as Unprompted LRs, 26.7% as Prompted LRs, 3% as Inconsistent LRs, and 54.6% as NLRs. Unprompted LRs demonstrated significantly higher/worse PSS-10 and CTQ-SF scores than all other groups. Reliability of LR classification was moderate upon follow-up, κ = .62, 95% confidence interval [0.47, 0.77]. Unprompted LRs described their symptoms in ways that were indistinguishable from patients with functional voice disorders (e.g., throat clenches, voice gets tired easily, lose my voice, voice gets hoarse). The method of self-report solicitation impacted the resulting response. Specifically, the report of larynx-related symptoms differed substantially depending on whether or not the participants were directly prompted to consider the larynx and its related functions.

Influence of pathogens on host genome and epigenome in development of head and neck cancer.

Head and neck cancer (HNSCC) is a heterogeneous group of cancers, affecting multiple regions such as oral cavity, pharynx, larynx, and nasal region, each showing a distinct molecular profile. HNSCC accounts for more than 6 million cases worldwide, soaring mainly in the developing countries. The aetiology of HNSCC is complex and multifactorial, involving both genetic and environmental factors. The critical role of microbiome, which includes bacteria, viruses, and fungi, is under spotlight due to the recent reports on their contribution in the development and progression of HNSCC. This review focuses on the effect of opportunistic pathogens on the host genome and epigenome, which contributes to the disease progression. Drawing parallels from the host-pathogen interactions observed in other tumour types arising from the epithelial tissue such as colorectal cancer, the review also calls attention to the potential explorations of the role of pathogens in HNSCC biology and discusses the clinical implications of microbiome research in detection and treatment of HNSCC. Our understanding of the genomic effects of the microbes on the disease progression and the mechanistic insights of the host-pathogen interaction will pave way to novel treatment and preventive approaches in HNSCC.

Abstract 5765: Promoter DNA methylation patterns in oral, laryngeal, and oropharyngeal anatomical regions are associated with tumor differentiation, nodal involvement, and survival in Latinos

Abstract Hispanics/Latinos, Black Americans, and poor Non-Latino Whites in the United States are at higher risk of developing head and neck squamous cell carcinoma (HNSCC). The incidence of HNSCC in Puerto Rico is 2.5 higher than for Hispanics/Latinos living in the United States. These health disparities are a serious public health concern due to HNSCC high mortality and morbidity rates, higher treatment costs, and significant quality of life burden. We hypothesized that the discovery of actionable targets for HNSCC early detection, diagnosis, prognostication. Differentially Methylated Regions (DMRs) can be used as HNSCC diagnostic, prognostic, and therapeutic targets in precision medicine workflows. DNA from 23 HNSCC samples and 10 healthy oral tissue samples from patients in Puerto Rico were hybridized to a genome-wide tiling array to identify DMRs in a discovery cohort. Downstream analyses identified differences in promoter DNA methylation patterns in oral, laryngeal, and oropharyngeal anatomical regions associated with tumor differentiation, nodal involvement, and survival. Genome-wide DMR analysis showed 2,565 DMRs common to the three subsites. We identified 738 DMRs unique to laryngeal cancer (n=7), 889 DMRs unique to oral cavity cancer (n=10), and 363 DMRs unique to pharyngeal cancer (n=6). Based on the genome-wide analysis, and a gene ontology analysis, we selected 10 candidate genes to test for prognostic value and association with clinicopathological features. TIMP3 was associated with tumor differentiation in oral cavity cancer (p =0.039), DAPK1 was associated with nodal involvement in pharyngeal cancer (p = 0.017), and PAX1 was associated with tumor differentiation in laryngeal cancer (p = 0.040). We selected 5 candidate genes, DAPK1, CDH1, PAX1, CALCA, and TIMP3, for a prevalence study in a larger validation cohort: 42 oral cavity; 25 pharyngeal; and 52 laryngeal cancer samples. PAX1 hypermethylation differed across HNSCC anatomic sub-sites (p= 0.029), and predominantly detected in laryngeal cancer. Kaplan-Meier survival analysis (p=0.043) and Cox regression analysis of overall survival (p=0.001) showed that DAPK1 methylation is associated with better prognosis in HNSCC. Our findings show that HNSCC sub-sites (oral cavity, pharynx, and larynx) display substantial differences in aberrant DNA methylation patterns among Hispanic/Latinos HNSCC patients in the US. These data suggest further research may lead to the development of diagnostic medical devices, prognostic biomarkers and novel therapeutic targets that may lead to a reduction in HNSCC disparities among Hispanic/Latinos in the US. Citation Format: BIanca Rivera-Peña, Oluwasina Folawiyo, Nitesh Turaga, Rosa J. Rodríguez-Benítez, Marco E. Felici, Jaime A. Aponte-Ortiz, Francesca Pirini, Sebastián Rodríguez-Torres, Roger Vázquez, Ricardo López, David Sidransky, Rafael E. Guerrero-Preston, Adriana Báez. Promoter DNA methylation patterns in oral, laryngeal, and oropharyngeal anatomical regions are associated with tumor differentiation, nodal involvement, and survival in Latinos. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5765.

Safety, feasibility and diagnostic value of Clinical Swallow Examination and FEES in children between 0 and 24 months

BackgroundClinical Swallowing Examination (CSE) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) are relevant diagnostic methods in pediatric dysphagia. Satisfactory and comprehensive healthcare is still not part of the standard diagnostic process. AimsThe purpose of this article is to evaluate the safety, feasibility, and diagnostic value of CSE and FEES in children 0–24 months of age. Study designA retrospective cross-sectional study which was conducted at the pediatric clinic of the University Hospital Düsseldorf, Germany, between 2013 and 2021. SubjectsA total of 79 infants and toddlers with suspected dysphagia were included. Outcome measuresAnalyses of the cohort and FEES pathologies were performed. Dropout criterion, complications and change of diet were recorded. Chi-square identified associations between clinical symptoms and FEES results. ResultsAll FEES examinations were performed without complications and with a completion rate of 93.7 %. Anatomical abnormalities in the laryngeal region were diagnosed in 33 children. Wet voice was significantly associated with premature spillage (p = .028). ConclusionsCSE and FEES are important and uncomplicated examinations for children with suspected dysphagia between 0 and 24 months. They are equally helpful for differential diagnosis of feeding disorders and anatomical abnormalities.The results underline the added value of combining both examinations and their importance for individual nutritional management. History taking and CSE are mandatory as they reflect the everyday eating situation. This study adds essential knowledge to the diagnostic work-up of dysphagic infants and toddlers. Standardizing the examinations and validating dysphagia scales are future tasks.

Microbiome in Nasal Mucosa of Children and Adolescents with Allergic Rhinitis: A Systematic Review

The human upper respiratory tract comprises the nasal cavity, pharynx and larynx regions and offers distinct microbial communities. However, an imbalance and alterations in the nasal mucosa microbiome enhance the risk of chronic respiratory conditions in patients with allergic respiratory diseases. This is particularly important in children and adolescents once allergic rhinitis (AR) is an inflammatory disorder of the nasal mucosa, often associated with an increase in pulmonary allergic inflammation. Therefore, this systematic review aimed to collect scientific data published concerning the microbial community alterations in nasal mucosa of children and adolescents suffering from AR or in association with adenotonsillar hypertrophy (AH) and allergic rhinoconjunctivitis (ARC). The current study was performed using the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Publications related to microbiome alterations in the nasal mucosa in pediatric age, studies including next-generation sequencing platforms, and studies exclusively written in the English language were some of the inclusion criteria. In total, five articles were included. Despite the scarcity of the published data in this research field and the lack of prospective studies, the genera Acinetobacter, Corynebacterium, Dolosigranulum, Haemophilus, Moraxella, Staphylococcus and Streptococcus dominate the nares and nasopharyngeal microbiome of the pediatric population regardless of their age. However, an imbalance in the resident bacterial community in the nasal mucosa was observed. The genera Acinetobacter, and Pseudomonas were more abundant in the nasal cavity of AR and AH children, while Streptococcus and Moraxella were predominant in the hypopharyngeal region of AR infants. An abundance of Staphylococcus spp. was also reported in the anterior nares and hypopharyngeal region of children and adolescents suffering from AR passive smoke exposure and ARC. These records suggest that different nasal structures, ageing, smoke exposure and the presence of other chronic disorders shape the nasal mucosa microbiome. Therefore, the establishment of adequate criteria for sampling would be established for a deeper understanding and a trustworthy comparison of the microbiome alterations in pediatric age.

First-line antibiotic treatment in patients with localized extragastric mucosa-associated lymphoid tissue lymphoma.

Between January 2010 and December 2015, we enrolled 28 patients with stage IEI/IIE1 extragastric mucosa-associated lymphoid tissue (MALT) lymphoma who received first-line antibiotic treatment, after informing them about the pros and cons of alternative therapies. In addition, during the same period, 64 patients with stage IE/IIE1 disease who received conventional treatment were selected as the control group. The most common primary sites were the ocular adnexal area (17 cases), followed by the salivary glands (four cases), pulmonary (three cases), and thyroid, trachea, larynx, and colon region (one case each). First-line antibiotic treatment resulted in an overall response rate of 57.1%: 12 patients achieved complete remission (CR), while four achieved partial remission (antibiotic-responsive tumors). Monoclonal gammopathy was significantly prevalent in antibiotic-unresponsive tumors than in antibiotic-responsive tumors (50.0% [6/12] vs. 12.5% [2/16], p=0.044). After a median follow-up of 7years, all patients with CR remained lymphoma-free, with 7-year event-free survival (EFS) and overall survival (OS) rates of 62.7% and 96.4%, respectively. The 7-year EFS and OS rates of patients who received conventional treatments were 73.1% and 91.1%, respectively. Compared with that noted in patients who received conventional treatment, antibiotic treatment was effective in some patients with localized extragastric MALT lymphoma.

S2k Guideline for the diagnosis and treatment of mucous membrane pemphigoid.

Mucous membrane pemphigoid (MMP) is a pemphigoid disease with predominant mucous membrane involvement. It mainly affects the mucous membranes of the mouth, eyes, nose and pharynx, but also the larynx, trachea, esophagus, genital and perianal regions. The manifestation of the disease covers a wide spectrum from gingival erythema and single oral lesions to severe tracheal strictures that obstruct breathing and conjunctival scarring with marked visual impairment and, not infrequently, blindness. In addition to a clinical picture of predominant mucosal involvement, diagnosis is based on direct immunofluorescence of a peri-lesional biopsy and serology. The main target antigen is BP180 (collagen XVII), and reactivity with laminin 332 is associated with malignancy in approximately 25% of MMP patients. The treatment of MMP is challenging. On the one hand, due to the involvement of different mucous membranes, good interdisciplinary cooperation is required; on the other hand, due to the rarity of the disease, no randomized controlled clinical trials are available. The aim of this guideline is to present the clinical picture, including severity and scoring systems, and to give guidance for diagnosing and treating this complex disease. In MMP, interdisciplinary cooperation plays an essential role as well as the prompt diagnosis and initiation of adequate therapy in order to avoid irreversible damage to the mucous membranes with serious complications.

Equine papillomavirus type 2‐associated, carcinomatous lesions of the penis and laryngopharynx of an elderly Icelandic horse gelding

AbstractA 28‐year‐old Icelandic horse gelding was presented with a laryngopharyngeal squamous cell carcinoma. The gelding had been treated for penile carcinoma in situ with a partial phallectomy 2 years earlier. Polymerase chain reaction of tumour DNA and subsequent amplicon sequencing revealed that the equine papillomavirus type 2 E6 oncogene sequences of both lesions were identical. There is strong evidence that equine papillomavirus type 2 is causally associated with genital squamous cell carcinomas and precancerous lesions. Recent reports indicate that equine papillomavirus type 2 might also play an active role in the pathogenesis of approximately 20% of equine squamous cell carcinomas in the oronasal, pharyngeal and laryngeal regions. To the authors’ knowledge, this is the first report of a horse consecutively developing a penile carcinoma in situ and a laryngopharyngeal squamous cell carcinoma that were apparently induced by the same equine papillomavirus type 2 variant. Possible equine papillomavirus type 2 infection pathways in this horse and the importance of early detection of lesions are discussed in this context.

Stomatognathic System Changes in Obese Patients Undergoing Bariatric Surgery: A Systematic Review.

Background: Obesity is a multifactorial chronic disease involving multiple organs, devices, and systems involving important changes in the stomatognathic system, such as in the orofacial muscles, temporomandibular joint, cheeks, nose, jaw, maxilla, oral cavity, lips, teeth, tongue, hard/soft palate, larynx, and pharynx. Patients with obesity indicated for bariatric surgery reportedly presented with abnormalities in the structures and function of the stomatognathic apparatus. This occurs through the accumulation of adipose tissue in the oral cavity and pharyngeal and laryngeal regions. Therefore, this systematic review aimed to elucidate the changes occurring in the stomatognathic system of patients with obesity after undergoing bariatric surgery. Method: Information was searched based on the equations developed with the descriptors obtained in DECS and MESH using the PRISMA methodology. Studies published between 2010 and October 2021 in databases including PubMed, ProQuest, Scielo, Dialnet, EBSCO, and Springer Link were considered. Results: Eighty articles met the inclusion criteria after evaluating the articles, thereby allowing for the determination of the morphophysiological correlation of the stomatognathic system with the population studied. At the morphological or structural level, changes were observed in the face, nose, cheeks, maxilla, jaw, lips, oral cavity, teeth, tongue, palate, temporomandibular joint, neck, muscles, head, shoulders, larynx, and pharynx. At the morphological level, the main changes occurred in, and the most information was obtained from, the labial structures, teeth, muscles, pharynx, and larynx. Physiological changes were in breathing, phonation, chewing, and swallowing, thereby revealing the imbalance in basic and vital functions. Conclusions: Analyzing the changes and structures of obese patients and candidates for bariatric surgery revealed that, in the preoperative period, the evidence is clear owing to the presence of a wide range of information. However, the information is more limited regarding the postoperative period; thus, further research focusing on characterization of the system postoperatively is warranted.

Anatomical variations in the origin of the superior thyroid artery

Superior thyroid artery (STA) is first and lowest branch of external carotid artery (ECA) and it supplies thyroid, parathyroid, upper larynx and neck region. The STA origins either from ECA, common carotid artery (CCA) or its bifurcation level. Various researchers have reported differences in its origin. The STA commencing from the ECA is comparatively more in Indian and Ethiopian but its derivation from CCA bifurcation point is more in Turkey and Korean. Origin of STA in relative to upper border of thyroid cartilage is used as a landmark. The CCA bifurcates into external and internal carotid arteries at same level and occasionally bifurcates at a higher or lower level than its usual site. Origin of STA from CCA is associated with high bifurcation and its origin from the ECA is related with the low CCA division. Comparatively STA origin from CCA or its bifurcation level is more on right side. The CCA developed from third aortic arch and any alteration in development of aortic arches might also contribute to these variations. The STA is an artery of abundant clinical significance and it is recommended to do detailed study of its origin, course, branches, size, and positional relation with the external laryngeal nerve, hyoid bone and thyroid cartilage. Understanding of these variations is immense importance in academic and clinical arena for planning and performing surgical procedures in neck region.

Anatomy matters: The role of the subject-specific respiratory tract on aerosol deposition — A CFD study

The COVID-19 pandemic is one of the greatest challenges to humanity nowadays. COVID-19 virus can replicate in the host’s larynx region, which is in contrast to other viruses that replicate in lungs only, i.e. SARS. This is conjectured to support a fast spread of COVID-19. However, there is sparse research in this field about quantitative comparison of virus load in the larynx for varying susceptible individuals. In this regard the lung geometry itself could influence the risk of reproducing more pathogens and consequently exhaling more virus. Disadvantageously, there are only sparse lung geometries available. To still be able to investigate realistic geometrical deviations we employ three different digital replicas of human airways up to the 7th level of bifurcation, representing two realistic lungs (male and female) as well as a more simplified experimental model. Our aim is to investigate the influence of breathing scenarios on aerosol deposition in anatomically different, realistic human airways. In this context, we employ three levels of cardiovascular activity as well as reported experimental particle size distributions by means of Computational Fluid Dynamics (CFD) with special focus on the larynx region to enable new insights into the local virus loads in human respiratory tracts. In addition, the influence of more realistic boundary conditions is investigated by performing transient simulations of a complete respiratory cycle in the upper lung regions of the considered respiratory models, focusing in particular on deposition in the oral cavity, the laryngeal region, and trachea, while simplifying the tracheobronchial tree. The aerosol deposition is modeled via OpenFOAM\\protect \\relax \\special {t4ht=®} by employing an Euler-Lagrangian frame including steady and unsteady Reynolds Averaged Navier–Stokes (RANS) resolved turbulent flow using the k-ω-SST and k-ω-SST DES turbulence models. We observed that the respiratory geometry altered the local deposition patterns, especially in the laryngeal region. Despite the larynx region, the effects of varying flow rate for the airway geometries considered were found to be similar in the majority of respiratory tract regions. For all particle size distributions considered, localized particle accumulation occurred in the larynx of all considered lung models, which were more pronounced for larger particle size distributions. Moreover, it was found, that employing transient simulations instead of steady-state analysis, the overall particle deposition pattern is maintained, however with a stronger intensity in the transient cases.

Long term outcome of a subcutaneous colonic interposition after pharyngo-laryngectomy for strictures of the larynx and hypopharynx resulting from caustic ingestion: A case report.

IntroductionCaustic agents, also called corrosive agents, could be acids or alkali in nature. If ingested, these agents can injure any part of the aerodigestive tree. Extent of injury depends on the type, concentration, duration of exposure and volume of caustic agent ingested. Serious complications after caustic agent ingestion can occur both in the short term such as hollow viscus perforation and death and in the long term such as stricture formation causing obstruction and lifetime risk of development of carcinoma.Presentation of a caseThis is a case of a 25-year-old female who ingested an unknown substance resulting to a severe stricture of the larynx, hypopharynx, esophagus and pyloroantral region of the stomach. Six months after her tracheostomy and tube jejunostomy, she sought further medical attention in our institution due to inability to swallow food and saliva. She underwent pharyngolaryngectomy (PL) with the strictured esophagus and stomach left in-situ due to extensive adhesions. The subcutaneous colonic interposition reestablished the alimentary continuity by providing enough length for tension-free anastomosis and a more direct route for cervical anastomosis.DiscussionStricture formation is one of the most challenging late complication of corrosive injury. It results from scar formation in response to inflammation of the aerodigestive tract. Key factors in managing caustic strictures include safety of strictured segment resection, choice of replacement organ for reconstruction and route of conduit.ConclusionTiming of surgery and proper selection the surgical procedure for complications of caustic ingestion can result in excellent long term outcomes.

Electromyographic measures of asymmetric muscle control of swallowing in Parkinson's disease.

During the early stages, Parkinson's disease (PD) is well recognized as an asymmetric disease with unilateral onset of resting tremor with varying degrees of rigidity, and bradykinesia. However, it remains unknown if other impairments, such as swallowing impairment (i.e., dysphagia), also present asymmetrically. The primary aim of this study was to examine muscle activity associated with swallow on the most affected side (MAS) and least affected side (LAS) in persons with PD. A secondary aim was to explore the relationship between differences in muscle activity associated with swallow and subjective reports of swallowing impairment and disease severity. Function of muscles associated with swallowing was assessed using surface electromyography placed over the right and left submental and laryngeal regions during three swallows for a THIN and THICK condition. The Swallowing Quality of Life (SWAL-QOL) questionnaire and the Unified Parkinson's Disease Rating Scale (UPDRS) were collected as measures of subjective swallow impairment and disease severity, respectively. Thirty-five participants diagnosed with idiopathic PD and on a stable antiparkinsonian medication regimen completed this study. Results revealed no significant mean difference in muscle activity during swallow between the more and less affected side. For the laryngeal muscle region, a significant difference in coefficient of variation between the MAS and LAS was revealed for peak amplitude for the THIN swallow condition. For the laryngeal muscle region, a significant association was revealed between muscle activity and disease severity but not subjective reports of swallowing impairment. Superficially it appears that swallowing impairment present symmetrical during the early stages of PD, however, our variability data indicates otherwise. These results will be used to inform future studies in specific types of swallowing impairment (i.e., oral dysphagia, pharyngeal dysphagia, and esophageal dysphagia), disease progression, and overall asymmetry.

Diagnostic Accuracy of 18F‐FDG‐PET/CT and 18F‐FDG‐PET/MRI in Detecting Locoregional Recurrence of HNSCC 12 Weeks after the End of Chemoradiotherapy: Single‐Center Experience with PET/MRI

Purpose In head and neck squamous cell carcinoma (HNSCC), the early diagnosis and efficient detection of recurrences and/or residual tumor after treatment play a very important role in patient's prognosis. Positron emission tomography (PET) using 2-deoxy-2-18F-fluoro-D-glucose (18F-FDG) has become an established method for the diagnosis of suspected recurrence in head and neck carcinomas. In particular, integrated PET/MRI imaging that provides optimal soft tissue contrast and less dental implant artifacts compared to PET/CT is an intriguing technique for the follow-up imaging of HNSCC patients. The aim of this study was to evaluate the benefit of PET/MRI compared to PET/CT in post-treatment follow-up imaging of HNSCC patients. Methods This retrospective observational cohort study consists of 104 patients from our center with histologically confirmed HNSCC. All patients received chemoradiotherapy (CRT) and underwent 18F-FDG-PET/CT (n = 52) or 18F-FDG-PET/MRI (n = 52) scan 12 weeks after the end of treatment. Image analysis was performed by two independent readers according to a five-point Likert scale analysis. Results PET/MRI was more sensitive (1.00 vs. 0.77) than PET/CT in the detection of locoregional recurrence. PET/MRI also had better negative (1.00 vs. 0.87) predictive values. AUCs for PET/MRI and PET/CT on patient-based analysis were 0.997 (95% CI 0.989–1.000) and 0.890 (95% CI 0.806–0.974), respectively. The comparison of sensitivity, AUCs, and negative predictive values revealed a statistically significant difference, p < 0.05. In PET/CT, false-negative and positive findings were observed in the more advanced disease stages, where PET/MRI performed better. Also, false-negative findings were located in the oropharyngeal, laryngeal, and nasopharyngeal regions, where PET/MRI made no false-negative interpretations. Conclusion Based on these results, PET/MRI might be considered the modality of choice in detecting locoregional recurrence in HNSCC patients, especially in the more advanced stages in the oral cavity, larynx, or nasopharynx.

CLINICAL AND MORPHOLOGICAL PARALLELS IN DIFFERENT VARIANTS OF EXUDATIVE LESIONS OF REINKE’S SPACE

Introduction. The prevalence of exudative lesions of Reinke’s space (EPPR) is high and is of particular medical and social significance. Despite the similarity of clinical manifestations and a certain commonality of pathogenesis, there are morphological differences between various forms of EPPR. Purpose. to study the clinical and morphological features of various forms of EPPR. Materials and methods. The sampling of material for the study was carried out intraoperatively in 56 patients aged 28–56 years with a diagnosis of J38.1 Polyp of the vocal fold and larynx. Conducted indirect laryngoscopy and questioning. Tumor excision was performed using an Olympus TYPE 150 fiber bronchoscope (Germany). The material was fixed in 10% formalin and embedded in paraffin. Prepared standard sections, stained with hematoxylin-eosin. For microscopy, a DMRXA microscope (Leika, Germany) was used. Results. All patients presented the same type of complaints of dysphonia, sensation of a foreign body in the throat, cough, regardless of gender and professional affiliation. According to the results of a morphological study, 22 patients were diagnosed with vocal fold polyps, 18 patients with vocal nodules, and 16 patients with Reinke’s edema. Reinke’s edema and myxoid type of polyps had similar morphological features: pronounced edema of the stroma and small cystic infiltration with cavities filled with gelatinous fluid, the predominance of lymphocytes and histiocytes in the tissues. Vocal nodules and polyps of the angiomatous type were characterized by a high specific density of the vascular component, more pronounced circulatory disorders, and tissue infiltration with fibroblasts. Discussion. Despite the similar clinical manifestations and the commonality of the mechanisms of the formation of EPPR, which consist in increased permeability and fragility of the capillary bed against the background of chronic intoxication and phonotrauma, combined with difficulty in outflow of lymph due to the anatomical features of the lymphatic drainage system of the larynx region, there are morphological features that allow you to clearly differentiate various forms EPPR. Conclusions: the identified morphological features of various forms of EPPR allow us to combine Reinke’s edema and myxoid polyps into one clinical and morphological subgroup, and vocal nodules and angiomatous type of polyps into another.

TRANSITION AND LAMINAR FLOWS IN A REALISTIC GEOMETRY OF HUMAN UPPER AIRWAY

In this study, a realistic respiratory airway model extending from oral to the end of the trachea including all the key details of the passage was produced. A series of CT scan images were used to generate the topological data of airway cross-sections that were used to generate the computational model, as well as the three-dimensional (3D) printed model of the passage for experimental study. The airflow velocity field and pressure drop in the airway for different breathing rates of 5, 7.5, 10, and 12.5[Formula: see text]L/min were investigated numerically (by laminar and transition models) and experimentally. The velocity distributions, pressure variation, and streamlines along the oral–trachea airway model were studied. The maximum pressure drop was shown to occur in the narrowest part of the larynx region. It was also concluded that the laryngeal jet could significantly influence the airway flow patterns in the trachea. A comparison between the numerical results and experimental data showed that the transition [Formula: see text]–kl–[Formula: see text] model can give better predictions of pressure losses, especially for flow rates higher than 10[Formula: see text]L/min. The simulation results for the velocity profiles in the trachea were also compared with the available particle image velocimetry (PIV) data and earlier simulations. Despite inter-personal variability and difference in the flow regime, the qualitative agreement was found.

Modelling of long-term retention of high-fired plutonium oxide in the human respiratory tract: importance of scar-tissue compartments

The U.S. Transuranium and Uranium Registries whole-body tissue donor Case 0407 had an acute intake of ‘high-fired’ plutonium oxide resulting from a glove-box fire in a fabrication plant at a nuclear defence facility. The respiratory tract of this individual was dissected into five regions (larynx, bronchi, bronchioles, alveolar-interstitial, and thoracic lymph nodes) and analysed for plutonium content. The activities in certain compartments of the respiratory tract were found to be higher than expected from the default models described in publications of the International Commission on Radiological Protection. Because of the extremely slow rate of dissolution of the material inhaled, the presence of bound fraction is incapable of explaining the higher-than-expected retention. A plausible hypothesis—encapsulation of plutonium in scar tissues—is supported by the review of literature. Therefore, scar-tissue compartments corresponding to the larynx, bronchi, bronchioles and alveolar-interstitial regions were added to the existing human respiratory tract model structure. The transfer rates between these compartments were determined using Markov Chain Monte Carlo analysis of data on urinary excretion, lung counts and post-mortem measurements of the liver, skeleton and regional retention in the respiratory tract. Modelling of the data showed that approximately 30% of plutonium activity in the lung was sequestered in scar tissues. The dose consequence of such sequestration is qualitatively compared against that of chemical binding.

Solitary fibrous tumor of the larynx treated with transoral endoscopic CO2 laser surgery – a case report and literature review

Presented is a case of an exceptionally rare laryngeal tumor removed by means of endoscopic surgery using a CO2 laser following earlier embolization of the left superior laryngeal artery. From the patient’s perspective, it is extremely important that the procedure be performed in a possibly least invasive manner so that no laryngeal or pharyngeal dysfunctions develop as the consequence thereof. &lt;/br&gt; &lt;/br&gt; Due to the total nature of the resection with negative (R0) resection margins being achieved, and due to the histopathological examina-tion being suggestive of the benign nature of the lesion, no adjuvant treatment was required in the reported case. &lt;/br&gt; &lt;/br&gt; Due to the sporadic incidence of SFTs within the laryngeal region and the incompletely studied biology of these tumors, long-term follow-up in the setting of an outpatient laryngological clinic is advisable.

254 LYMPH NODE DISSECTION IN T1 AND T2 ESOPHAGEAL SQUAMOUS CELL CARCINOMA: MINIMALLY INVASIVE ESOPHAGECTOMY VERSUS OPEN SURGERY

Abstract Minimally invasive esophagectomy is increasingly performed for esophageal squamous carcinoma, with advantages of improved perioperative outcomes in comparison with open esophagectomy. Lymph node dissection is one of most important prognostic factors, in esophageal squamous cell carcinoma. It is still unknown whether MIE can meet the criteria of lymph node dissection in the mediastinum, especially in T1 and T2 esophageal cancer. Here, we compared the lymph node dissection between MIE and open surgery. Methods We retrospectively reviewed the clinicopathological data from 147 patients who underwent open surgery and MIE for esophageal squamous cell carcinoma from December 2016 to January 2020. The clinicopathological data including age, gender, number of lymph node resected were analyzed. Results 68 patients underwent MIE and 79 patients underwent open surgery. The number of harvested lymph node didn’t differ between the open surgery group and MIE group (26 ± 11.9 vs 26 ± 13.4, respectively, p = 0.128). However, the number of resected lymph node in the low para-esophageal region was significantly higher in open surgery group (4.1 ± 3.9 vs 2.8 ± 2.6, respectively, p = 0.019). The number of resected lymph node in the upper mediastinal region was significantly higher in the MIE group in T1 and T2 patients (4.7 ± 3.8 vs 2.7 ± 2.9, respectively, p = 0.014). the difference was also noticed in the para-recurrent laryngeal lymph node regions (3.6 ± 2.9 vs 2.0 ± 2.3, respectively, p = 0.020). Conclusion For stages T1 and T2 esophageal squamous cell carcinoma, the lymph node dissection by MIE was comparable to that by open surgery. However, the number of harvested lymph node in the upper mediastinal region was better in the MIE group, which may indicate a better outcome. There was no difference in the postoperative complications, hospital stay and overall survival rate.