Laryngeal Resection Research Articles

Extended partial laryngectomy with functional preservation using the rotational crico-thyrotracheopexy.

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. 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. 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. 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. 4 (retrospective case series review).

Efficacy and Safety of Microsurgical Pharyngolaryngeal and Pharyngoesophageal Reconstruction: A Systematic Review of the Literature

We performed a systematic literature review on PubMed (Medline), Embase and Cochrane Library over the last two decades for articles reporting the surgical reconstructive modalities available after total or partial pharyngeal and/or laryngeal resection using a structured search strategy and strict inclusion and elimination criteria. Our search identified a total of 677 articles, 112 full texts were fully reviewed for eligibility, and 39 met the inclusion criteria. The use of both FJF and fasciocutaneous flaps is safe. The FJF has optimal swallowing outcomes and a low incidence of major recipient-site complications. Nevertheless, free fasciocutaneous flaps exhibit comparable functional results, while they seem linked with fewer cases of perioperative mortality and flap failure. However, none of the currently available techniques can combine all potential benefits. Despite these procedures being mainly palliative in nature, the advent of microvascular techniques and utilization of fasciocutaneous free flaps has allowed optimal restoration of function combined with a reduced rate of perioperative and longterm complications. Both FJF and fasciocutaneous flaps can be viable treatment options, depending on the expertise of the surgeon and patient selection, to ensure the best outcomes.

Guest Co-Editors’ Messages

<h3>Objectives</h3> To investigate the utilisation of different treatment modalities for patients with laryngeal cancer (LC) during last decade in Poland. <h3>Setting</h3> Retrospective population-based study. <h3>Participants</h3> Patients with LC treated between January 2009 and December 2018. <h3>Primary and secondary outcome measures</h3> The contemporary utilisation of treatment modalities of LC: surgery with intent of radical resection (total or partial laryngectomy), radiotherapy (RT) and chemoradiotherapy (CRT). <h3>Results</h3> There was determined the overall number of 22 957 new diagnosis of LC from 2010 to 2018 and confirmed the steady decrease in the incidence rate of LC in the following years from 7.7 to 6.03. The mean age of patients with LC was raising by an average of 0.3832 of year per year. There was observed decrease in number of total laryngectomies (TLs) in subsequent years (from 1122 in 2009 to 776 in 2018). The number of procedures involving partial laryngeal resection was within stable ranges however the upward trend was observed separately for vocal cordectomy. There was established decreased involvement of surgery in LC treatment from 52.8% in 2009 to 24.3% in 2016 with the subsequent rise to 33.7% in 2018. The percentage of patients receiving RT increased from 23.8% in 2009 to 42.1% in 2013 with the next decrease to 25.7% in 2018. The utilisation of CRT in LC treatment was progressively increasing over analysed years from 23.4% in 2009 reaching 40.6% in 2018. <h3>Conclusions</h3> The presented data revealed an increase in total number of organs preserving treatment modality with CRT in subsequent years with decreasing number of TLs in Polish patients with LC.

INCIDENTAL EXTENSIVE THYROID MALIGNANCY IN A LARYNGECTOMY FOR SQUAMOUS CARCINOMA: A CASE REPORT

<h3>Introduction</h3> Laryngectomy specimens for extensive squamous cell carcinoma (SCC) often include thyroid for both access and staging. Occasionally, incidental pathology is discovered within this tissue or the associated neck structures. We present a case of unexpected extensive thyroid malignancy, concurrent with squamous carcinoma. <h3>Clinical Presentation</h3> A 56-year-old man presented to Ear, Nose, and Throat with a 4-month history of hoarseness and palpable neck masses. He had previously suffered from follicular non-Hodgkin lymphoma, treated with bendamustine and rituximab. Following a past assault, he sustained brain damage and required tracheostomy. He was a previous smoker. A computed tomography scan revealed a supraglottic mass, subsequently confirmed as moderately differentiated SCC on microlaryngoscopic biopsy. <h3>Histopathology</h3> A total laryngectomy with bilateral modified neck dissections was performed. On sectioning, a bilateral tumor was present within the anterior supraglottis and glottis, destroying the anterior thyroid cartilage and involving the strap muscles. The included right thyroid lobectomy contained a number of pale nodules, which were sampled extensively. Histology confirmed the laryngeal tumor to be moderately differentiated SCC. The thyroid gland contained numerous foci of invasive papillary thyroid carcinoma that, at one point, collided with the SCC. The selective neck dissections contained numerous bilateral deposits of both squamous and papillary thyroid carcinoma with extracapsular extension. <h3>Conclusions</h3> Laryngeal resection specimens include numerous adjacent anatomical structures, removed both for surgical and staging purposes. Our case report highlights that these adjacent structures can include additional incidental primary disease, making careful macroscopic dissection and description vital to ensure both correct staging and to avoid second pathologies being overlooked.

Complete atrio-ventricular block with coronary artery spasm due to direct laryngoscopy in a pediatric patient with laryngeal papillomatosis: a case report

BackgroundCoronary artery spasm has rarely been reported in pediatric patients. Previous studies have reported comorbidities and risk factors for coronary artery spasms. We present the case of a complete atrio-ventricular (AV) block that occurred in the absence of other risk factors immediately after direct laryngoscopy.Case presentationA 2-year-old girl developed severe coronary artery spasm after direct laryngoscopy for elective laryngeal papillomatosis resection. Immediately after the initiation of laryngoscopy, complete AV block and ST elevation on lead II of the electrocardiogram were observed. These findings indicated that the complete AV block was caused by a right coronary artery spasm.ConclusionCoronary artery spasm resulting in lethal arrhythmia rarely occurs in healthy pediatric patients. To the best of our knowledge, this is the first pediatric case of a severe coronary artery spasm resulting in a complete AV block due to direct laryngoscopy in a healthy patient.

Review of recent treatment trends of laryngeal cancer in Poland: a population-based study

ObjectivesTo investigate the utilisation of different treatment modalities for patients with laryngeal cancer (LC) during last decade in Poland.SettingRetrospective population-based study.ParticipantsPatients with LC treated between January 2009 and December 2018.Primary...

Primary Sarcomas of the Larynx: A Clinicopathologic Study of 27 Cases.

Primary sarcomas of the larynx are rare and are associated with diagnostic and treatment challenges. Studies of these tumors are limited, and most examples have been reported as small series. To further increase our understanding of laryngeal sarcomas, we reviewed our experience of an adult cohort. A retrospective search for laryngeal sarcomas from our pathology archives and consultation files of one of the authors was performed. We studied 27 primary laryngeal sarcomas that included 25 males, and 2 females, with a mean age of 60years (range 33-85). The cases included conventional chondrosarcoma (16), well-differentiated liposarcoma (2), clear cell chondrosarcoma (1), leiomyosarcoma (2), high grade myxofibrosarcoma (2), high grade myofibroblastic sarcoma (1), low-grade myofibroblastic sarcoma (1), malignant granular cell tumor (1), and Kaposi sarcoma (1). Data on treatment and follow-up was available in 17 and 16 cases, respectively. 12 patients underwent partial laryngeal resection; five had total laryngectomy, and the patient with Kaposi sarcoma received combined highly active antiretroviral therapy and chemotherapy. Three patients developed local recurrence, and two patients developed metastases. The remaining patients with follow up had a favorable outcome and were disease-free after treatment. The important differential diagnosis of spindle cell sarcoma is sarcomatoid squamous cell carcinoma, and their distinction often requires extensive sampling of the mucosal surface and immunohistochemical analysis. The mainstay of treatment for laryngeal sarcomas is surgical removal, with the extent dictated by tumor type and grade. Adjuvant therapy is reserved for high-grade sarcomas and may be given in a neoadjuvant or adjuvant setting.

Smoking Behaviour after Partial Resection of the Larynx: The Role of Causal Attribution

The aim of our study was to examine how different causal attributions in patients with laryngeal cancer are associated with smoking behaviours (smoking cessation rates and amount of cigarettes per day) after partial resection of the larynx. Multicentre prospective cohort study including 4 interviews: between diagnosis and partial resection of larynx (t1), one week (t2), 3 months (t3) and 12 months (t4) after surgery. Presented in this study are t1 and t4. A total of 134 patients (mean age 62 years, 93% male) were interviewed at t1 and t4 between 2007 and 2013. Key items were causal attribution as well as previous and current smoking behaviour. Patients were grouped according to the subjectively stated causal attribution. Results were analysed descriptively and group as well as mean value comparisons were conducted. Smoking was the most commonly stated causal attribution (43.3%). The quantity of cigarettes decreased significantly by about 6 cigarettes from 17 (range 3-40) to 11 (range 2-30) cigarettes per day in this group (p=0.001). 25% of patients did not recognize a reason for their illness. In longitudinal analyses of all groups of different causal attributions, there was a non-significant decrease in the percentage of smokers. We show that causal attribution does not affect smoking cessation rate significantly in a positive way. But active smokers after PRL reduce their quantity of cigarettes per day significantly. This impact is more noticeable in patients who were able to define a causal attribution. Psycho-oncological care, information services and smoking cessation programs could contribute to this effect by making the causal attribution a subject of discussion.

Laryngeal cancer in two non-consanguineous people (spouses): a case report

The objective is to report a rare case of laryngeal cancer in spouses. Case report. A 59-year-old female patient was admitted to the Department of Head and Neck Tumors in December 2019 with complaints of hoarseness. In 1997, she had radiotherapy for T1N0M0 laryngeal cancer. After comprehensive examination, she was diagnosed with recurrent laryngeal cancer. The patient has undergone frontolateral laryngeal resection. A 67-year-old male patient was admitted to the Department of Head and Neck Tumors in November 2019 with T3N0M0 laryngeal cancer (diagnosed 2 months before). He has undergone extended frontolateral laryngeal resection followed by radiotherapy in the postoperative period. Discussion. Both patients had no risk factors, such as occupational hazards or smoking. However, both spouses had close relatives with cancer, what indicates their genetic predisposition to malignant tumors. The female patient was found to have human papilloma virus (HPV) in the tumor cells, whereas her spouse was HPV-negative, although rapid histology showed indirect signs of HPV, which does not exclude the elimination of HPV. Conclusion. In this rare case of laryngeal cancer diagnosed in two non-consanguineous spouses, the disease is likely to be caused by their hereditary predisposition, HPV infection, and the fact that they lived in the same socioeconomic conditions.

Tracheal/Laryngeal Infiltration in Thyroid Cancer: a Single-Centre Experience.

Around 1/3 of patients of locally advanced carcinoma thyroid present with tracheal infiltration either alone or along with infiltration of other adjacent structures. Even though trachea is infiltrated, adequate resection is the main modality of treatment in these patients. We retrospectively analysed carcinoma thyroid patients who were operated at our institute, between January 2011 and December 2018, and underwent thyroidectomy with tracheal or laryngeal resection. Seventeen patients underwent tracheal/laryngeal resection with thyroidectomy. The mean age of patients was 57years. Six and eleven were male and female, respectively, 0.14 (82%) patients had dyspnoea on presentation, 6 had hoarseness of voice, 6 had haemoptysis, and in 2 patients, neck swelling was the only complain. Two patients in our study presented with acute stridor, underwent emergency intubation and subsequently surgery. Two other patients had bulky pedunculated tumour in preoperative bronchoscopy and required tracheostomy for intubation before proceeding with surgery. In 11 patients, sleeve resection followed by end-to-end anastomosis was done, window resection was done in 3 patients, partial laryngectomy in 1, and total laryngectomy in 2 patients. In 10 patients (59%), the site of infiltration was in the lateral tracheal wall, with relatively small posterior primary (mean size 3.7cm) in the thyroid lobe. Two patients developed postoperative complication, one patient with sleeve resection had secondary haemorrhage, and one patient who underwent window resection with myochondrial thyroid lamina flap reconstruction developed salivary fistula. These patients underwent re exploration with tracheostomy and were subsequently decannulated. Preoperative diagnosis of tracheal infiltration helps in better planning of surgery and counseling the patients of any possible complication. Clinical workup and pre-emptive diagnosis is therefore of paramount importance.

Expressions of OCT-4 and CD44 in laryngeal squamous cell carcinoma and the clinicopathological significance of OCT-4 and CD44 double positive

Objective To detect the expression of nuclear transcription factor OCT-4 in laryngeal squamous cell carcinoma (LSCC) and its relationship with CD44, and to explore the relationship between OCT-4 and the cancer stem cells and its significance in tumors. Methods Sixty-nine specimens of laryngeal surgical resection were selected from LSCC patients from January 2008 to December 2012 in Lanzhou General Hospital of Lanzhou Military Region. Another 18 cases of normal laryngeal mucosa tissues were selected as control. OCT-4, CD44 and OCT-4+ CD44+ cells were observed by using tissue microarray, immunohistochemistry staining and immunohistochemical double staining techniques, and the relationship between their pathological features, such as expression intensity, distribution, cell morphology and clinical parameters were analyzed to explore the clinicopathological significance of CD44+ OCT-4+ cells. Results The percentage of CD44-positive cells in LSCC was significantly higher than that in normal laryngeal mucosa tissues [(63.62±8.76)% vs. (13.61±5.81)%, P < 0.001]. The percentage of OCT-4-positive cells in LSCC was (50.44±10.84)%, while it was not expressed in normal laryngeal mucosa tissues (P < 0.001). In LSCC, the expression of OCT-4 was significantly lower than that of CD44 (P < 0.001); the coexpression rate of these two molecules was (5.07±2.90)%. The percentage of CD44-positive cells in poorly differentiated LSCC was significantly higher than that in the well-differentiated group [62.78% (8.22%) vs. 28.62% (30.45%), P < 0.05]. The percentage of OCT-4-positive cells in poorly differentiated LSCC was significantly higher than that in the well-differentiated group [49.89% (13.12%) vs. 33.00% (20.00%), P < 0.05]. In the cancer stem cells, the percentage of OCT-4+ CD44+ cells in poorly differentiated carcinoma group was also significantly higher than that in the well-differentiated carcinoma group (P < 0.01), the lower the degree of differentiation, the higher the expression level of OCT-4. In LSCC poorly differentiated group, the expressions of OCT-4 and CD44 showed no significant difference between different T stages, but the percentage of OCT-4+ CD44+ cells elevated with T stage increasing (P < 0.05). The expression of OCT-4 in patients with lymph node metastasis was significantly higher than that in patients without lymph node metastasis (P < 0.01). Conclusions The expressions of OCT-4 and CD44 are associated with the malignant biological behaviors of LSCC closely. OCT-4 may be a valuable marker of tumor stem cells of LSCC. Key words: Laryngeal neoplasms; Carcinoma, squamous cell; OCT-4; CD44; Neoplastic stem cells

Results of cases with combined resection of larynx, trachea and/or esophagus for thyroid carcinoma

Results of cases with combined resection of larynx, trachea and/or esophagus for thyroid carcinoma

EXPERIENCE OF USING ALLOGENIC BIOIMPLANTS IN LARYNGEAL RESECTION

Introduction. Currently, a great importance is being attached to improvement of the surgical component of combination treatment of locally advanced laryngeal cancer. New technological capabilities (transoral microsurgery of the larynx and robotic surgery) offer great opportunities for early cancer stages. However, in some cases capabilities of endoscopic laser intervention are limited. Therefore, open laryngeal resection is still relevant as it serves as the only type of radical organ preservation treatment for stages Т2–Т3. But major laryngeal resection is associated with a problem of tissue defect closure. The article describes data on the use of biocompatible materials, their advantages and disadvantages. The study objective is to present experience of using a Russian allogenic bioimplant for plastic reconstruction of the opening of the larynx after laryngeal resection. Materials and methods . The authors present their experience of using a Russian bioimplant produced in collaboration with the Samara Tissue Bank of the Research Institute of Experimental Medicine and Biotechnology of the Samara State Medical University. The material was tested in anterolateral laryngeal resection with simultaneous reconstruction in 5 patients with stages Т2–Т3 laryngeal cancer and in a patient with chondrosarcoma. Conclusion. The Russian biocompatible implant served as a reliable, simple, cheap, and effective variant of plastic material for reconstruction of the larynx.

Microbiocenosis of upper respiratory airway as a risk factor for local complications during the postoperative period after resection of the larynx

Unadequate antibiotic therapy, the low level of hemoglobin in erythrocytes, concomitant somatic diseases are confirmed to complicate early postoperative period for oncology patients. Authors suggest the idea, that pathologic mucosal microbiocenosis in the upper respiratory airway stipulates local postoperative complication after larynx resection in cases of laryngeal cancer. The authors proved that postoperative complications occur, because virulent strains of gram-positive microorganisms, both in monoculture and in association with Candida fungi are predominant in the mucosal microbiocenosis of upper respiratory airway. Authors have confirmed in clinic-based studies that nonpathologic microorganisms as indigenous microflora can reduce probability of local complications duringearly postoperative period after larynx resection in cases of laryngeal cancer. It is revealed that postoperative complications associated pathologic mucosal microflora with the presence of anisocytosis of red blood cells and do not depend on the level of hemoglobin in the erythrocyte before the surgery.

The opportunities of using an antitumor antibiotic for prevention of larynx cicatrices development after endolaryngeal resections for squamous cell cancer

The development of medical technologies and the related interest of oncologists in organ-preserving treatment led to an increase in patients with cicatricial laryngeal stenosis after endolaryngeal resection. The development of the principles of prevention of scar deformities in patients after laryngeal resections is an urgent and important issue that needs to be studied. The article gives comparative characteristics of two methods of prevention of scarring in the area of anterior commissure of the larynx when performing endolaryngeal resections for cancer.

Software for Speech Rehabilitation of Cancer Patients after Larynx Resection

Software has been developed for rehabilitation exercises in patients after complete or partial loss of the sonorous speech due to laryngectomy. The structure of the software, the algorithm of its work, and results of a functional test are given. Results of primary testing of the package on a group of healthy speakers are also presented.

The systemic approach to the rehabilitation of the patients presenting with laryngeal cancer after the resection of the organ and laryngectomy with tracheoesophageal by-pass and endoprosthetics

The objective of the present study was to enhance the effectiveness of rehabilitation of the patients presenting with laryngeal cancer after the resection of the organ and laryngotomy with tracheoesophageal by-pass and endoprosthetics. Our experience in this field is based on the treatment of 102 patients. They were distributed by the nosological forms as follows: primary laryngeal cancer in 97 patients including T1NoMo - 8 (8.2%), T2NoMo - 63 (65%), T3NoMo - 18 (17.6%), T2N1Mo - 1 (0.9%), T4NoMo - 3 (2.9%), and T4N1M0 - 4 (3.9%), root of the tongue cancer spreading over the vestibular part of the larynx in one patient, laryngeal sarcoma in one patient, relapse of cancer following the full-dose radiotherapy and organ-sparing surgery in 3 patients. Laryngeal resection was performed in 83 patients; 19 patients underwent laryngectomy with tracheoesophageal by-pass and endoprosthetics using a domestically manufactured voice prosthesis. The systemic approach to the rehabilitation of the patients and the use of the proposed treatment algorithm made it possible to restore the function of the larynx by means of organ-sparing surgery in 79 (95.1%) of the 83 patients. The vocal function in the patients following laryngectomy with tracheoesophageal by-pass and endoprosthetics was restored in 18 (94.7%) of the 19 patients.

Software Implementation of a Singular Meter of the Pitch Frequency of a Speech Signal

The article deals with software implementation of the evaluation of the pitch frequency of the speech signal based on the mathematical apparatus for singular spectral analysis. The program is used in calculation module of a program complex for speech rehabilitation of cancer patients after resection of larynx used in rehabilitation training of patients after complete or partial loss of sounding speech as a result of laryngectomy.

MODERN ASPECTS OF TREATMENT OF THE LARYNX AND TRACHEA STENOSIS AFTER FUNCTIONAL-SPARING OPERATIONS

Treatment and rehabilitation of patients with cancer of the larynx is a complex issue, as the majority of patients (60-70%) are diagnosed at the III and IV stages of the disease. The main type of surgery is a laryngectomy which leads to organ dysfunction and disability. It is known that in cases of locally advanced laryngeal tumors resection may be performed. However, after these operations from 22 to 57% of patients couldn’t be rehabilitated due to the difficulty in creating of sufficient lumen of the larynx, development of chondroperihondritis, growth of granulation tissue, fibrosis formation and stenosis of the larynx (Bukhman L.A., 1982; Bityutskij P.T., 1990; Park H.Y., 2009; SoYeonLimatal, 2012).

Upper digestive tract reconstruction for caustic injuries.

The aim of the study was to compare the short- and long-term outcomes of colopharyngoplasty and esophagocoloplasty for caustic injuries of the upper digestive tract. Simultaneous esophageal and pharyngeal reconstruction by colopharyngoplasty allows regaining nutritional autonomy in patients with severe pharyngoesophageal caustic injuries. Patients who underwent upper digestive tract reconstruction for caustic injuries by colopharyngoplasty (n = 116) and esophagocoloplasty (n = 122) between 1993 and 2012 were included. Survival and functional outcomes were analyzed. Success was defined as nutritional autonomy after removal of the jejunostomy and tracheotomy tubes. Quality of life was assessed using the QLQ-OG25 and SF12v2 questionnaires. Overall Kaplan-Meyer survival at 1, 5, and 10 years after colopharyngoplasty and esophagocoloplasty were 92%, 74%, 67% and 92%, 83%, 73%, respectively (P = 0.56). Quality of life and functional results (success: 57% vs 95%, P < 0.0001) were impaired after colopharyngoplasty. On multivariate analysis, older age (odds ratio [OR]: 0.94; confidence interval [CI]: 0.91-0.97 P < 0.0001) and pharyngeal reconstruction (OR: 0.05; CI: 0.02-0.13, P < 0.0001) were associated with failure. The decline in success with age was more pronounced after colopharyngoplasty with only 1 (7%) of 15 patients operated after the age of 55 being self-sufficient for eating and breathing. Laryngeal resection during colopharyngoplasty had no influence on success (54% vs 58%, P = 0.67) CONCLUSIONS:: The need to associate pharyngeal reconstruction during esophageal reconstruction for caustic injuries has a long-term negative impact on functional outcome.