Lateral Pharyngotomy Research Articles

Vocal cord immobility after lateral pharyngotomy extraction of the impacted dentures in the upper esophagus: A Case Report

Impaction of foreign bodies in the esophagus is a frequent emergency in otorhinolaryngology. However, diagnosing and managing denture impaction in the esophagus presents greater challenges compared to other foreign bodies, often leading to various complications. This study reported a rare case of vocal cord immobility after the evacuation of denture impaction in the esophagus using lateral pharyngotomy. The patient, a 73-year-old man, experienced throat discomfort after swallowing a denture an hour before admission. According to the CT scan carried out, a 3.7 cm long denture was found around the T3-T5 spine level and was located 3 mm lateral right to the descendant aorta and 4 mm posterior of the trachea. During esophagoscopy extraction, the denture was stuck in the upper esophagus and was successfully evacuated by lateral pharyngotomy. Subsequently, the patient developed vocal cord immobility, and this case underscores the importance of considering vocal cord complications following the extraction of a denture impaction in the esophagus.

Laryngeal Paraganglioma with Neck Metastasis.

Paragangliomas are neoplasms of neural crest cells. They represent less than 1% of head and neck tumors. Laryngeal paragangliomas constitute a smaller fraction of head and neck paragangliomas. Malignant laryngeal paragangliomas with metastasis are extremely rare tumors. Definitive treatment includes complete surgical excision with maximum preservation of laryngeal function. Here, we report a rare case of a 55year old woman who was diagnosed with recurrent laryngeal paraganglioma along with neck metastasis. A complete excision of mass with a lateral pharyngotomy approach along with neck dissection followed by chemotherapy was done.

Schwannoma base of Tongue - Case Report with a Novel Reconstruction Technique.

Schwannomas are benign, slow-growing well-encapsulated neoplasms arising from Schwann cells of nerve sheaths. Oral cavity schwannomas are very rare with an incidence less than 1%. The posterior third of the tongue is not frequently involved. We report a rare case of a large tongue base schwannoma in a 44 year old female managed surgically by lateral pharyngotomy approach. A novel reconstruction method involving the use of submental flap is described for the functional reconstruction of the defect. Being a rare tumor, schwannoma should not be missed in the differential diagnosis of tongue base tumors. Complete surgical resection is the treatment of choice with recurrence being very rare.

Cribriform adenocarcinoma of the minor salivary glands: a case report

BackgroundPolymorphous adenocarcinoma is the third most common malignant salivary gland tumor. Within polymorphous adenocarcinoma, cribriform adenocarcinoma of salivary glands is a rare subtype and resembles papillary thyroid carcinoma histopathologically. Diagnostically, cribriform adenocarcinoma of salivary glands is challenging for pathologists and surgeons alike as initial presentation and cytologic nuclear features can be easily confused with papillary thyroid carcinoma arising from a thyroglossal duct remnant or lingual thyroid.Case presentationA healthy 64-year-old Caucasian woman presented to a community otolaryngologist with a 4-year history of progressive postnasal drip, globus sensation, and eventual dysphonia. Flexible fiberoptic laryngoscopy showed a large, smooth, vallecular lesion filling the oropharynx. Computed tomography imaging of the neck showed a rounded heterogeneous mass centered within the right aspect of the oropharynx measuring 4.2 × 4.4 × 4.5 cm. Fine needle aspiration biopsy was suspicious for papillary carcinoma due to microscopic findings of malignant cells, nuclear grooves, and a powdery chromatin pattern. In the operating room, the tumor was resected en bloc using a lateral pharyngotomy approach with partial resection of the right lateral hyoid. A limited cervical lymphadenectomy was performed to facilitate the lateral pharyngotomy approach and two out of three lymph nodes demonstrated regional metastatic disease. Nuclear grooves, nuclear membrane notching, and occasional intranuclear pseudoinclusions were identified, which are overlapping histopathological characteristics of papillary thyroid carcinoma and cribriform adenocarcinoma of salivary glands. It was negative for thyroglobulin and thyroid transcription factor-1, which was in keeping with cribriform adenocarcinoma of salivary glands rather than papillary thyroid carcinoma.ConclusionIt is difficult to distinguish cribriform adenocarcinoma of salivary glands from papillary thyroid carcinoma solely by cytology, and the distinct characteristics of regional lymph node metastasis coupled with nuanced histologic differences should be emphasized in the evaluation of patients presenting with neck lymphadenopathy and an unknown primary or tongue mass. If sufficient fine needle aspiration biopsy material is available, thyroid transcription factor-1, thyroglobulin, or molecular testing may prove useful in differentiating cribriform adenocarcinoma of salivary glands from papillary thyroid carcinoma. A misdiagnosis of papillary thyroid carcinoma may lead to inappropriate treatment including unnecessary thyroidectomy. Therefore, it is critical for both pathologists and surgeons to be aware of this uncommon entity to avoid misdiagnosis and subsequent mismanagement.

Functional Outcomes After Transoral Plus Lateral Pharyngotomy Approach for Advanced Oral and Oropharyngeal Tumors.

The aim of this study was to evaluate our institutional experience with the combined transoral plus lateral pharyngotomy (TO+LP) approach in a subset of patients with advanced or recurrent oral and oropharyngeal malignancy. A retrospective study of procedures utilizing TO+LP for cancer resection between January 2007 and July 2019. Tertiary academic medical center. Thirty-one patients underwent a TO+LP approach for the resection of oral and oropharyngeal tumors. Functional and oncologic outcomes were analyzed. Eighteen (58.1%) patients were treated with TO+LP for recurrent disease. Twenty-nine required free tissue transfer and 2 (6.5%) had positive margins. The median time to decannulation was 22 days (range 6-100 days). Thirteen (41.9%) patients still required enteral feeding at their most recent follow-up. Patients without a history of prior radiation were decannulated sooner (p = .009) and were less likely to require enteral feeding at the first postoperative follow-up (p = .034) than those who had prior head and neck radiotherapy. A TO+LP approach can be used to achieve good functional and oncologic results for selected patients with advanced or recurrent oral and oropharyngeal cancer when minimally invasive options such as transoral robotic surgery, transoral laser microsurgery, or radiotherapy are not possible.

Transpharyngeal Approaches for Management of Oropharyngeal Squamous Cell Carcinoma: Mayo Clinic Institution Experience.

Investigate oncologic and functional outcomes associated with transhyoid and lateral pharyngotomy (transpharyngeal) approaches in the treatment of oropharyngeal squamous cell carcinoma (OPSCC). Retrospective review. Single institution (tertiary care center). This is a retrospective case series of patients with OPSCC undergoing transpharyngeal resection from 1990 to 2017 at Mayo Clinic. Oncologic outcomes, postoperative complications, objective swallowing data, and rates of tracheostomy and percutaneous gastrostomy tube dependence were recorded. Of 83 patients meeting inclusion criteria, 56 (68%) were human papillomavirus positive. Overall survival rates at 5 and 10 years following surgery were 85% and 80%, respectively. Cancer-specific survival rates at these same time points were 90% and 88%. Following treatment, 35 of 49 patients (71%) had a Functional Oral Intake Scale score ≥5, indicating total oral intake of multiple consistencies; 79 of 82 (96%) were without tracheostomy or laryngectomy; and 71 of 81 (88%) were on a full oral diet. Transpharyngeal approaches provide adequate functional and oncologic outcomes in the majority of patients with OPSCC. These results may have important implications for patients who are not candidates for, or are unwilling to undergo, nonoperative therapy or for those without access to radiation therapy.

Congenital laryngeal cyst causing respiratory distress in a neonate: a rare case report

Congenital laryngeal cyst is a rare but responsible of upper airway obstruction which can be potentially life-threatening. The most common symptoms are inspiratory stridor, dyspnea, cyanosis, abnormal voice and difficulty with feeding. It should be differentiated from laryngomalacia. It is diagnosed by flexible fibro-optic laryngoscopy. Surgical options are endoscopic excision, needle aspiration, de-roofing, external laryngo-fissure and lateral pharyngotomy. The best treatment consists in the entire removal of the cyst. This case report described the case of 28 days old neonate with a severe airway distress and stridor caused by a congenital laryngeal cyst which has been managed by de-roofing of the cyst entirely with flexible laryngoscope.

Hyoid Chondroma.

Mass lesions of the larynx are one of the most common clinical entity which we come across in routine otorhinolaryngology and head neck practice with varied symptomatology. Among all the mass lesions of the larynx, Epithelial neoplasms constitute up to 97%. Mesenchymal tumours of the larynx constitute only 0.3-1.0% of all the laryngeal tumors. Abundance of cartilage structures in the larynx made it a spot for mesenchymal tumors [chondromas and chandrosacrcomas]. The spectrum of mesenchymal neoplasms can vary from chondromas, chondroblastoma to chondrosarcoma. Here we want to share our experience of a mesenchymal tumour of the larynx. This case is reported for the rarity and ambiguity in diagnosis. Though these are slow-growing tumours with an early presentation, in our case, the patient had a supportive tracheostomy without definitive treatment for more than 2years. We managed this patient by excising the mass by lateral pharyngotomy with the preservation of larynx followed by successful Decannulation in 20days.

Carcinoma of the posterior wall of the hypopharynx: surgical treatment with larynx preservation

IntroductionPosterior pharyngeal wall is the most rare subsite for hypopharyngeal carcinomas. Because of its rarity, there are few studies published in the literature specifically concerning posterior pharyngeal wall carcinoma. ObjectivesTo report our functional results in patients with the carcinoma of the posterior wall of the hypopharynx after surgical treatment by resection via a lateral or infrahyoid pharyngotomy approach, with the preservation of the larynx and reconstruction with a radial forearm free flap. MethodsThe study included 10 patients who underwent surgery for a carcinoma of the posterior wall of the hypopharynx over a 6 year period. The associated postoperative morbidity was investigated and functional results were analyzed. ResultsNine patients had T3 lesions and one patient had a T2 lesion. The preferred approach to access the hypopharynx was a lateral pharyngotomy in 5 patients and lateral pharyngotomy combined with infrahyoid pharyngotomy in 5 patients with superior extension to oropharynx. The pharyngeal defects were reconstructed successfully with radial forearm free flaps. Four patients received adjuvant radiotherapy only, and 4 patients with N2b and N2c neck diseases received adjuvant chemoradiotherapy. The mean duration of hospitalization was 15.6 days (range, 10–21 days). All patients achieved oral intake in a median time of 74 days (range, 15–180). Decannulation was achieved in all patients and the median time for decannulation was 90 (range, 21–300 days). The mean followup duration was 38.3 months (range, 10–71 months) and 8 patients survived. One patient died due to regional recurrence in the retropharyngeal lymph nodes and 1 patient died due to systemic metastasis. ConclusionPrimary surgery is still a very effective treatment modality for the carcinoma of the posterior wall of the hypopharynx and does not permanently compromise the swallowing and laryngeal functions if pharyngeal reconstruction is performed with a free flap.

A rare case of oropharyngeal angiomyolipoma

A rare case of oropharyngeal angiomyolipoma - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/2394-6792.2019.0028, Indian Journal of Pathology and Oncology-Indian J Pathol Oncol

Pleomorphic adenoma of the larynx

A 47-year-old man, with complaints of dysphonia and snoring for 10 years, sought medical assistance and underwent physical evaluation and complementary tests that showed a non-infiltrative, well-delimited, approximately 3 cm-large nodular lesion in the supraglottic region, occluding the laryngeal aditus during inspiration. It evolved with need for tracheostomy, followed by lateral pharyngotomy for excision of the lesion. Histologic and immunohistochemical examinations confirmed the rare diagnosis of pleomorphic adenoma of the minor salivary gland located in the larynx. The patient is being followed up with improvement of the symptomatology and absence of lesion recurrence. Pleomorphic adenomas (PA) are heterogeneous benign tumors originating in the salivary gland.

Lateral pharyngotomy

Based on a review of the medical literature, the authors document the key technical points, variants, technical errors to avoid and main functional results of lateral pharyngotomy for resection of cancers originating from the lateral oro and/or hypopharynx.

Management of laryngeal cleft in mechanically ventilated children with severe comorbidities

Laryngeal clefts are rare congenital malformations of the posterior part of the larynx. The severities are correlated with the downward extension of the cleft and can involve numerous clinical symptoms including dysphagia and respiratory distress. As significant comorbidities may be present, individual treatments depend on the child’s general condition and type of cleft involved. Herein, we describe two cases of children with laryngeal clefts and severe comorbidities requiring mechanical ventilation. One child with type III laryngeal cleft was successfully managed with the lateral pharyngotomy approach. The other child with type II laryngeal cleft has not been able to undergo cleft-closure surgery because of severe general conditions, therefore has continued training for feeding and swallowing.

Review of ‘‘Transoral Robotic Surgery With Radial Forearm Free Flap Reconstruction: Case Control Analysis’’ by Biron VL, O’Connell DA, Barber B, Clark JM, Andrews C, Jeffery CC, Côté DW, Harris J, Seikaly H in Journal of Otolaryngology–Head and Neck Surgery

Surgical management of large oropharygneal malignancies has always been a challenging procedure due to the risk of significant morbidity. Traditional approaches to surgical management of these tumors involved a lip-splitting mandibulotomy to completely excise these complex lesions and appropriately reconstruct the defects. Biron et al present an interesting and innovative approach (Fig 1) to managing these malignancies surgically, with a less morbid approach. The use of robotic surgery in oral and maxillofacial, and head and neck surgery, continues to increase. Biron et al compared the outcomes of patients with oropharyngeal squamous cell carcinoma, 18 of whom were treated with transoral robotic surgery (TORS) resection and reconstruction with a radial forearm free flap (RFFF), and 39 patients being treated with a lip-splitting mandibulotomy and RFFF reconstruction. Their results demonstrated that addressing these lesions with TORS led to a shorter hospital stay post-operatively (14.4 days vs. 19.7 days), but no significant differences in regards to post-operative complications or morbidity. It is important to note that the RFFF inset was not performed with TORS, but with direct visualization via the neck dissection incision and lateral pharyngotomy approach. This study describes another treatment modality for oropharygneal malignancies, and demonstrates the primary benefit of decreased hospital length of stay postoperatively. The use of TORS in head and neck surgery also affords us the ability to appropriately treat patients with a less morbid approach.

상설골접근법을 통한 설갑상선 절제술 1예

Lingual thyroid is a rare anomaly which was found to occur due to the failure of the thyroid gland to descend to its normal location in neck. The mainstay of treatment of a symptomatic lingual thyroid is surgical resection. Different types of surgical approaches have been introduced in the management of lingual thyroid such as transoral, transmandibular, translingual, lateral pharyngotomy, transhyoid, suprahyoid depending on the size and the location of the lesion. Herein, we report a case of 46-year-old female with about 4 cm-sized symptomatic lingual thyroid which was successfully and safely removed via suprahyoid approach. (J Clinical Otolaryngol 2017;28:316-319)

Lateral pharyngotomy approach in the treatment of oropharyngeal carcinoma.

Surgery for early-intermediate oropharyngeal squamous cell carcinoma (OPSCC) may involve using transoral endoscopic approaches or open surgical procedures. "Lateral pharyngotomy" (LP) is an open surgical approach that improves exposure of the oropharyngeal region, while avoiding mandibulotomy. The aim of the present study was to retrospectively analyze our experience with the surgical treatment of early-intermediate OPSCC using the LP approach, and to investigate the potentially prognostic clinical and/or pathological factors that might identify patients at higher risk of recurrence after primary surgery. Sixty-four patients with previously untreated early-intermediate (pT1-T2-T3) OPSCC consecutively underwent partial pharyngectomy using a LP approach, performed by the same surgical team at a tertiary head and neck oncology center (Otolaryngology Unit, Vittorio Veneto Hospital, Italy). The 2-year disease-specific survival rates were 86% for stage I-II and 77% for stage III-IV disease. All patients who experienced locoregional or distant metastases died of their disease, while no patients died of any complications of the treatment. Postoperative complications occurred in 25 patients (39%), the most common being pharyngocutaneous fistula. All but one of the patients experienced a complete recovery of oral food intake. In conclusion, the LP approach to oropharyngeal cancer could be a valid open surgical alternative to oropharyngectomy with mandibulotomy for: (a) patients with early-intermediate OPSCC in whom oropharyngeal exposure proves difficult, and/or who are not eligible for transoral endoscopic surgery; (b) HPV-negative OPSCCs; and

Classification system for lateral pharyngotomy: systematic study of anatomic exposure in a human cadaver model.

Lateral pharyngotomy (LP) is a surgical procedure that allows exposure to tumors of the pharynx and supraglottic larynx. This study was undertaken to: (1) propose a classification system of LP used in exposing various sites of the oropharynx, supraglottis, and hypopharynx. (2) Describe the structures visible with each category of LP. Five tissue-fixed human cadavers from our gross anatomy laboratory were dissected in a manner similar to surgical lateral pharyngotomy. After exposure of the neurovascular structures of the anterior compartment of the neck and laryngeal framework, traditional pharyngotomy was performed with entry between the hypoglossal nerve cephalically and the superior laryngeal nerve caudally (traditional LP). Progressively increased exposure was created by division of adjacent structures. The ability to visualize certain structures (epiglottis, ipsilateral and contralateral base of tongue, postcricoid area, arytenoids, uvula, soft palate, and vallecula) through the pharyngotomy was recorded. The epiglottis and ipsilateral tongue base were visible via the traditional or Type I LP. Type II, III, and IV LP provided exposure to increasingly remote sites of the pharynx and supraglottic larynx. The additional exposure provided by each type of LP was consistent across all five cadaver specimens. Our system catalogs the additional exposure of both cephalic and caudal tumor sites associated with division of adjacent structures. This anatomic study illustrates and systematizes the structures requiring division to provide access to a given tumor location.

Double nail in Hypopharynx- A rare presentation

Introduction
 An extremely rare case of a pair of nails impacted in the right pyriform sinus, presenting 72 hours after the incident, is reported.
 Case Report
 X-ray soft tissue neck revealed the presence of a pair of nails in the neck at C4-C5 vertebral level. The foreign bodies could not be seen on hypopharyngoscopy due to severe mucosal oedema. Lateral pharyngotomy was done to remove the nails with C-arm guidance.
 Discussion
 Retained foreign bodies in the aerodigestive tract are known to produce complications. Delayed presentation makes the management difficult. C-arm guidance during surgical exploration is helpful to locate a radiopaue foreign body in difficult situations.

Myoepithelial carcinoma of the vallecula: A case report and review of the literature.

Myoepithelial carcinoma (MEC) of the vallecula is relatively rare, and there is no specific surgical guideline for resecting MEC in the vallecula. To the best of our knowledge, the current study reports the first case of MEC involving the vallecula of a 48-year-old female patient. In the present study, the lesion was correctly diagnosed as MEC and successfully managed using lateral pharyngotomy and by the construction of a sternohyoid myofascial flap. The patient was free of local recurrence or metastasis 18 months after surgery. The present study briefly reviews the current knowledge concerning the diagnosis and treatment of MECs in the head and neck area and offers suggestions for managing MEC in the vallecula. To conclude, MEC of the vallecula may be successfully managed by surgical treatment without evident post-surgery complications.

Coated collagen patches for closure of pharyngo-cutaneous fistulas

After laryngectomy or lateral pharyngotomy for treatment of laryngeal or hypopharyngeal cancer the occurrence of a pharyngo-cutaneous fistula is a challenging complication. Especially after previous radiotherapy and expanded surgical resections of mucosa the management is demanding. Besides the prolonged hospital stay, increased treatment costs and reduced quality of life, a delayed adjuvant treatment follows the development of a fistula. Treatment strategies range from conservative procedures comprising parenteral nutrition, antibiotics and local wound care to primary surgical closure or reconstructive tissue transfer. We report three cases of using the fibrin/thrombin-coated collagen patch TachoSil® as a solitary or adjuvant strategy in surgical treatment. In one patient primary closure of the fistula was achieved by transoral application of the collagen patch. In the other cases a not tension free primary suture was strengthened by the adjuvant use of TachoSil®. The healing process was rapid and straightforward in all patients. The use of TachoSil® may be indicated in between conservative treatment strategies and reconstructive surgery. After occurrence of a fistula the healing process is intended to be accelerated by primary closure with TachoSil® or by sealing of a primary suture.