Postcricoid Region Research Articles

Efficacy of Minor Salivary Glands as Indicators of Depth of Resection for Superficial Hypopharyngeal Carcinoma.

This study aimed to investigate the utility of minor salivary glands in the hypopharynx as novel indicators for safe resection of superficial hypopharyngeal carcinomas with fewer complications. Cadaveric study. Cadavers were stored in the pathology laboratory at Kansai Medical University. Twenty-three cadaveric specimens were examined for minor salivary glands in the pyriform sinus, posterior wall, and postcricoid regions of the hypopharynx. Their count, size, and depth were assessed. Resected specimens from 5 consecutive patients with superficial hypopharyngeal carcinomas were pathologically analyzed to determine the positional relationship between cancer and minor salivary glands. Minor salivary glands were present in more than 70% of patients in each region during autopsy, with the postcricoid region having a larger count and size. The glands were universally present, regardless of sex, height, or body mass index. Minor salivary glands in the pyriform sinus and postcricoid region were present at a depth of 30% from the bottom of the submucosal layer, whereas those in the posterior wall were present in the shallow muscularis. During surgery, endoscopic findings revealed minor salivary glands as small white nodules in the submucosal layer. Pathological examination of the resected specimen confirmed that the white nodule was a minor salivary gland. In addition, tumor position in relation to minor salivary glands provided an adequate margin for resection. Minor salivary glands may serve as reliable indicators for determining adequate deep safety margins during surgery for superficial hypopharyngeal carcinoma.

Modified Killian Method for Flexible Nasopharyngoscopic Observation of the Hypopharynx: A Systematic Review and Meta-Analysis

Objective: Flexible nasopharyngoscopy is a common procedure for evaluating the hypopharynx. The modified Killian method has been reported to enhance visualization during this examination. The aim of this study was to compare the visibility of the hypopharynx using conventional and modified Killian methods. Methods: A systematic literature search was conducted in PubMed, EMBASE, and the Cochrane Library to identify studies that compared the visibility of the hypopharynx using the 2 methods. Comprehensive meta-analysis software was used to analyze the data. Studies that evaluated the overall hypopharyngeal visibility score and the visibility of the pyriform sinus, postcricoid region, and upper esophageal sphincter were included. Results: Five studies were included in the analysis. The pooled results showed that the modified Killian method significantly improved overall visibility score (SMD=1.09; 95% CI, 0.39–1.80) and complete visibility of the pyriform sinus, postcricoid region, and upper esophageal sphincter (log OR=3.83; 95% CI, 2.30–5.35; log OR=4.20; 95% CI, 3.21–5.19; log OR=3.38; 95% CI, 1.68–5.08). Conclusion: The modified Killian method is a valuable technique for improving hypopharyngeal visibility during flexible nasopharyngoscopy. This technique can enhance the detection of potential abnormalities or lesions, leading to better diagnostic accuracy and improved patient outcomes.

Role of flexible fiberoptic nasopharyngolaryngoscopy and indirect laryngoscopy in the diagnosis of laryngopharyngeal pathologies

Background: Visualization of the larynx and pharynx is essential to diagnose and treat pathologies, and to prognosticate. This can be done by using indirect laryngoscopy, rigid and flexible endoscopy, and direct laryngoscopy. The main purpose of the article was to assess the profile of laryngopharyngeal pathologies diagnosed by flexible fiberoptic nasopharyngolaryngoscopy and indirect laryngoscopy in patients with laryngopharyngeal symptoms and to estimate the level of agreement between flexible fiberoptic nasopharyngolaryngoscopy and indirect laryngoscopy for selected laryngopharyngeal conditions like vocal nodule, vocal cord polyp, Reinke’s edema, hypopharyngeal growth, vocal cord palsy, vocal cord growth. An Independent t-test and chi-square test were used to analyze the results. Statistical package for the social sciences (SPSS) version 20 was used for statistical analysis. Methods: In this descriptive cross-sectional study, 101 patients with laryngopharyngeal symptoms were subjected to both indirect laryngoscopy and flexible fiberoptic nasopharyngolaryngoscopy. The structures visualized, pathologies detected, time taken and discomfort levels were statistically analyzed. Results: In our study, we found that laryngopharyngeal symptoms were more common among the 61 to 70 years age group. The majority of them were males. The majority of them were retired employees. The most common presenting complaint was difficulty in swallowing, followed by globus sensation and voice change. All structures were visualized by flexible fiberoptic nasopharyngolaryngoscopy. Whereas, in indirect laryngoscopy, some structures were visualized and some were not. Pyriform fossa apex and post-cricoid region were not visualized for all patients with indirect laryngoscopy. Laryngopharyngeal reflux was the most common pathology detected. There is no significant difference between IDL and FOL in site, subsite, and clinical appearance of the pathology detected. There is a significant difference between IDL and FOL in time taken (FOL has a higher mean) and discomfort levels (IDL has a higher mean). Conclusions: Though indirect laryngoscopy is cost-effective in terms of investment, the time taken for the procedure is also less, flexible fiberoptic laryngoscopy is considered superior because it can visualize all structures and can detect pathologies early in their stage so that the patient gets treatment early which can alter the prognosis.

Establishment and characterization of a novel hypopharyngeal squamous cell carcinoma cell line CZH1 with genetic abnormalities.

Hypopharyngeal squamous cell carcinoma (HPSCC) has the worst prognosis among head and neck squamous cell carcinomas. The lack of available tumor cell lines poses a significant obstacle to the development of efficient treatments for HPSCC. In this study, we successfully established a novel cell line, named CZH1, from the postcricoid region of a Chinese male patient with a T3N0M0 HPSCC. Short tandem repeat analysis confirmed the uniqueness of CZH1. The cell line was characterized by its phenotypes, biomarkers, and genetics. Importantly, CZH1 cells retained the typical features of epithelial malignancy, similar to the primary tumor tissue. Furthermore, CZH1 demonstrated a greater capacity for invasion and increased susceptibility to irradiation in comparison to FaDu, which is the most commonly used HPSCC cell line. Whole-exome sequencing analysis revealed that CZH1 cells had typical genomic features of HNSCC, including mutations of TP53 and amplifications of multiple transcripts. Therefore, our newly developed CZH1 cell line could serve as an efficient tool for the in vitro investigation of the etiology, pathogenesis, and preclinical treatment of HPSCC.

Downhill varices in the hypopharynx due to huge thyroid tumor: a case report.

Downhill varices are usually caused by superior vena cava (SVC) obstruction due to bronchogenic carcinoma or mediastinal tumors. These structures show retrograde blood flow and are located in the proximal esophagus. Varices in the hypopharynx resulting from mediastinal thyroid tumor are extremely rare. A 70-year-old man visited a local hospital with a 35-year history of enlarging thyroid tumor in the right neck. Fine needle aspiration cytology of the tumor revealed benign goiter. Contrast-enhanced computed tomography showed a huge tumor (13×10×5 cm) in the right to left lobe of the thyroid extending into the mediastinum. Further, a well-enhanced mass mimicking hypopharyngeal cancer was identified in the hypopharynx. Endoscopic examination demonstrated varices in the postcricoid region, so we avoided biopsy. The preoperative diagnosis was huge adenomatous goiter and hypopharyngeal varices caused by obstruction of the internal jugular and brachiocephalic vein by the goiter. Total thyroidectomy was performed and hypopharyngeal varices had disappeared by the next day. The histopathological diagnosis of the thyroid tumor was poorly differentiated carcinoma. Mediastinal thyroid tumor rarely causes downhill varices due to SVC obstruction. However, in this case, signs of SVC obstruction were absent and varices were found not in the upper esophagus, but in the hypopharynx. Obstructed venous flow from the thyroid plexus might circulate via superior laryngeal vein and cause varices in the postcricoid region. When a patient with large mediastinal tumor shows a tumor-like lesion in the hypopharynx, considering the possibility of downhill varices is important before conducting immediate biopsies.

A rare presentation of Intralaryngeal Schwannoma and the study of 50 cases of intralaryngeal Schwannoma from the literature

<p class="abstract"><strong>Background:</strong> Laryngeal schwannoma is a rare, slow-growing, benign neurogenic tumour usually located in the aryepiglottic folds. The aim is to report a rare case of laryngeal schwannoma and to review 50 cases of a similar entity from the literature in terms of age, sex, presenting symptoms, site, size, the nerve of origin, mode of surgery and outcome.</p><p class="abstract"><strong>Methods:</strong> A retrospective study was conducted at the Department of Otorhinolaryngology, in a tertiary care centre along with a review of cases from the literature.<strong> </strong>A detailed description of the case of laryngeal schwannoma in a 20-year-old patient, who presented with difficulty in swallowing, dyspnoea and hoarseness in the voice to the department of otorhinolaryngology will be given. Along with the data on a comprehensive literature search on about 50 cases of laryngeal schwannomas. </p><p class="abstract"><strong>Results:</strong> Out of the 50 cases, 54% were females and the majority of the cases were above the age of 55 years. Aryepiglottic folds were the common site of tumours (38%). Other sites where the tumour was found included the false cords, true vocal cords, ventricle, arytenoids, epiglottis, post cricoid region, trachea, and thyroid gland. All cases were treated surgically.</p><p class="abstract"><strong>Conclusions:</strong> Laryngeal schwannomas are rare, nerve sheath tumours usually located in the supraglottic larynx. The surgical approach depends on the site, size and extent of the tumour. Sparing the parental nerve depends on the size of the tumour and the nerve of origin.</p>

Isolated hypopharynx lipoma: a case presentation and literature review

BackgroundLipomas are the most common benign mesenchymal tumors. They are defined as subcutaneous neoplasms of mature adipocyte cells that can occur wherever fatty tissue is. Lipomas are rare in the upper aerodigestive tract. Usually asymptomatic, they may be painful, uncomfortable, or even life-threatening especially if voluminous and located in the upper aerodigestive tract.Case presentationA 67-year-old female patient has presented with dyspnea on mild effort and chronic orthopnea. The physical examination was normal while the fiber optic endoscopy revealed a submucosal round-shaped mass rising from the left side of the post-cricoid region. CT scan revealed a well-circumscribed fatty mass of the left piriform sinus for which the patient underwent an endoscopic transoral approach for a complete removal with good results.Discussion and conclusionPharyngeal lipomas are rare entities that might be life-threatening. Although clinical manifestations are not specific, imaging techniques, especially MRI, help set the diagnosis showing a fatty mass of the upper aerodigestive tract. However, pathology examination is crucial to rule out low-grade liposarcomas. Surgical management is not well-codified and has benefited from the development of endoscopic techniques.

The Prognostic Capacity of Systemic Inflammation Response Index, Neutrophil-to-Lymphocyte Ratio, Lymphocyte-to-Monocyte Ratio, and Platelet-to-Lymphocyte Ratio in Patients with Hypopharyngeal Squamous Cell Carcinoma

Introduction: Systemic inflammation response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) have been proposed as peripheral blood biomarkers. We compared these blood biomarkers to identify the best predictor in patients with hypopharyngeal squamous cell carcinoma (HPSCC). Methods: We conducted a retrospective study on 304 patients with HPSCC. SIRI was divided into three groups using X-tile version 3.6.1. The optimal cut-off points for NLR, LMR, and PLR were selected through RStudio. We compared the prognostic capacity of SIRI with that of NLR, LMR, and PLR using receiver operating characteristic curves. Results: Smoking, cancer in the postcricoid region, lymph node metastasis (N+), extracapsular invasion, SIRI in the highest tertile (>2.80), and LMR in the lowest tertile (<5.0) may cause poor 5-year overall survival (OS) in patients with HPSCC. Local and distant recurrences may occur earlier in those with lymph node metastasis and a tumor invading beyond the mucosa layer. Conclusions: SIRI was a better predictor of OS than LMR, PLR, and NLR in HPSCC patients. SIRI in the highest tertile (>2.80) and LMR in the lowest tertile (<5.0) may cause poor 5-year OS.

Long-Term Survival of Patients After Total Pharyngolaryngoesophagectomy With Gastric Pull-Up Reconstruction for Hypopharyngeal or Laryngeal Cancer Invading Cervical Esophagus.

Hypopharyngeal and laryngeal cancers are aggressive and usually diagnosed at advanced stage with esophagus invasion. Total pharyngolaryngoesophagectomy with gastric pull-up reconstruction has been a common surgery for these cancers but long-term outcomes are still questionable. This study aimed to investigate short-term and long-term outcomes of patients who underwent this surgery. Patients with hypopharyngeal or laryngeal cancer invading cervical esophagus who underwent total pharyngolaryngoesphagectomy with gastric pull-up between 2012 and 2016 was included and followed up until 2021. Short-term outcomes were complications and long-term outcomes were overall survival (OS) and disease-free survival (DFS). Fifty patients were included with a mean age of 60.3 years and 94% were male. Pyriform fossa was the most common primary site of tumor (50%), followed by posterior hypopharyngeal wall (18%) and postcricoid region (18%). Mean operating time, postoperative oral intake and hospital stay was 363.1 ± 43.6 minutes, 8.8 ± 3.6 days and 14.2 ± 3.0 days respectively. Complications occurred in 15 patients (30%) without any in-hospital death. During the follow-up period, 17 patients had recurrence and 35 patients died. Median (95% confidence interval [CI]) OS and DFS time were 30 (21-37) and 30 (19-36) months. Five-year OS and DFS probability (95% CI) were 22.6% (12.8-39.7) and 22.7% (12.9-39.8). Total pharyngolaryngoesophagectomy with gastric pull-up is feasible and safe. However, even with curative surgery and multimodal treatment, advanced pharyngeal or laryngeal cancer with cervical esophagus invasion still has poor survival outcome.

Large cell neuroendocrine carcinoma of hypopharynx: A distinct histopathological entity

Aim: To present a case of large cell neuroendocrine carcinoma (LCNEC) involving the hypopharynx focusing on the histopathological diagnosis, radiological investigations and oncology treatment. Methodology: A case report with relevant literature review Case report: A 71-year-old Caucasian male presented with a four-month history of right sided sore throat, a one-month history of feeling something stuck in his throat at the level of the larynx associated with a deeper voice and two weeks history of right referred otalgia. On examination his voice has a rough but there was no stridor. There was a 2 x 2 cm node palpable in the right neck level II. Flexible pharyngolaryngoscopy revealed an exophytic growth on the right aryepiglottic fold that was covering the whole of the glottis. However, panendoscopy showed a large exophytic mass filling up the right piriform fossa involving the adjacent aryepiglottic fold and the postcricoid region. The biopsy confirmed the LCNEC and the fine needle aspiration cytology showed metastasis in his neck. The scans did not show any widespread disease in the body. He was managed in the multidisciplinary team setting and was treated with chemoradiotherapy. Conclusion: LCNEC involving the hypopharynx is an extremely rare clinical entity with poor prognosis. Early diagnosis and radical treatment with chemoradiotherapy would appear to be an acceptable treatment option.

302 Migratory Foreign Body in The Neck- How A Fishbone Morphed into A Piece of Glass In 18 Months

Abstract Background Foreign body (FB) ingestion is a common presentation to ear, nose, and throat (ENT) surgeons. Usual culprits include fish or chicken bones, steak, or non-organic items. FBs can be categorised into batteries, hard objects, and soft boluses. Hard objects that have not passed beyond the post-cricoid region require removal to minimise perforation risk. In rare cases FBs are reported to migrate extra-luminally into surrounding tissues of the neck necessitating cross-sectional imaging ahead of neck exploration. Case Report A 70-year-old lady presented to A&amp;E with a sensation of FBs in her throat. She was aphagic without dyspnoea. Home-cooked fish ingestion was the precursor. Panendoscopy was clear. The patient was discharged once tolerating fluids and soft diet. She presented 14 months later to the ENT clinic with a persistent FB sensation in her throat. A computed-tomography scan of neck showed a right sided, radio-opaque, 3 cm foreign body sitting just anterior to the carotid sheath, behind the right superior thyroid lobe. An elective external neck exploration revealed a 3 cm shard of glass which was successfully removed without complications. Conclusions Extra-luminal migration of FBs is extremely rare. They may present with life-threatening suppurative or vascular complications. A literature review revealed that migratory FBs tend to be sharp and long such as needles, wires, or fishbones. To allow prompt diagnosis and management, we propose a low threshold for CT imaging in instances with a clear history and persistent symptoms even when panendoscopy is negative.

RETROPHARYNGEAL ABSCESS WITH MEDIASTINITIS REQUIRING VIDEO-ASSISTED THORACOSCOPIC SURGERY

SESSION TITLE: Medical Student/Resident Disorders of the Mediastinum Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Retropharyngeal abscesses are rare in adults. We present a case of anterior and posterior mediastinitis and empyema secondary to retropharyngeal abscess requiring video-assisted thoracoscopic surgery (VATS) and median sternotomy. CASE PRESENTATION: A 58-year-old male with chronic obstructive pulmonary disease presented to the ED with 2 days of right sided pleuritic chest pain with associated worsening dyspnea on exertion, odynophagia/dysphagia, hoarseness, and night sweats over the past two weeks. He had two prior ED visits with milder symptoms where he was cleared by ENT and sent home with oral corticosteroids. No history of immunosuppression, recent drug use, or odontogenic procedures. He was afebrile, tachycardic, and saturating 95% on 2 L nasal cannula. Exam was significant for neck swelling with tenderness of the submandibular region and right chest wall along with expiratory coarse prolonged wheezes. Labs were notable for leukocytosis with neutrophilia and bandemia. He was started on corticosteroids and broad spectrum antibiotics. Computed tomography (CT) of the neck showed a rim enhancing hypodensity around the post cricoid region of the hypopharynx with extension into the anterior mediastinum (Figure 1). He had emergent incision & drainage by ENT and thoracic surgery where a Jackson-Pratt drain was placed. Repeat imaging revealed progression with a loculated empyema and mediastinal tracking which required VATS with right pleural decortication (Figure 2 & 3). Two days later, the patient's clinical status did not improve despite broad spectrum antibiotics and drainage and he required a median sternotomy with washout of the anterior/posterior mediastinal fluid collections and three chest tubes. Abscess cultures were positive for Streptococcus parasanguinis, Rothia mucilaginosa, and Candida glabrata. All drains were removed after minimal drainage. On discharge, he was requiring oxygen with exertion and went to a long term acute care hospital to continue broad spectrum antibiotics. DISCUSSION: Retropharyngeal abscess can be associated with high mortality and morbidity (1). It may be secondary to accidental penetrating trauma, iatrogenic, or spread of oropharyngeal infection (2). This case is unique in that there was no clear etiology for the retropharyngeal abscess. Deep neck infections tend to follow the path of least resistance of the well-defined cervical fascial planes and can lead to pericardial and pleural effusions. High index of suspicion should be entertained for patients presenting with fevers, sore throat, and dysphagia. Contrast enhanced CT imaging is utilized to characterize the extent of the abscess. Management typically requires surgical intervention and intravenous antibiotics. CONCLUSIONS: Descending mediastinitis can be life-threatening if not diagnosed promptly. Early intervention with surgical management and antibiotics is vital to improved outcome. Reference #1: Jain H, Knorr TL, Sinha V. Retropharyngeal Abscess. In: StatPearls. StatPearls Publishing; 2020. Accessed May 30, 2020. http://www.ncbi.nlm.nih.gov/books/NBK441873/ Reference #2: Mark R, Song S, Mark P. Taking heed of the ‘danger space’: acute descending necrotising mediastinitis secondary to primary odontogenic infection. Case Rep. 2018;2018:bcr-2018-225019. doi:10.1136/bcr-2018-225019 DISCLOSURES: no disclosure on file for Frank Ajatta; No relevant relationships by Venkata Bandi, source=Web Response No relevant relationships by Lorraine Cornwell, source=Web Response No relevant relationships by Kalpalatha Guntupalli, source=Web Response My spouse/partner as a Consultant relationship with Abbvie Please note: $1-$1000 Added 05/27/2020 by Ebtesam Islam, source=Web Response, value=Consulting fee No relevant relationships by Sarah Jaroudi, source=Web Response

S1904 Downhill Esophageal Varices Secondary to Pulmonary Hypertension: A Diagnostic and Therapeutic Challenge

INTRODUCTION: The incidence of Downhill esophageal varices is 0.4-10% and bleeding from these varices account for only 0.1% of acute esophageal bleeding. Our case report highlights the diagnostic and therapeutic challenges associated with this rare condition. CASE DESCRIPTION/METHODS: A 78-year-old female with a past medical history of Class II pulmonary hypertension on tadalafil and atrial fibrillation presented to the hospital with melena. On examination, heart rate was 59 beats/minute and blood pressure was 112/42 mm Hg. Hb/Hct (g/dL/%) was 8.6/25.5. Esophagogastroduodenoscopy (EGD) showed grade I proximal esophageal varices with old blood in the pharynx (shown in Figure 1). No signs of nasopharyngeal bleed were found on ENT exam. The patient was discharged on pantoprazole. She was re-admitted two more times within a month with gastrointestinal bleeding. A repeat nasopharyngolaryngoscopy showed coagulated blood at the post cricoid region of the glottis without active signs of bleeding. She had an EGD during every admission with no identifiable source of active bleeding. Work-up for cirrhosis was negative. CT thorax was negative for superior vena cava obstruction. During this period the patient had increasing oxygen requirements from fluid overload. Echocardiography showed PA systolic pressure of 87 mm Hg, impaired right ventricular function and severe tricuspid regurgitation. The family sought comfort measures in view of worsening clinical status and endoscopic therapy of the downhill varices was hence not attempted. DISCUSSION: Intrinsic narrowing of super vena cava (SVC) from malignancy or catheter related thrombosis (most common), extrinsic compression of SVC from intrathoracic goiter, thymoma and lung cancer are some causes of downhill varices. The increased pressure in the SVC secondary to pulmonary hypertension can rarely cause downhill varices. The extent of esophageal varices is related to the level of SVC-azygous vein junction obstruction. High degree of suspicion is needed, as in our patient, when there no active bleeding on EGD or SVC obstruction is seen on imaging. Early diagnosis is crucial as the cornerstone of management is treatment of SVC obstruction. Balloon angioplasty, SVC stenting, vascular bypass are a few treatment options to relieve SVC obstruction. When the underlying medical disorder cannot be corrected, downhill varices can be controlled using endoscopic band ligation, sclerotherapy, or balloon tamponade although the risk of perforation in this region of esophagus is very high.Figure 1.: Esophagogastroduodenoscopy showing grade I proximal esophageal varices.

Surgical alternative to tracheoesophageal prosthesis for voice preservation in selected hypopharyngeal carcinoma

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;&lt;strong&gt;: &lt;/strong&gt;Pearson’s near-total laryngectomy (NTL) is a voice- preserving alternative to total laryngectomy in patients with advanced but localized laryngeal and hypopharyngeal cancers, wherein lung- powered speech is achieved by creation of a dynamic biological trachea-pharyngeal shunt. Report our experience with NTL in a series of 24 patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective case series analysis was done at VMMC and Safdarjung Hospital from January 2014- September 2019 after attaining ethical clearance. 24 patients with lateralized, locally a post- cricoid areas were included in the study. Patients who had involvement of the post cricoid region, interarytenoid region or involvement of bilateral cricoarytenoid units were excluded from the study. The subjects underwent Pearson’s NTL and were followed- up to examine for disease- control and functional results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; 22 patients (91.6%) attained a good quality voice following surgery with 2 patients (8.3%) developing minor aspiration problems. 1 patient (4.16%) developed local recurrence after 5 months. Surgical complications were surgical site infection (20.8%), pharyngocutaneous fistula (16.67%) and shunt stenosis (4.16%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: NTL is an oncologically safe alternative to total laryngectomy in selected patients and is capable of achieving excellent functional results with minimal surgical complications and post-operative maintenance.&lt;/p&gt;

Post cricoid tumours; a limiting factor for percutaneous endoscopic gastrostomy insertion in cancer patients: Results from a tertiary care hospital

Background and study aimsThe aim of this study was to review all episodes of PEG insertion in patients with head and neck cancer (HNC) at a cancer specialist centre. Patients and methodsUsing a structured data extraction form, we abstracted patients’ demographic data and clinical information including the primary site of tumour, TNM staging, whether PEG tube was inserted successfully, any complications resulting from PEG tube insertion and duration the tube was in place. ResultsWe identified a total of 339 HNC patients who had received at least one attempted PEG tube insertion. The mean age of patients was 49.5 ± 14.5 years and 66% (n: 233/339) were males. 151/ 339 (44.5%) patients had a tumour in the pharynx and nasopharynx, 103/ 339 (30.4%) in oral cavity, 81/ 339 (23.9%) in post-cricoid region and 4 (1.1%) of the patients had a laryngeal carcinoma. Histopathologically, most tumours (75.8%) were squamous cell carcinoma presenting at a T4 (52.6%), N0 (38.3%) and M0 (91.7%) stage. PEG tube was successfully inserted in 303/339 (89.4%) patients. There were 36 PEG failures; 24 (66.6%) in postcricoid and laryngeal tumours, 8 (22.3%) in pharynx/nasopharynx and 4 (11.1%) in oral cavity tumours. Of the 81 patients with post-cricoid tumour, PEG tube was successfully inserted in 57/ 81 (70.3%) of the patients.Age, gender or T stage of the tumour was not found to be statistically significant predictors of PEG failure. The only significant factor was presence of post-cricoid or laryngeal tumours that increased the risk of PEG failure 12 times (95% confidence interval: 3.4 to 42.3). ConclusionPEG tube should be used as a first line feeding option in patients with all type of head and neck cancers, however, the attending clinicians should have this foresight of higher failure rates in patients with post-cricoid tumour.

A Rare Case Report on Plummer-Vinson Syndrome with a Complication of Oral Cancer in a South-Asian Woman

Plummer-Vinson syndrome (PVS), also called "Paterson-Brown-Kelly syndrome“, is a rare medical syndrome generally affecting middle-aged women. Iron deficiency anemia is the prime etiological factor and other probable factors include malnutrition, genetic predisposition, or autoimmune processes characterized by three distinctive features: iron deficiency anemia, dysphagia, and esophageal web. The dysphagia is generally painless and intermittent or progressive over years, restricted to solids, and associated with weight loss. The exact pathogenesis of PVS is still indistinguishable, but it is interconnected with iron deficiency anemia. Plummer-Vinson syndrome, if left untreated, carries an increased risk of developing squamous cell carcinoma of the upper alimentary tract.In this case report, a 40-year-old female patient presented long-standing dysphagia for months, which progressively developed to postcricoid squamous cell carcinoma by the time she approached to medical treatment. Diagnosis was confirmed through laboratory tests, showing iron deficiency anemia and whole-body positron emission tomography-computed tomography (PET-CT) presenting squamous cell carcinoma in postcricoid region (hypopharynx).

Narrow band imaging might contribute to the diagnosis of laryngopharyngeal reflux.

Laryngopharyngeal reflux (LPR) accounts for 4-10% of outpatient visits. The standard domestic LPR diagnostic tools are the reflux finding score (RFS) and reflux symptom index (RSI). Narrow band imaging (NBI) can identify previously unknown characteristic microvessel features. Our aim was to explore the role of NBI in LPR diagnosis. We recruited 56 LPR outpatients and 41 symptom-negative controls. All individuals received RSI and RFS scores and underwent 24-hour multichannel intraluminal impedance-PH (MII-pH) monitoring and endoscopic NBI before and after treatment. The positivity rates in the study and control groups, before and after treatment, and using NBI and the conventional method were evaluated. Fifty-one LPR and six control patients had sparse light brownish dots or tufted light brownish dots in the postcricoid region. The RSI and RFS positivity rates were 31.3% and 87.1%, respectively. NBI is as effective as the RFS (P<0.05), and has poor consistency with the RSI (P<0.05). Fifty-three LPR patients underwent posttreatment laryngoscopy. The positivity rate decreased to 17.0% (P<0.05). NBI has good value for LPR diagnosis.

Patterson-Kelly Syndrome: A Single Centre Experience

<i>Background</i>: Patterson Kelly syndrome is a rare entity, presenting with a triad of Iron deficiency anemia, Dysphagia and Esophageal webs. The syndrome is extremely rare and its incidence is decreasing probably due to improvements in nutritional standards. The syndrome is enigmatic in the sense that not all patients may be having anemia, the syndrome is associated with various autoimmune conditions, webs are located in post-cricoid region only and there is increased prevalence of upper gastrointestinal malignancies in these patients. The symptoms respond to iron replacement but many patients require rupture of web for relief of dysphagia. Savary dilators, TTS balloon, electro-cautery have been variably used to break the web. <i>Objectives</i>: 1. To study the profile of Patterson Kelly syndrome at our center; 2. To study if the endoscope itself can be used as effective dilator for rupturing the web; 3. To study the effect of iron replacement in these patients; 4. To study the occurrence of upper gastrointestinal malignancies in this condition. <i>Material and methods</i>: We report our experience of sixteen patients with Patterson Kelly syndrome over last fifteen years. This is a retrospective, single center, observational study. All patients had demonstrable web on endoscopy. The endoscope itself was used as a dilator to break the web in more than half of the patients. The endoscope being rigid instrument can easily break the thin web during diagnostic endoscopy itself. If the opening was too narrow, TTS balloon or Savary Guilard dilators were used. One patient had a perforation while using endoscope as the dilator. Five patients required more than one sitting of dilatation for achieving relief of dysphagia or for recurrent web formation. Most patients received intravenous iron supplementation. Ten patients had complete relief of dysphagia without recurrence. One patient had concomitant esophageal squamous cell carcinoma in lower esophagus which became evident when the scope was passed distally, post dilatation of the web. <i>Conclusions</i>: Although rare, Patterson Kelly syndrome continues to exist and can be effectively treated by iron replacement, dilatation and rupture of esophageal webs using various methods. The web can be ruptured by careful maneuvering of the endoscope itself. Intravenous iron replacement can be used prior to the procedure which can ameliorate the symptoms and reduce the need for the dilatation or can make it easier. Patients need surveillance for upper gastrointestinal malignancies however exact guidelines in this regard are lacking.

Case report on Plummer Vinson syndrome

Plummer Vinson syndrome or Paterson-Brown-Kelly syndrome is a rare disorder is characterized by a triad of iron deficiency anemia, post-cricoid dysphagia and upper oesophageal web. This is a condition that is hypothesized to occur in people with long-term iron-deficiency anemia. It is more prevalent in females than in male patients. This disorder is characterized by iron deficiency anemia, post-cricoid dysphagia and oesophageal webs, symptoms typically progress over a period of six months and often include other systemic effects such as angular cheilitis, glossitis, and spooning of the fingernails. Here we report a case of 38 years female admitted in general medicine female with complaints of breathlessness and tightness of chest relieving after vomiting and had history of anemia, dysphagia insidious in onset and dysphagia associated with solid food over a year on examination patient was found to be gross pallor, angular cheilitis, spoon-shaped nails of fingers and toes. The lab findings were hemoglobin of 7.8 g/dl, serum ferritin levels 7.23 ng/ml, vitamin B12 175.2 pg/ml and upper oesophageal endoscopy revealed oesophageal web in the post-cricoid region. Treatment of Plummer Vinson syndrome includes iron supplementation followed by endotracheal dilation if necessary.

Clinical research about using the method of rasing head to expose postcricoid region by electronic laryngoscope

电子喉镜检查是咽喉部检查的一种重要方法，本文通过对58例慢性咽炎患者分别采用常规法、改良Valsalva法、自主抬头前屈法行电子喉镜检查，观察比较这三种方法在环后区的显露程度，结果显示自主抬头前屈法具有明显优势，可明显提高电子喉镜对咽喉部病变范围判断的准确性，对发现咽喉部早期病变、评估病变范围、发现环后区异物有着重要的临床意义。.