Subglottic Extension Research Articles

Prognostic impact of different tumor invasion patterns in the surgical treatment of T3 glottic laryngeal cancer

Objective:To investigate the prognostic impact of different tumor invasion patterns in the surgical treatment of T3 glottic laryngeal cancer. Methods:A retrospective analysis was conducted on the clinical data of 91 patients with T3 glottic laryngeal cancer. Results:Among the 91 patients, 58 cases （63.7%） had anterior invasion and 33 cases （36.3%） had posterior invasion. The posterior invasion was significantly correlated with invasions of the dorsal plate of cricoid cartilage （P<0.001）, arytenoid cartilage （P= 0.001）, and subglottic region（P = 0.001）. There was no statistical difference in survival outcomes between the total laryngectomy group and the partial laryngectomy group. But in the partial laryngectomy group, the 5-year disease-free survival（DFS） of patients with anterior invasive tumors was better than that of patients with posterior invasion tumors （HR: 4.681, 95%CI 1.337-16.393, P=0.016）, and subglottic invasion was associated with worse loco-regional recurrence-free survival（LRRFS）（HR: 3.931, 95%CI 1.054-14.658, P=0.041）. At the same time, we found that involvement of the dorsal plate of cricoid cartilage was an independent risk factor for postoperative laryngeal stenosis in partial laryngectomy patients （HR:11.67, 95%CI 1.89-71.98,P=0.008）. Conclusion:Compared with total laryngectomy, selected partial laryngectomy can also achieve favorable oncological outcomes. Posterior invasion and subglottic extension are independent prognostic factors for recurrence of partial laryngectomy in T3 glottic laryngeal cancer, and the involvement of the dorsal plate of cricoid cartilage is associated with postoperative laryngeal stenosis. The tumor invasion pattern of laryngeal cancer should be further subdivided in order to select a more individualized treatment plan.

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).

Neuroendocrine carcinoma of the larynx: A case report

In the physical examination of a 65-year-old male patient who presented with hoarseness and dysphagia, an ulcerovegetative mass was observed in the medial wall of the right pyriform sinus, with subglottic extension involving the right hemilarynx. The right vocal cord was found to be paralyzed. The patient underwent neck magnetic resonance imaging and thorax computed tomography. The pathology report revealed findings consistent with a neuroendocrine neoplasm, Grade 1 (typical carcinoid) neuroendocrine carcinoma. The patient underwent total laryngectomy and bilateral functional neck dissection after the completion of treatment by the recommendations of infectious diseases, as the coronavirus disease 2019 polymerase chain reaction test performed one day before the operation was positive. The patient developed herpes zoster and a local fungal infection after the surgery, and the patient was discharged with a plan for adjuvant chemoradiotherapy after the completion of treatment. The patient’s follow-up is ongoing.

Carcinoma larynx with thyroid gland metastasis: a rare case report

&lt;p&gt;Thyroid gland (TG) metastasis by laryngeal cancer is uncommon. However, now a days following concept of ‘organ preservation’, so ipsilateral hemithyroidectomy is not required in every case with total laryngectomy (TL) for laryngeal cancer. Studies for T3 and T4 laryngeal cancer having, anterior commissure involvement, transglottic growth or subglottic extension indicates thyroidectomy in the majority of cases. Hemithyroidectomies are linked to hypothyroidism in 23–63% of cases and hypoparathyroidism in 25–52% of cases. There is no recognized link between tumour differentiation and TG involvement. According to reports, the prognosis in cases of TG involvement is poor. The tumour differentiation determines whether the spread is contiguous or noncontiguous. Contiguous spread is more likely in well-differentiated carcinomas, while non-contiguous spread is more likely in poorly or moderately differentiated carcinomas. Anatomically, direct TG invasion is only possible through extralaryngeal soft tissue, which includes the cricothyroid and cricopharyngeus muscles. Non-contiguous spread only possible through lymphovascular invasion which is not necessarily, but seen in 87-91% of cases with subglottic extension over 10 mm, as seen in our case also.&lt;/p&gt;

Three-week hypofractionated radiotherapy in early glottic cancer – a single institution retrospective study

BackgroundRadiotherapy is a standard treatment option for early glottic carcinoma (stage I and II) with a fraction size of 2–2.2 Gy over 5–7 weeks. This study evaluates the outcome and prognostic factors of a 3-week hypofractionated treatment in early glottic malignancy.Materials and MethodsThe case records of 329 eligible patients with stage I and II glottic carcinoma recorded at the institution from 2003 to 2008 were retrospectively analysed. All patients were treated in a Cobalt-60 machine to a dose of 52.5 Gy in 15 fractions (3.5 Gy/fraction) over 3 weeks.ResultsEighty-three percent had stage I disease. The local control rate at 5 years was 91.9%. On univariate analysis, stage I and II patients without subglottic extension had better local control. Disease extension to the subglottis fared poorly on multivariate analysis. After salvage treatment, the 5-year disease-free survival rate was 96.1% and the functional larynx preservation rate was 94.9% for stage I and 83.9% for stage II. The rate of severe complications was 2.1%.ConclusionComparable results with low morbidity are achievable with a 3-week hypofractionation in early glottic cancers and it offers better patient convenience.HighlightsIn early glottic cancer, hypofractionated radiation provides excellent local control.Subglottic extension is a poor prognostic factor.5-year disease-free survival rate of 96.1%.5-year functional larynx preservation rate of 94.9%.Severe complication rate of 2.1%.

Have We Made Progress in Early Stage Vocal Cord Cancer with Impaired Cord Mobility?

<h3>Purpose/Objective(s)</h3> The probability of cure after hypofractionated larynx radiotherapy (RT) decreases among patients with T2 glottic cancers with impaired cord mobility. The role of concurrent chemotherapy in this setting is unclear. We report outcomes of patients with T2 (and T3 based on paraglottic space invasion alone) N0 glottic squamous cell carcinoma (SCC) treated with curative-intent hypofractionated larynx RT with or without chemotherapy. <h3>Materials/Methods</h3> We retrospectively reviewed the medical records of all patients with AJCC 8^th edition stage T2-T3 N0 M0 SCC of the glottic larynx treated with curative intent at a single institution between 2000 and 2020. T3 patients were included if they were upstaged by paraglottic space invasion alone. All patients received hypofractionated RT (2.25 Gy/fraction) to the larynx to 63 - 65.25 Gy, with or without concurrent systemic therapy, and had at least 6 months of follow-up. Disease control and survival outcomes were calculated by the Kaplan-Meier method, and we used descriptive analysis to compare prognostic factors since more robust statistics were limited by sample size. <h3>Results</h3> The study population included 71 patients with a median follow-up time of 3.8 (range, 0.1 – 17.2) years. Major 2-year outcomes (95% CI) were as follows: local control, 74% (62% - 83%); regional control, 92% (83% - 97%); laryngectomy-free survival, 70% (58% - 80%); and overall survival, 82% (71% - 90%). Among the 23 patients who received systemic therapy (92% received weekly cisplatin or carboplatin), a greater proportion had impaired mobility (70% vs. 40%, p=0.02), larger median gross tumor volume (3.0 vs 1.6 cc, p=0.003), and subglottic extension (61% vs. 25%, p=0.008). Despite their worse prognostic factors, patients with impaired cord mobility who received chemotherapy experienced better local control and avoided total laryngectomy, without increased toxicity (see Table). One patient (4%) treated with chemotherapy required gastrostomy tube and tracheostomy during RT (both removed within 1 year). All but 6 late grade 3+ adverse events occurred after salvage laryngectomy for local recurrence. There were only 2 isolated regional relapses despite limited use of elective nodal RT (n=2). <h3>Conclusion</h3> The addition of concurrent platinum-based chemotherapy to hypofractionated larynx RT among patients with early-stage glottic SCC with impaired cord mobility appears safe, effective, and worthy of additional investigation.

Frequency of Thyroid Gland Invasion by Laryngeal Squamous Cell Carcinoma: The Role of Subglottic Extension.

Introduction Management of the thyroid gland during laryngectomy has been controversial. The primary tumor may invade the thyroid gland by direct invasion or lymphovascular spread. Hypothyroidism and hypoparathyroidism are potential risks when lobectomy or total thyroidectomy are performed simultaneously. Objective To report the frequency of thyroid gland involvement by primary laryngeal squamous cell carcinoma in patients undergoing laryngectomy and to identify possible risk factors for thyroid gland involvement so that judicious excision of thyroid gland can be attained. Methods We performed a retrospective review of 9 years. Data was collected from medical records of patients dated from December 2009 to October 2018. All patients with laryngeal cancer who underwent laryngectomy with lobectomy or total thyroidectomy were included in the present study. Results We reviewed 151 laryngectomy records. A total of 130 surgeries included the thyroid gland with the excised specimen and were available for analysis. There were 124 males and 6 females. The mean age was 59.4 years old. The glottis was the most common subsite involved, in 70 patients, followed by 38 transglottic, 16 supraglottic and 03 subglottic tumors. On histology, 12 out of 130 excised thyroid glands were involved by squamous cell carcinoma. Only subglottic involvement ( p = 0.01) was significantly associated with thyroid gland invasion (TGI). Type of laryngectomy, subsite of the primary tumor, thyroid cartilage involvement, neck nodal metastases, and perineural and lymphatic invasion by the primary tumor were not associated with TGI. Conclusion Only subglottic involvement is associated with TGI; therefore, preoperative and intraoperative assessment is necessary prior to considering excision of the thyroid gland.

Routine thyroidectomy with total laryngectomy: Is it really indicated? A randomized controlled trial

BackgroundWe investigated the incidence of thyroid gland invasion in patients with advanced laryngeal carcinoma who were treated with total laryngectomy, also the impact of different preoperative and intraoperative predictors on thyroid gland invasion. Moreover, the impact of thyroid gland preservation on the locoregional tumor control and the recurrence rates after surgery were investigated. Materials and methodsThis study was conducted over 5 years on 100 patients with advanced laryngeal carcinoma who underwent total laryngectomy. The adopted protocol in our hospital is to perform an ipsilateral thyroid lobectomy if there is subglottic extension, thyroid or cricoid cartilage invasion or true invasion of the thyroid gland. The patients of the study were divided into thyroid sparing and thyroid sacrificing groups. The two groups were compared in terms of demographic data, tumor characteristics, incidence of postoperative hypothyroidism and tumor recurrence. ResultsThere was no significant difference between groups regarding the tumor profile. Regarding local tumor spread, the only two subsites that showed significant difference is anterior commissure and thyroid cartilage invasion. In the thyroid sacrificing group, invasion of the thyroid gland was proved histopathologically in only one patient. Postoperatively, the incidence of hypothyroidism was significantly higher in the thyroid sacrificing group. However, there was no statistically significant difference between the two groups regarding the incidence of tumor recurrence. ConclusionThe incidence of thyroid gland invasion by an advanced laryngeal carcinoma is low. Preservation of the thyroid gland during laryngectomy to reduce the risk of thyroid dysfunction does not affect the oncological control.

Neck metastasis in transglottic laryngeal carcinomas

In laryngeal cancers, the first metastasis occurs in the cervical lymph nodes This study aimed to determine the levels of cervical metastatic lymph nodes in patients with transglottic laryngeal carcinoma, the effect of tumor prognostic factors on cervical lymph node metastasis. The research retrospectively examined 32 patients who underwent total laryngectomy and neck dissection, with the diagnosis of transglottic squamous cell carcinoma (SCC). Age, gender, complaint, smoking status, and other prognostic factors were evaluated. All patients underwent total laryngectomy with 63 neck dissections. Seven patients had metastatic cervical lymph nodes. Among the prognostic factors, thyroid cartilage invasion, combined perineural–perivascular invasion, subglottic extension, extralaryngeal extension, and preoperative tracheotomy procedure had statistically significant effects on neck metastasis. In conclusion; Dissection at level IIB should be reassessed to decrease morbidity due to the low prevalence of level IIB metastasis, both clinically and pathologically. In locally advanced laryngeal cancers, considering the prognostic factors, it is ideal to plan specific treatments for each patient.

Prognostic imaging variables for recurrent laryngeal and hypopharyngeal carcinoma treated with primary chemoradiotherapy: A systematic review and meta-analysis.

BackgroundIn this systematic review, we aim to identify prognostic imaging variables of recurrent laryngeal or hypopharyngeal carcinoma after chemoradiotherapy.MethodsA systematic search was performed in PubMed and EMBASE (1990–2020). The crude data and effect estimates were extracted for each imaging variable. The level of evidence of each variable was assessed and pooled risk ratios (RRs) were calculated.ResultsTwenty‐two articles were included in this review, 17 on computed tomography (CT) and 5 on magnetic resonance imaging (MRI) variables. We found strong evidence for the prognostic value of tumor volume at various cut‐off points (pooled RRs ranging from 2.09 to 3.03). Anterior commissure involvement (pooled RR 2.19), posterior commissure involvement (pooled RR 2.44), subglottic extension (pooled RR 2.25), and arytenoid cartilage extension (pooled RR 2.10) were also strong prognostic factors.ConclusionPretreatment tumor volume and involvement of several subsites are prognostic factors for recurrent laryngeal or hypopharyngeal carcinoma after chemoradiotherapy.

Incidence and predictors of thyroid gland invasion by laryngeal carcinoma: a 7-year experience review

BackgroundStudy the incidence of thyroid gland invasion by laryngeal carcinoma and the risk factors that may predispose to this condition. Aiding surgeons develop an evidence-based plan for the management of the thyroid gland during total laryngectomy.ResultsRetrospective analysis of the available medical records for patients who had total laryngectomy together with total thyroidectomy or hemithyroidectomy in the same procedure. Associated pathological features were also investigated. Patients who had laryngeal carcinoma managed by total laryngectomy with total thyroidectomy or hemithyroidectomy between January 1, 2011, and December 31, 2017.Three hundred seventy-seven records were retrieved. The incidence of thyroid gland invasion by the laryngeal carcinoma was 24 (6.4%). Three patients showed microscopic extension (3/356; 0.8%). Six patients had malignant pathology other than squamous cell carcinoma (SCC). Two over six had invasion of the thyroid gland; OR (95% CI): 7.9 (1.4-45.4). Patients who had primary tumor stage of T4a were 244. 23/244 had thyroid gland invasion, 13.7 (1.8-102.9). Poorly differentiated tumors had significant incidence of thyroid gland invasion (4/15), 6.2 (1.8-21.3). Patients who had subglottic extension by the primary tumor were 177 with 20 patients having thyroid gland invasion (20/177), 6.2 (2.1-18.6).ConclusionSeveral risk factors are associated with higher incidence of invasion of the thyroid gland by laryngeal carcinoma. Identification of these factors can help surgeons develop a surgical strategy for the management of the thyroid gland during total laryngectomy.

Surgical Management of Anterior Glottic Webs.

Congenital webs are rare and represent <5% of all congenital laryngeal anomalies. They are usually a partial laryngeal atresia rather than a true web, and present as a thick and fibrotic web with subglottic extension and associated subglottic stenosis. All patients with a congenital anterior glottic web should be evaluated for chromosome 22q11.2 deletion syndrome. Management strategies are mainly based on the severity of airway obstruction and the anatomical extension of the webs. Simple division of the web endoscopically may be adequate for rare thin webs, however, an open approach is usually warranted for thick glottic webs regardless of Cohen grades. Open repair can be either with keel placement or reconstruction of the anterior commissure.

Is thyroid excision mandatory with laryngectomy in carcinoma larynx?

BackgroundAdvanced stage operable cancers of larynx are treated with total laryngectomy including thyroid resection in most of the cases, which may expose patient to hypothyroidism and hypoparathyroidism. The requirement of thyroidectomy during Total Laryngectomy is controversial.MethodsA cross sectional observational study was set out to review preoperative clinical and radiological assessment; intraoperative and histopathological findings; and follow-up data to predict thyroid gland invasion in the setting of squamous cell carcinoma of the Larynx.Results11 (16%) out of 69 patients had thyroid gland involvement on histopathological examination with mean age 63 years. Out of these 11 cases, 8 (72%) underwent primary total laryngectomy. 90% patients with thyroid gland involvement were male. 9 cases with thyroid gland involvement were staged as T4a preoperatively.ConclusionInvasion of thyroid gland by laryngeal cancer is uncommon. Unnecessary hemithyroidectomies lead to hypothyroidism and hypoparathyroidism. The study points out the clear indications of thyroid excision in patients undergoing total laryngectomy. We can suggest that total thyroidectomy should be done with total laryngectomy in cases which have gross clinical, radiological or intraoperative thyroid gland involvement, subglottic extension and thyroid cartilage invasion. This can save the patients from the brunt of unnecessary morbid hypothyroidism and hypoparathyroidism.

Chemoradiotherapy for high-risk stage II laryngeal cancer.

Definitive radiotherapy (RT) for stage II laryngeal cancer is known to be less effective for locoregional control and survival (LRCS) in patients with high-risk factors (e.g., subglottic extension, impaired cord mobility, or bulky tumor size) than in low-risk patients. The purpose of this study was to evaluate the safety and efficacy of chemoradiotherapy (CRT) for stage II laryngeal cancer patients with high-risk factors METHODS: Sixty-five consecutive patients with stage II laryngeal cancer who received radiotherapy (RT) alone or CRT were retrospectively analyzed. The patients were classified into three groups: RT, low risk (RT-low, n = 26); RT, high risk (RT-high, n = 25); and CRT, high risk (CRT-high, n = 14). The glottis was the most common primary tumor site in all groups. Most patients in the CRT-high group received platinum-based CRT. The 5-year locoregional control and survival (LRCS) rates were 88.3, 44.2, and 85.7% in the RT-low, RT-high, and CRT-high groups, respectively. In multivariate analysis, high-risk disease and CRT were significantly associated with 5-year LRCS rates. CRT may provide better locoregional control than RT alone in high-risk stage II laryngeal cancer.

Two cases of recurrent laryngeal cancer with subglottic extension treated with supratracheal laryngectomy

Two cases of recurrent laryngeal cancer with subglottic extension treated with supratracheal laryngectomy

Laryngeal Web in the Pediatric Population: Evaluation and Management.

To discuss the presentation, evaluation, and management of pediatric laryngeal web. Retrospective case series. Single tertiary care center. All patients with laryngeal web at Boston Children's Hospital in the past 22 years. No exclusion criteria. Charts mined for age at presentation, presenting symptoms, degree/location of web, associated syndromes, number/type of surgical procedures, and postoperative outcomes. Thirty-seven patients were included (13 male, 24 female). Average age at diagnosis was 3.7 years (0-19.5 years). Mean follow-up was 4.4 years (range, 0-16.4 years). There were 26 congenital webs (70.2%) and 11 acquired webs (29.8%). Presenting symptoms were vocal (29 patients, 78.4%) and respiratory (22 patients, 60%). Underlying syndromes or synchronous airway lesions included the following: premature (n = 5), congenital heart disease (n = 18), subglottic stenosis (n = 5), 22q11.2 deletion syndrome (n = 10), and recurrent respiratory papillomatosis (n = 4). There were 20 type 1 webs, 6 type 2 webs, 8 type 3 webs, and 3 type 4 webs; 10 had subglottic extension of the laryngeal web. Twelve patients were managed conservatively with observation. Eighty-four interventions were performed: 18 open and 66 endoscopic (sharp division, 32; dilation, 33; mitomycin C, 14; laser, 5; keel, 6; triamcinolone injection, 8; stent, 15; removal of granulation tissue, 5). Tracheotomy was required in 11 patients, and 5 patients were decannulated. Voice improved in 12 patients, with respiratory symptoms in 12 patients. Web recurred in 17 patients. One patient died due to airway complications. Pediatric laryngeal web is an uncommon but challenging lesion. Patients need to be evaluated for comorbid syndromes and synchronous airway lesions. Management includes open and endoscopic procedures. Procedures should be tailored to the child's presentation.

The incidence of thyroid gland invasion in advanced laryngeal squamous cell carcinoma

IntroductionInvasion of the thyroid gland is not a general feature of advanced laryngeal carcinoma. There is no need for performing thyroidectomy in all total laryngectomy cases. ObjectivesTo evaluate the frequency of the thyroid gland invasion in patients with advanced laryngeal squamous cell carcinoma submitted to total laryngectomy and thyroidectomy and to determine whether clinical and pathological characteristics of laryngeal carcinoma can predict glandular involvement. MethodsA retrospective case series with chart review, from March 2009 to January 2018, was undertaken in the the Princess Norah Oncology Center, King Abdul-Aziz Medical City, Jeddah/KSA. An inception cohort of 56 patients with laryngeal squamous cell carcinoma was considered. Nine cases were excluded. All patients had advanced stage cancer of the larynx (clinically T3‒T4) and underwent total laryngectomy in association with thyroidectomy. Total thyroidectomy was performed in all bilateral lesions or if there was suspicion of contralateral lobe involvement. Hemithyroidectomy was performed in all lateralized lesions. Retrospective histopathologic analysis of thyroid specimens was subsequently performed. The frequency of thyroid gland invasion was calculated and analysis of demographic, clinical and pathological characteristics associated with thyroid gland invasion was performed. ResultsIn all, 47 patients underwent total laryngectomy (40 treated with primary laryngectomy and seven treated with salvage laryngectomy following radiation failure or chemoradiation failure). Hemithyroidectomy was performed in 42 patients and the total thyroidectomy was performed in five patients. The overall frequency of invasion of the thyroid gland was 4.3%. Glandular involvement was seen in one advanced transglottic squamous cell carcinoma and one subglottic. In spite of thyroid cartilage invasion in 25.5% of cases detected in the preoperative radiological imaging, only one case demonstrated microscopic thyroid gland invasion. ConclusionsThyroidectomy may only be required during total laryngectomy for selected cases of advanced transglottic tumors and tumors with subglottic extension more than 10 mm.

Schwannoma of the Larynx with Subglottic Extension Removed by Transoral Surgery: A Case Report

Schwannoma of the Larynx with Subglottic Extension Removed by Transoral Surgery: A Case Report

Outcome of supracricoid laryngectomy in moderately advanced cancer larynx

Objective To assess the oncological outcomes of supracricoid laryngectomy in moderately advanced laryngeal cancer. Background Recently supracricoid partial laryngectomy (SCPL) with cricohyoidopexy (CHP) or cricohyoidoepiglottopexy (CHEP) and other surgical laryngeal preservation protocols have undergone major advancement to treat early and moderately advanced laryngeal tumors. SCPL with CHEP and CHP preserves the airway and laryngeal sphincter function with considerable decrease in the amount of risk of aspiration. Patients and methods A total of 10 patients with moderately advanced laryngeal squamous cell carcinoma (T2b toT4a) who were fit for surgery were recruited from two different specialized care centers in Egypt and India from January 2017 to January 2018. Patients with interarytenoid area involvement, cricoarytenoid joint involvement, pre-epiglottic space invasion, or subglottic extension were excluded. Results Patients were mainly T3 (four patients). They underwent SCPL with CHP in four cases and with CHEP in six cases. Preservation of one arytenoid was done in nine patients. The local control rate was 100%. Aspiration occurred in two cases. Both pexy rupture and salivary fistula occurred in one case. Removing of nasogastric tube and decannulation of tracheostomy were done in seven and six cases, respectively, before 1 month. Conclusion SCPL with CHEP and CHP was an effective treatment option with excellent oncological outcomes for T2b–T4a laryngeal cancer. Specific efficacy was revealed in cases with anterior commissure or paraglottic space involvement. Low rate of complications was reported in our study.

Risk factors for severity of juvenile-onset recurrent respiratory papillomatosis at first endoscopy

ObjectiveThe study objective was to determine risk factors for severity of juvenile-onset recurrent respiratory papillomatosis (RRP) at first endoscopic evaluation. MethodsBased on a review of all cases undergoing surgery for juvenile-onset RRP in two pediatric otolaryngology departments in the USA and France, the following severity risk factors were analyzed: number of laryngeal levels involved, extension to the subglottis, and bilateral involvement. ResultsThirty-two patients were included, with 571 endoscopic procedures. Number of endoscopies per patient varied according to initial extension: 30.67 procedures when all three levels were involved, 15.57 procedures when two and 14.08 procedures when only one (P=0.03). The odds ratio for risk of >14 procedures in 3-level involvement was 20.43 (P=0.047). Initial subglottic extension tended to be associated with more endoscopic procedures (23.67 vs 15.56, P=0.16). ConclusionsRRP severity correlated with initial laryngeal extension of papillomatous lesions at first endoscopy. This finding allowed a short 3-item assessment scale to be created for routine use, complementary to Derkay's assessment scale.