Supraglottic Mass Research Articles

Alternative Hybrid Technique of Intubation Using C-MAC and Yankauer Suction Catheter: Case of A Floppy Supraglottic Mass.

Supraglottic masses can be an anaesthesiologist's nightmare due to the difficult airway scenario and bleeding risk during airway manipulation. Awake fibreoptic intubation is the primary method to secure the airway in such cases. However, most practising anaesthesiologists are not experts at handling the fibreoptic scope, especially in cases with a floppy supraglottic mass where it becomes difficult to displace the mask with the thin flexible bronchoscope. A hybrid technique of intubation in supraglottic masses using Bonfils rigid scope and C-MAC is often described but frequently not available. Here we describe a case of an elderly patient in their 80s presenting with a floppy supraglottic mass where an awake fibreoptic bronchoscope failed to secure the airway. Without access to a rigid Bonfils scope, we intuitively used a C-MAC to visualize the larynx and a yankauer suction catheter to displace the mass and perform a bougie-guided endotracheal intubation.

Managing a difficult airway due to supraglottic masses: successful videolaryngoscopic intubation after induction of general anesthesia.

While awake, flexible bronchoscopic intubation has long been considered the gold standard for managing anticipated difficult airways, the videolaryngoscope has emerged as a viable alternative. In addition, the decision to perform awake intubation or to proceed with airway management after induction of general anesthesia should be grounded in a comprehensive assessment of risks and benefits. A 41-year old female patient was scheduled for excision of bilateral, mobile, and pedunculated masses on both aryepiglottic folds, which covered almost the entire upper part of the glottis. We conducted a comprehensive evaluation of the patient's signs and symptoms, which included neither stridor nor dyspnea in any position, along with the otolaryngologist's opinion and the findings from the laryngeal fiberscopic examination. Given the potential challenges and risks associated with awake flexible bronchoscopic intubation for this patient, we decided to proceed with gentle tracheal intubation using a videolaryngoscope under general anesthesia. In case of failed mask ventilation and tracheal intubation, we had preplanned strategies, including awakening the patient or performing an emergent tracheostomy, along with preparations to support these strategies. Ensuring that mask ventilation was maintained with ease, the patient was sequentially administered intravenous propofol, remifentanil, and rocuronium. Under sufficient depth of anesthesia, intubation using a videolaryngoscope was successfully performed without any complications. Videolaryngoscopic intubation after induction of general anesthesia can be a feasible alternative for managing difficult airways in patients with supraglottic masses. This approachshould be based on a comprehensive preoperative evaluation, adequate preparation, and preplanned strategies to address potential challenges, such as inadequate oxygenation and unsuccessful tracheal intubation.

Navigating Challenges During Airway Management and Anesthetic Considerations in a Patient with a Supraglottic Mass: Integrating Anesthesiologists and Otolaryngologist Expertise

Introduction: Managing patients undergoing head and neck surgeries necessitates meticulous evaluation, strategic planning, and collaborative efforts with surgical teams. This approach is crucial to mitigate perioperative complications and optimize patient safety. Rationale: Expert navigation of the challenging airway in these patients, particularly in the perioperative period, is essential to significantly reduce the risks of morbidity and mortality associated with such complex conditions. Patient Concerns and Diagnosis: The patient presented with a supraglottic mass extending into the epiglottis space, posing significant anesthetic challenges to airway management. Outcomes: A surgical airway was established via tracheostomy. Postoperatively, the patient was monitored in the intensive care unit for further management and was subsequently discharged to commence chemoradiotherapy. The tracheostomy tube remained in place at the time of discharge. Lessons: This case underscored our commitment to enhancing expertise in airway management for patients with oral cancer. Our experience contributes valuable insights to the evolving field of airway management in complex head and neck surgeries.

Indications and Outcomes of Tracheostomy: A Descriptive Study Using the Outcome-Based Evaluation Forms of Otorhinolaryngology - Head and Neck Surgery Department in a Tertiary Hospital (2016-2020)

Introduction: Tracheostomy is a surgical procedure that creates a neck opening directly into the trachea, typically performed to establish an alternative airway for individuals who experience difficulty breathing as a result of certain medical conditions. Tracheostomy can be temporary or permanent, and it plays a crucial role in the management of both acute and chronic respiratory issues and can significantly improve the quality of life for those who require it. Objective: This study aims to investigate the incidence, common indications and outcomes of tracheostomy in the Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) department of a tertiary hospital in Manila, Philippines. Methodology: This is a retrospective descriptive study including all admissions and in-patient referrals to the clinical division of the Department of Otorhinolaryngology-Head and Neck Surgery who underwent tracheostomy from January 2016 to December 2020. Data were retrieved by review of medical records and Outcome Based Evaluation (OBE) form of all patients who underwent tracheostomy during the study period. Results: Our study involved 74 patients with a male-to-female ratio of 22:15. The patients' ages ranged from 5 to 89 years. Prolonged intubation was the main reason for tracheostomy, followed by upper airway obstruction due to supraglottic mass for males and vocal cord paralysis for females. Only three patients who had tracheostomy experienced complications and were managed accordingly. Conclusion: Tracheostomy is one of the most valuable and reliable surgical procedures for managing airway obstructions. Proper patient and caregiver education as well as constant follow-up are crucial to prevent complications. Keywords: Airway, Tracheostomy, ORL-HNS, Outcome Based Evaluation form, Head and Neck Surgery

Laryngeal Sialometaplasia Presenting as a Supraglottic Mass.

Laryngeal Sialometaplasia Presenting as a Supraglottic Mass.

Laryngeal Anaplastic Lymphoma Kinase-Positive B-cell Lymphoma: Case Report and Review.

Larynx is an uncommon extranodal site for non-Hodgkin lymphoma (NHL). Anaplastic lymphoma kinase (ALK)-positive B-cell lymphoma is a rare and aggressive form of NHL. A 19-year-old male presented to the ENT department with globus sensation, hoarseness, cervical lymphadenopathy and weight loss. A 70-degree rigid endoscopic examination of the larynx showed a vascular, irregular, submucosal mass arising from the right aryepiglottic fold causing near complete obstruction of the laryngeal airway. PET-CT showed hypermetabolic lesions in the supraglottis, cervical lymph nodes, cervical spine, ribs and abdominal lymph nodes. Biopsy was taken from the supraglottic mass as well as the enlarged cervical lymph nodes, which revealed ALK-positive large B-cell NHL. In this report, we present a rare case of ALK-positive large B-cell NHL of the larynx, discussing its clinical, radiological and pathological features. A limited review of literature is also presented. There is a need to develop a database for the description of lymphomas affecting the larynx and this case report adds to the existing knowledge of this rare entity.

Редкий клинический случай: метастаз плоскоклеточной карциномы надгортанника в брюшную полость

Squamous cell carcinoma is a malignant neoplasm that affects many anatomical sites and is the most common cancer capable of metastatic disease. The usual localization of the spread of squamous cell carcinoma of the head and neck is regional-cervical lymphadenopathy. The lungs are the most common site of distant metastases (77%). The etiology of squamous cell carcinoma of the head and neck most commonly involves tobacco use and alcohol abuse. The clinical picture may be different, depending on the localization of the process and its extent of damage. Patients with a supraglottic mass may present with dysphonia, odynophagia, dysphagia, and hemoptysis. The article presents a case of an epiglottis tumor in a 50-year-old patient who underwent surgical and chemoradiotherapy. With subsequent progression, control positron emission tomography revealed a mass in the abdominal cavity, which was successfully verified using endosonography with fine needle aspiration biopsy and regarded as a rare localization of metastasis in squamous cell carcinoma of the epiglottis. Modern technologies and a multidisciplinary approach have made it possible to diagnose and morphologically confirm the pathological process in a minimally invasive way.

Comparison of Ultrasound-Guided Superior Laryngeal Nerve Block with the Traditional Method for Direct Laryngoscopic Biopsy of Supraglottic Masses: A Clinical Trial.

A bilateral superior laryngeal nerve block (SLNB) can provide complete anesthesia for laryngeal sampling and by providing this block we can manage the biopsy of supraglottic masses without the complications of general anesthesia. This study aimed to compare 2 superior laryngeal nerve block (SLNB) methods using ultrasound and the traditional method for direct laryngoscopic surgery for the biopsy of supraglottic masses. In this single-blind clinical trial, 50 patients undergoing supraglottic laryngeal mass biopsy under direct laryngoscopy were divided into 2 groups. The first group was anatomical landmark bilateral SLNB (C group), and the second group was sono-guided bilateral SLNB (U group). Hemodynamic changes, pain, oxygen desaturation, surgeon satisfaction, and the complication obtained and noted. There was no significant difference in the success rate of the procedure (P = 0.99), as well as the surgeon's satisfaction with the procedure (P = 0.337). Mean arterial pressure (MAP), oxygen saturation, and their changes in the studied groups were compared before the block, after the block, after the biopsy, and in the recovery room, showing no significant difference between the 2 groups (P > 0.05). Only the heart rate (HR) after the biopsy and in the recovery room showed significant differences between the 2 groups (P < 0.05). There was no significant difference between the 2 groups in the level of patient and surgeon satisfaction and pain during and after the procedure (P > 0.005). SLNB for direct laryngoscopic surgery for biopsy of supraglottic masses using ultrasound was not significantly superior to the traditional method, and there was no significant difference between the 2 methods in terms of procedure success, surgeon's satisfaction, and patients' pain.

Airway Obstruction from Intralaryngeal Extension of Thyroglossal Duct Cyst in an Elderly Man: A Case Report

&#x0D; &#x0D; &#x0D; &#x0D; ABSTRACTObjective: To report an unusual presentation of thyroglossal duct cyst causing airway obstruction in an elderly man.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Methods:&#x0D; Design: Case Report&#x0D; Setting: Tertiary Government Training Hospital&#x0D; Patient: One&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Results: A 71-year-old man with an anterior neck mass was brought to the Emergency Room due to progressive difficulty of breathing. A smooth, non-ulcerating right supraglottic mass obstructed the airway. Following an emergency high tracheotomy, contrast computed tomography scan of the neck revealed a hypodense mass with peripheral rim enhancement in the right supraglottis and an extralaryngeal component. Intra-operatively, a dumbbell- shaped cystic mass with a tract connected to the hyoid bone led to a Sistrunk procedure. Final histopathology findings were consistent with thyroglossal duct cyst.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Conclusion: It is possible for an elderly patient with impending upper airway obstruction, dysphonia, and neck mass to still have a benign and congenital thyroglossal duct cyst with intralaryngeal extension.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

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.

Primary Localized Amyloidosis of Larynx: A Case Report.

Primary localized laryngeal amyloidosis is a rare presentation of amyloid deposition. A case of 22years old male presented with progressive hoarseness of voice and supraglottic mass on laryngoscopy reported here. Complete excision of mass was done using Coblator wand. Histopathological examination and Congo red stain demonstrated AL amyloidosis of Larynx.

Oncocytic papillary cystadenoma of the larynx: comparative study of ten cases and review of the literature.

Oncocytic papillary cystadenomas (OPCs) of the larynx are rare benign cystic lesions that usually present as supraglottic masses arising from the laryngeal ventricles. OPCs are found in patients older than 60years, with a female predominance. Symptoms vary from asymptomatic to hoarseness, dyspnea, and dysphagia; often, they mimic a laryngocele. The treatment is surgical. Diagnosis is based on histopathologic examination. Surgical records for laryngeal masses diagnosed between 2005 and 2020 were searched retrospectively. Ten patients were identified and included in the study. OPCs predominantly occurred in women (9/10), and the mean age at presentation was 73years. Most patients (8/10) presented with hoarseness and were smokers. OPCs were localized in the ventricle in eight out of ten patients. Surgical treatment was performed in all cases, mostly using transoral endolaryngeal approach (9/10). Histopathologic examination revealed oncocytic cyst or oncocytic papillary cystadenoma (the former term being the older synonym for OPC). OPCs present a separate clinicopathologic entity, distinct from other cystic laryngeal lesions. They have a characteristic location, age and sex group, microscopic appearance, and potential for local recurrence.

Transoral robotic resection of unusual spindle cell/pleomorphic lipoma of the larynx.

Spindle cell/pleomorphic lipoma (SC/PL) is a subcutaneous mass usually localised on nape, shoulder or upper back. It is a benign lipogenic tumour composed of primitive CD34-positive spindle cells, floret-like multinucleated giant cells and mature adipocytes. Complete surgical excision is the optimal treatment. This unusual tumour in the larynx has only been reported in the medical literature once and was treated surgically by open approach. Actually, transoral robotic surgery (TORS) is most suitable because provides tridimensional magnified view plus a greater mobility with instruments, allowing complete and safe removal of the supraglottic mass, allowing rapid healing and recovery. We present the first case of a SC/PL of larynx managed with TORS. Four hours after surgery, the patient was able to take a soft diet and was discharged 2 h later. The follow-up showed an excellent clinical and functional outcome.

Successful airway management of twin coincidental supraglottic and thyroid masses with difficult fiber optic intubation: a case report

BackgroundAberrant airway anatomy in cases of laryngeal carcinomas makes airway management a herculean task for the anesthesiologist. What can further compound the situation is an external compression by thyroid mass.Case presentationWe present a case report of successful airway management by awake nasal fiberoptic intubation in a 65-year-old male who was found to have compressive symptoms due to thyroid swelling in addition to supraglottic obstructive mass. Although a detailed airway examination and indirect laryngoscope did assist in planning the procedure, but what lay inside could only be dealt with by having an in-depth orientation of airway anatomy, practical know-how to fiberoptic scope, and swift reflexes to prevent an adverse event.ConclusionFrom our experience, fiberoptic intubation can only be optimally utilized if emphasis is laid on planning and preparation for the procedure which are key elements in making any difficult airway management successful.

Supraglottic subepithelial benign mass lesions: Focus on clinical features of sialolipoma-like lesion

ObjectivesSialolipoma has been classified as a benign soft tissue lesion in the 2017 World Health Organization classification of head and neck tumors. To our knowledge, only one case of laryngeal sialolipoma has been reported in the English literature. We conducted a retrospective study to identify clinical characteristics of supraglottic sialolipoma-like lesion and differentiate it from other supraglottic subepithelial masses. MethodsMedical records of 16 patients with supraglottic subepithelial benign mass lesions who underwent histological evaluation between 2003 and 2019 were retrospectively analyzed. Sialolipoma-like lesion was defined as a local finding of a well-circumscribed gross mass with pathological presence of salivary gland-like parenchymal lobules with evenly interspersed adipose tissue. ResultsEight patients showed histological positivity for sialolipoma-like lesion, 3 for amyloidosis, 2 for hemangioma, and 1 each for cyst, lymphoid hyperplasia, and chondrometaplasia. Sialolipoma-like lesion tended to be predominant among men; those affected had a mean age of 52.8 (range, 39–74) years. By contrast, among patients with amyloidosis, the ratio of men to women was 1:2 (100% vs. 33%; p = 0.055). Fiberscopic examination of all patients with sialolipoma-like lesions identified well-circumscribed, yellowish masses, closely resembling local amyloidosis findings. Sialolipoma-like lesion was associated with a significantly higher body-mass index (BMI; 27.4 ± 2.8 kg/m2) than amyloidosis (21.6 ± 1.4 kg/m2; p = 0.014). The transoral approach was used for lesion resection in all patients with sialolipoma-like lesion. No patient experienced postoperative recurrence. ConclusionLaryngeal sialolipoma-like lesion might be more prevalent than was previously reported, and histological examination is important to differentiate it from amyloidosis. Supraglottic sialolipoma-like lesion must be differentially diagnosed in patients with high BMI presenting with well-circumscribed, yellowish supraglottic masses.

Fiberoptic intubation in a child with previous unexpected difficult airway due to lingual tonsil hypertrophy

Lingual tonsils are normal components of the oropharynx localized at the base of the tongue, which sometimes can become enlarged by inflammation. This may be a cause of unexpected difficult airway, considering most patients are asymptomatic and this supraglottic mass is not usually detected during a routine preoperative airway assessment. Commonly described in adults, there are limited reports in pediatric patients. We describe a case of a 12 years old boy diagnosed with a cerebellar brain tumor that was scheduled for a resection. The first surgery was postponed because of respiratory complications as a result of unexpected difficult airway due to lingual tonsil hypertrophy. His surgery was rescheduled and a plan for airway management was laid out: fibroscopic intubation with spontaneous ventilation. Considering this is a problem that cannot be identified by regular airway examination, we should be aware of the most effective ways to manage the situation as it arises.

2662 A Unique Presentation of Concurrent Duodenal and Peritoneal Metastasis From Head and Neck Cancer

INTRODUCTION: It is very rare for head and neck squamous cell carcinoma (HNSCC) to metastasize to the duodenum or the peritoneum. Only a few cases have been reported for each metastatic site, however, there have been no reported cases of concurrent duodenal and peritoneal metastasis (PM) from HNSCC. Such a presentation enhances the literature on HNSCC and illustrates the need for further studies to understand the mechanism of HNSCC metastasis. CASE DESCRIPTION/METHODS: 68-year-old male with history of HNSCC presented with worsening nausea, postprandial vomiting, and abdominal pain for over 2 months. 3 months prior he was worked up for several postauricular lumps, with computerized tomography (CT) scan showing a supraglottic mass and excisional biopsy of a nodule confirming metastatic HNSCC. Imaging upon admission showed new peritoneal carcinomatosis and worsening diffuse lymphadenopathy (LAD). Esophagogastroduodenoscopy (EGD) showed a large nodular lesion occupying one third of the lumen circumference. Like the neck nodule, biopsies of the mass showed metastatic, poorly differentiated SCC that was strongly positive for p63 and p16. The patient was not deemed a candidate for chemotherapy due to poor prognosis and poor functional status and was eventually discharged on home hospice. DISCUSSION: We hereby described the first case of concurrent duodenal and peritoneal metastasis from a HNSCC, with both being independently rare sites of metastasis. The patient’s history of chronic tobacco use increased his risk of SCC. Chemotherapy and peritoneal excision, in certain cases, have shown to be a viable treatment option and have a beneficial impact on survival and quality of life. In select cases of obstruction, palliative stenting can be an option to improve quality of life. Due to rapid disease progression and the patient’s poor functional status, these treatment options were deemed not feasible. There are many speculated mechanisms regarding intestinal and PM such as direct extension, tumor rupture or trauma leading to seeding of the peritoneum, hematogenous dissemination, and even via the lymphatics. In our case, the patient did not have any abdominal surgeries and had multiple metastatic sites, including the duodenum, making hematogenous or lymphatic spread more likely. In any case, further studies are needed to understand the mechanism involved in HNSCC metastasis.

Trans-oral, Carbon Dioxide-Assisted Excision of an Unusual Schwannoma of the Tongue Base: Case Report and Review of the Literature.

Introduction Schwannomas are benign, solitary, encapsulated tumors that may originate at any site of the peripheral nervous system, with the exception of the olfactory and optic nerves. Schwannomas of the base of tongue are very rare, and only sporadic cases are documented. The tongue base represents a challenge for surgeons. Carbon dioxide (CO 2 ) laser might provide an effective surgical option for such lesions because of the easy access to the lesion, the bloodless surgical field and optimum epithelization of wounds. Objective We present an unusual case of pedunculated schwannoma of the tongue base treated via transoral CO 2 -assisted excision. We also provide a review of the available literature, in English language, on humans. Data synthesis The authors searched the PubMed database and Google up to July 2018. The following search terms were applied: tongue and lingual, combined with schwannoma and neurilemmoma . Titles and abstracts were screened, and, then, only supraglottic (hypopharyngeal) tongue base masses were considered. Fourteen articles were included in this review, reporting 17 cases. The age of the patients ranged from 9 to 39 years, affecting predominantly females. Dysphagia and lump sensations were the most common presenting symptoms, and the mean follow-up period range was 1.5 to 60 months (mean = 13 months). There was no evidence of recurrence in any of the cases. Conclusion We could conclude that tongue base schwannomas are rare. Transoral complete excision of the tumor is the treatment of choice. CO 2 laser surgery is a minimally invasive treatment option that has been performed in few reports with no recurrence and with favorable outcomes.

Solitary Fibrous Tumor of the Larynx and Anterior Neck

Whether benign or malignant, laryngeal and neck masses may involve the upper airway and obstruct breathing. While surgically-resectable malignancies are generally extirpated with adequate margins of normal tissue, benign lesions are usually excised conservatively. However, even benign masses may behave malignantly, necessitating more aggressive surgical resection. We present one such case.&#x0D; &#x0D; CASE REPORT&#x0D; &#x0D; A 35-year-old man from Cotabato City consulted due to difficulty of breathing. He had a six-year history of progressively enlarging anterior neck mass with intermittent dyspnea, foreign body sensation, progressive dysphagia and hoarseness over the last three months. Physical examination revealed a well-defined, 5 x 6 cm smooth, firm, non-tender anterior neck mass that moved with deglutition. Rigid endoscopy showed a right supraglottic mass with bulging of the right glottic and subglottic area, with a less than 10% airway opening. (Figure 1A) Both arytenoids were visibly mobile, but glottic closure was impaired. (Figure 1B) Tracheostomy and suspension laryngoscopy with biopsy yielded inconclusive results (fibromuscular tissue) and fine needle aspiration cytology (FNAC) of the anterior neck mass only revealed blood and colloid. Contrast computed tomography of the neck showed a well-marginated, hypodense, thick-walled, heterogeneously enhancing mass in the right laryngeal fossa measuring 2.86 x 1.78 cm with a larger extension anteriorly measuring 4.66 x 2.52 cm. Effacement of the epiglottis and aryepiglottic fold was noted. The hyoid and thyroid cartilage were intact, and the thyroid gland was normal. (Figure 2A, B)&#x0D; &#x0D; Because of inconclusive histopathological and cytological results, an incision biopsy of the anterior neck mass was performed. Histopathological evaluation revealed spindle cell mesenchymal proliferation, and immunohistochemical stains showed positive immunoreactivity for CD34, with a weakly positive S-100 and negative SMA, favoring a solitary fibrous tumor.&#x0D;

Spontaneous Giant Laryngeal Granuloma in the Absence of Laryngeal Injury

The etiology of laryngeal granuloma can typically be attributed to endotracheal intubation, vocal abuse, or gastroesophageal reflux disease. There is a strong male predominance, except in cases due to intubation, where incidence is higher in women. We report a case of spontaneous development of multiple granulomas in a female with no history of intubation who presented with hoarseness and massive bilateral supraglottic masses obscuring her glottis. The disparity between the massive lesions and asymptomatic reflux highlights the need for further research in the pathophysiology of laryngeal granulomas.