Supraglottic Region Research Articles

Diagnostic Performance of Computed Tomography in Laryngeal Carcinoma and its Extension

Background: Laryngeal carcinoma is a common malignant neoplasm of the head and neck with high incidence of new malignancies worldwide every year. Several imaging techniques including magnetic resonance imaging (MRI) and computed tomography (CT) scans are widely used to detect laryngeal carcinoma. Of them, CT scan is relatively cheaper, easily available and sensitive in the evaluation of laryngeal carcinoma. Objective: To find out the diagnostic performance of CT scan in laryngeal carcinoma and its extensions. Methodology: This cross-sectional study was carried out in the department of Radiology and Imaging, Dhaka Medical CollegeHospital, Dhaka, during the period of July, 2016 to June, 2018 for a period of 2(two) years. A total of 50 samples were included purposively. The enrolled patients were attending outpatient department (OPD) or admitted in indoor and referred to the Radiology and Imaging department for CT scan. All the enrolled cases had laryngectomy and resected tissues were sent for histopathological examination. Data collection was done by the principal investigator and a preformed questionnaire was used during data collection. Following completion of data collection, it was analyzed by SPSS 20.0. Results: Age range of the patients was from 18 to 84 years, with the mean age of 61.2 years + 13.4 years standard deviation and a male-female ratio of about 7.3:1. By multidetector CT scan, majority (32, 64.00%) of the tumours were found confined in a specific area with no extension, followed by 12 (24.00%) involving both supraglottic and glottic region. On the other hand, by histopathology, almost all (47, 94.00%) of the cases were found malignant and majority of the malignant cases (31, 65.96%) were found without nodal metastasis. Validity tests of CT in the diagnosis of laryngeal carcinoma revealed sensitivity, specificity, accuracy and positive predictive values of 97.9%, 66.7%, 96% and 97.9% respectively. In case of nodal metastases, the sensitivity, specificity, accuracy and positive predictive value were 93.8%, 97%, 96% and 93.8% respectively. Conclusion: Contrast enhanced CT scan has good role in detecting nodal metastases, but had complementary role in detecting laryngeal carcinoma. Journal of Monno Medical College December, 2023; 9 (2): 63-67

Primary Malignant Melanoma of the Larynx: Case Report and Literature Review

Primary malignant melanoma of the larynx is extremely rare. This paper reports a case of a patient with primary malignant melanoma of the larynx. Preoperative laryngoscopy revealed a cauliflower-like mass in the supraglottic region, and a CT scan of the pharynx suggested laryngeal cancer with cervical lymph node metastasis. The patient underwent a total laryngectomy with lymph node dissection, and postoperative pathology confirmed a malignant melanoma in the supraglottic region of the larynx.

Intra-operative lymphatic mapping and sentinel node biopsy in laryngeal carcinoma using radiotracer injection.

The purpose of this study was to determine the value of sentinel lymph node biopsy (SLNB) in the laryngeal SCC, using intra-operative peri-tumoral injection of Tc-99m-phytate. Patients with biopsy-proven squamous cell carcinoma of the larynx were included. On the day of surgery, after anesthesia induction, suspension laryngoscopy was performed to inject 74MBq/0.4ml Tc-99m-phytate in four aliquots into the sub-mucosal peri-tumoral location. After a 10-min wait, a portable gamma probe was used to locate sentinel nodes. Subsequently, all patients underwent laryngectomy and neck dissection. Both sentinel nodes and non-sentinel nodes were examined using hematoxylin and eosin (H&E) staining. Twenty-six patients with a diagnosis of laryngeal carcinoma were included in the study. The SLN detection rate was 65.4%, with a 100% detection rate in the supraglottic region and a 52.6% detection rate for glottis/transglottic patients. Permanent pathology results showed lymph node involvement in four patients, but only one patient had a negative result in the SLNB, resulting in an overall false negative rate of 25%. The sensitivity of the SLN technique was 75% overall, 100% in the supraglottic region, and 67% in the glottis/transglottic region. The accuracy and feasibility of SLNB may be related to the location of the tumors in the larynx. For supraglottic tumors, the technique seems to be feasible with a low false negative rate. For glottis/transglottic tumors, both the detection rate and false negative rate seem to be suboptimal. Further studies are needed to validate our results.

Role of EBUS in lymphoma presenting as superior vena cava syndrome: bronchoscopic and sonographic findings: a case report

BackgroundThe clinical description of superior vena cava syndrome has been widely studied; however, there is limited information on bronchoscopic findings in clinical practice.Case presentationA 57-year-old man presented with facial and neck swelling and pedal edema of 6 months duration. Computed tomography showed mediastinal lesions in the right paratracheal stations with thrombosis of the right internal jugular vein and superior vena cava (SVC). Without establishing a diagnosis, he was started on oral steroids elsewhere and his symptoms progressed. He did not receive anticoagulation therapy. Bronchoscopy showed edematous supraglottic and glottic regions with hyperemia of the airway mucosa. Endobronchial Ultrasonography revealed a mediastinal mass of heterogeneous echotexture in the lower right paratracheal region, with mediastinal collateral blood vessels. He underwent EBUS-guided aspiration cytology and intranodal forceps biopsy, which confirmed the diagnosis of non-Hodgkin’s.ConclusionIn cases with an unconfirmed diagnosis of lymphoma, it is prudent to refrain from administering glucocorticoids, as these medications can exhibit lympholytic properties and may hinder the diagnostic process. Due to extensive collateral formation in superior vena cava syndrome, utilizing Doppler during endobronchial ultrasound transbronchial needle aspiration (EBUS TBNA) can identify numerous mediastinal collateral vessels, thus minimizing the risk of bleeding.

Laryngeal response to high-intensity exercise in healthy athletes

IntroductionExercise-induced laryngeal obstruction (EILO) is a common cause of exertional breathing problems. The current diagnostic approach rests on evaluation of laryngeal obstruction visualised by laryngoscopy performed continuously throughout a maximal...

Post-operative intensity-modulated vs 3D conformal radiotherapy after conservative surgery for laryngeal tumours of the supraglottic region: a dosimetric analysis on 20 patients.

To perform a dosimetric comparison between intensity modulated radiotherapy (IMRT) and 3D conformal radiotherapy in patients with locally advanced (stage III and IV) tumours of the supraglottic region treated with conservative surgery and post-operative radiotherapy. An in-silico plan using a 3D conformal shrinking field technique was retrospectively produced for 20 patients and compared with actually delivered IMRT plans. Eighteen structures (arytenoids, constrictor muscles, base of tongue, floor of mouth, pharyngeal axis, oral cavity, submandibular glands and muscles of the swallowing functional units [SFU]) were considered. IMRT allowed a reduction of maximum and mean doses to 9 and 14 structures, respectively (p < .05). IMRT achieved a reduction of unnecessary dose to the remnant larynx and the majority of surrounding SFUs. Further prospective analyses and correlations with functional clinical outcomes are required to confirm these dosimetric findings.

The Value of Computed Tomography in Recurrent Laryngeal Cancer Following Organ Preservation Therapy.

This study aims to assess the accuracy of computed tomography (CT) in detecting recurrent laryngeal tumors after failed chemoradiation therapy (CRT). Local recurrence of laryngeal tumors following CRT has been reported in approximately 25%, yet it is often difficult to detect. Ten patients with laryngeal cancer who failed CRT and subsequently underwent salvage total laryngectomy were included. The laryngeal subsites involved in the tumor were identified based on postoperative pathology. The corresponding preoperative CT scans were selected for review by seven experts (head-and-neck surgeons or radiologists) who scored the extent of tumor spread on each scan on a 5-point scale, from no tumor detected to clearly visible tumor. The rates of high tumor detectability (scores 4-5) varied according to laryngeal subsite, from 75% in the glottic region, to 45% in the subglottic region, and to 19% in the supraglottic region (P=0.01). The detectability rates were higher on scans performed 2 years or more after CRT. The CT evaluation of laryngeal cancer after CRT has limited value, particularly in the epiglottis and subglottis.

Laryngeal Xanthogranulomatosis: A Case Report

Xanthogranulomatosis is an uncommon disease affecting non-Langerhans histiocytes. Laryngeal involvement is very rare. We describe the clinical case of an adult patient with disseminated xanthogranulomas affecting the supraglottic region of the larynx, leading to thickening and immobility of the epiglottis. The patient experienced inspiratory dyspnea on exertion. A transoral supraglottic epiglottectomy was performed, and a tracheostomy was subsequently required.

B-cell non-Hodgkin lymphoma of the larynx: Case report and review of literature

Objectives The aim of the study is to expose and highlight the clinical, imaging and therapeutic features of B-cell laryngeal lymphoma, with a brief review of literature. Material and Methods We report a rare case of B-cell laryngeal lymphoma Results A 42-year-old female was referred to the Otorhinolaryngology department for progressive dyspnea and dysphonia. Endoscopic examination and imaging reveals a supraglottis mass. The final diagnosis is a B-cell non-Hodgkin lymphoma of the supraglottis. Conclusion Primary laryngeal lymphoma is a rare condition that should be considered in the differential diagnosis of a laryngeal mass, especially if it affects the supraglottic region. The diagnosis is difficult. Direct laryngoscopy with multiples and deep biopsies makes the diagnosis. The treatment and prognosis depend on the stage and grade of the lymphoma.

Definitive and Salvage Radiotherapy Compared to Other Modalities for Laryngeal Carcinoma in Situ

We sought to analyze survival endpoints for laryngeal carcinoma in situ (CIS) undergoing definitive radiotherapy (RT) compared to other modalities. Usingour prospectively maintained head and neck cancer database, we identified laryngeal CIS patients treated between 6/2001 and 12/2021. We excluded low-grade dysplasia, CIS with any synchronous invasive squamous cell carcinoma (SCC) within 3 months of the initial CIS biopsy and cases with inadequate follow up. Patients were offered either definitive RT, CO2/KTP laser ablation, photodynamic therapy (PDT) or any sort of therapeutic excision. After first line treatment, follow-up includes visits every 3-6 months with laryngoscopy and biopsies as appropriate. For recurrent CIS beyond 6 months of first line treatment, we reported salvage therapies received and long-term outcomes were reported. Using Kaplan-Meier curves and log-rank test we investigated recurrence free (RFS), progression to invasive SCC free (IFS) and overall (OS) survival across treatment groups. Patients managed with salvage RT were compared to first line RT recipients. Atotal of 85 CIS cases were included: median age 65 years (IQR: 55-74), 73 males (85%) and 70 white (82.4%). 86% had a history of smoking with median pack year of 38 (IQR: 20-55) and 66% had a history of alcohol use. CIS was glottic in most of the cases (90.6%: 66% unilateral, 21% bilateral & 13% involved commissure); with only 9.4% in the supraglottic region. RT was used in 49.4% (n = 42) after biopsy (55%) or surgery (45%) with median dose of 63 Gy/28 fractions, mainly by 3D conformal RT (76%). The remaining 50.6% (n = 43) got therapeutic excision alone (commonly microflap excision) (46.5%), CO2/KTP laser (32.6%) or PDT (20.9%). Demographics and clinicopathological details were non-different between RT and non-RT patients except for Charlson comorbidity index: median 2 (IQR 1-3) in non-RT vs 1 (IQR 0-2) in 1ry RT; p = 0.007. After a median follow-up of 4.8 years (IQR 3.5), 51.8% had recurrent disease, 21.2% progressed to invasive SCC and 9.4% had laryngectomies mainly for invasive SCC after RT. First line RT had improved 2-(83% vs 39%) and 5-(74% vs 22%) year RFS vs non-RT therapies (p<0.001). Nevertheless, 2- and 5-year IFS (89% vs 98% and 80% vs 79%) and OS (92% vs 93% and 81% vs 77%) were non-significant among both (p>0.05 for all). Among non-RT cases with CIS recurrences, 12/35 (34%) had salvage RT. Following RT, salvage RT patients had similar 2- and 5-year RFS (81% vs 83% and 81% vs 74%) and IFS (81% vs 89% and 81% vs 80%) compared to first line RT (p>0.05 for all). All cases with CIS recurrences were salvaged successfully with 100% living with no CIS at latest follow-up. Laryngeal CIS can be treated with a wide range of modalities including 1ry RT which has better recurrence free survival. Nevertheless, non-RT recurrent CIS can be salvaged successfully with many options including RT with equivalent long-term results.

A case report on attempted suicide by self-slitting resulting in laryngeal fracture

Introduction: Laryngeal fractures cause significant problems with airway patency, vocal production, and swallowing function. The mechanism of injury can be sharp or blunt and can occur in the supraglottic, glottic, or infraglottic regions. Blunt external trauma to the neck caused by motor vehicle accidents, sports-related trauma, assault, and strangulation are the most frequent causes of laryngeal ruptures and fractures. Penetrating trauma is the second leading cause, often due to gunshot or stab wounds to the neck. The immediate goal in patients presenting to the emergency department with laryngeal rupture is to secure the airway. One of the indications for tracheostomy placement includes acute respiratory failure with the need for prolonged mechanical ventilation.

The prognostic value of lymphatic metastatic size in head and neck squamous cell carcinoma.

Lymphatic metastatic size was proved to predict prognosis in different types of carcinomas, except in head and neck squamous cell carcinoma (HNSCC) located in hypopharynx, oropharynx and supraglottic region et al. The aim of this study is to evaluate the prognostic value of lymphatic metastatic size in HNSCC, which may guide clinical decision-making in practice. From 2008 to 2022, 171 patients, who were diagnosed as HNSCC in our center, were included. The demographic data, clinicopathological characteristics and lymphatic metastatic size were recorded and analyzed using the Kaplan-Meier method and Cox regression analysis. Among 171 patients, 107 cases were hypopharyngeal cancer, 38 cases supraglottic cancer and 26 cases oropharyngeal cancer. The median of lymphatic metastatic size was 8mm (range 0-46). According to lymphatic metastatic size, the patients were assigned to three subgroups: Group I (0mm), Group II ( ≤ 10mm) and Group III (> 10mm). Kaplan-Meier analysis with log rank test revealed that Group I and Group II had similar locoregional control rate, distant metastasis free probability, disease-free survival and overall survival (all p > 0.05), whereas Group III had significant worse prognosis. Adjusted for demographic and other clinicopathological characteristics, lymphatic metastatic size was an independent predictor of disease-free survival and overall survival in HNSCC. Lymphatic metastatic size was an independently prognostic factor in HNSCC, which may assist in postoperative adjuvant treatment decisions.

Vaping-induced acute epiglottitis: a case report

BackgroundE-cigarette use, or vaping, is an alternative nicotine delivery system that is becoming increasingly prevalent in adolescents and young adults. There is currently a lack of comprehensive research on the adverse effects of vaping on the upper airway.Acute epiglottitis is a potentially life-threatening condition that can lead to airway obstruction. It is commonly caused by bacterial infections such as streptococci, staphylococcus, and Moraxella. Adult patients with acute epiglottitis mainly present with odynophagia, dysphagia, and respiratory difficulties. The diagnosis of epiglottitis is made by direct laryngoscopy, and the mainstay of treatment is antibiotics.Bozella et al. (2020) reported a case of subacute non-infectious epiglottitis associated with e-cigarette use in a pediatric patient (Pediatrics 145(3), 2020). Here we present a case of acute epiglottitis in a healthy young adult after vaping, with a negative infectious workup. To our knowledge, there has been no such reported case of epiglottitis associated with e-cigarette use in an adult patient.Case descriptionA previously healthy 29-year-old male with daily e-cigarette use presented to the emergency department with a severe sore throat, dysphagia, mild hoarseness, and shortness of breath, especially when lying supine. A lateral neck soft tissue radiograph revealed a thickened epiglottis with a thumb sign. Direct bedside laryngoscopy showed a swollen epiglottis, partially obstructing the supraglottic region confirming the diagnosis of acute epiglottitis. Throat and nasal swabs were negative for streptococcus and COVID-19 infection, respectively. The patient’s condition improved significantly after receiving intravenous Dexamethasone and antibiotics for 2 days. Repeat laryngoscopy showed the resolution of epiglottis swelling, and subjective symptoms had resolved entirely 2 weeks following the start of the treatment.ConclusionsAlthough bacterial infections usually cause acute epiglottitis, this case presents the second report of this condition associated with vaping with negative microbiological investigations. Therefore, we recommend that physicians consider non-infectious causes such as vaping in their differential diagnosis for patients with acute and subacute epiglottitis. More research is warranted on the utility of antibiotics in treating vaping-induced epiglottitis.

The subglottic involvement is an independent risk factor for recurrence of laryngeal amyloidosis.

To analyze the risk factors for recurrence of laryngeal amyloidosis (LA). The clinical data of patients with LA admitted in the Otolaryngology Head and Neck Surgery Department of the Second Affiliated Hospital of Xi'an Jiaotong University from August 2009 to June 2022 were analyzed retrospectively; then, the risk factors for recurrence and their impacts on the recurrence time were also analyzed. Of the 44 patients with LA, the majority (38 cases, 86.4%) only involved one anatomical region and the others (6 cases, 13.6%) involved two laryngeal regions concurrently. Overall, the glottic region was the most commonly affected area (28 cases, 63.6%), followed by the supraglottic region (16 cases, 36.4%) and subglottic region (6 cases, 13.6%). In addition, all the lesions were categorized as isolated nodule (31.8%), submucosal localized deposition (52.3%), and submucosal diffuse deposition (15.9%) according to their morphologies under electronic laryngoscope. Finally, six patients (13.6%) had recurrence after operation with a median recurrence time of 24.5months, and subglottic involvement was confirmed to be an independent risk factor for recurrence of LA by univariate and multivariate logistic regression analyses (P < 0.05). Meanwhile, the patients with subglottic involvement presented as submucosal diffuse deposition had a considerable shorter recurrence time (t = 5.759, P = 0.005). The subglottic involvement is an independent risk factor for recurrence of LA.

Persistent Post-Extubation Stridor in an Intensive Care Unit: A Decision Dilemma

Stridor is a harsh, wheezing, often high-pitched sound produced by rapid, turbulent flow of air through a narrowed supraglottic region to proximal trachea and can be inspiratory, expiratory, or biphasic.[1] The incidence of post-extubation stridor varies from 2 to 42% in pediatric intensive care unit (ICU).[2] Factors like traumatic intubation, multiple attempts, prolonged intubation, use of cuffed or inappropriate sized tube, lower age, inadequate analgesia, and sedation are associated with significant risk of post-extubation stridor.[2] [3] Here, we report a case of persistent post-extubation stridor in a patient with traumatic brain injury, who was medically managed, thus avoiding reintubation. Informed consent for reporting this case was obtained from the child's parents.

Transnasal Videoendoscopy for Preoperative Airway Risk Stratification: Development and Validation of a Multivariable Risk Prediction Model.

Transnasal flexible videoendoscopy (TVE) of the larynx is a standard of care for the detection and staging of pharyngolaryngeal lesions in otorhinolaryngology. Patients frequently present with existing TVE examinations before anesthesia. Although these patients are considered high risk, the diagnostic value of TVE for airway risk stratification is currently unknown. How can captured images or videos be used for anesthesia planning, and which lesions are most concerning? This study aimed to develop and validate a multivariable risk prediction model for difficult airway management based on TVE findings and to determine whether the discrimination of the Mallampati score can be improved by adding this new TVE model. This retrospective single-center development and validation study assessed 4021 patients who underwent 4524 otorhinolaryngologic surgeries at the University Medical Centre Hamburg-Eppendorf between January 1, 2011, and April 30, 2018, with electronically stored TVE videos and included 1099 patients who underwent 1231 surgeries. TVE videos and anesthesia charts were systematically reviewed in a blinded fashion. The Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis was used for variable selection, model development, and cross validation. The prevalence of difficult airway management was 24.7% (304/1231). Lesions at the vocal cords, epiglottis, or hypopharynx were not selected by the LASSO regression, while lesions at the vestibular folds (ß-coefficient 0.123), supraglottic region (ß-coefficient 0.161), arytenoids (ß-coefficient 0.063), and viewing restrictions on the rima glottidis that cover ≥50% of the glottis area (ß-coefficient 0.485) and pharyngeal secretion retention (ß-coefficient 0.372) were relevant risk factors for difficult airway management. The model was adjusted for sex, age, and body mass index. The area under the receiver operating characteristic curve (95% confidence interval) of the Mallampati score was 0.61 (0.57-0.65) and 0.74 (0.71-0.78) of the TVE model combined with Mallampati ( P < .001). Stored images and videos from TVE examinations can be reused for the purpose of predicting risk associated with airway management. Vestibular fold, supraglottic, and arytenoid lesions are most concerning, especially if they are accompanied by secretion retention or restrict the glottic view. Our data indicate that the TVE model improves discrimination of the Mallampati score and might, therefore, be a useful addition to traditional bedside airway risk examinations.

Topographic and Histological Distribution of Carcinoma Pharynx and Larynx: Fiber Optic Laryngoscopic (FOL) Study of 700 Cases

Background: In Bangladesh, in 2020 estimated number of new cancer cases were 156775 and number of deaths were 108990. Carcinoma pharynx and larynx in 2020 were 7.86% and 3.4% of total new cancer cases, 5.71% and 3% of total cancer deaths. Fiber optic laryngoscopy (FOL) has been established as a valuable diagnostic tool and its accuracy is 80.65%. Objectives: The primary objective of this study was to see the topographic and histological distribution of pharyngeal and laryngeal cancers and secondary objective was to assess the role of Flexible Endoscopic Biopsy (FEB) in the diagnosis of cancers. Methods: This descriptive cross-sectional study was done from March 2021 to October 2022 at Mount Adora Hospital, Akhalia, Sylhet, Bangladesh. All suspected pharyngeal and laryngeal cancer patients attending in this hospital for FOL and FEB were included in this study in a convenient sampling method. Benign, recurrence and residual cases were excluded from this study. Results: Total 700 patients of suspected pharyngeal and laryngeal tumour were included in this study. Sensitivity of FEB was 98.3%. FOL was 91% successful in acquiring a definite diagnosis. The age of the patients ranged from 15 to 100 years with a mean age of 58.48 year (SD=13.26). Male, Femaleratio was 5.92:1. Nasopharyngeal cancer affected younger age group (mean age 39.59 year). Pharyngeal cancer was more common (62.9%) than laryngeal cancer (37.1%). Hypopharynx (63.2%) was most common site for pharyngeal cancers. In laryngeal cancer, supraglottic was more common (60%). In hypopharyngeal cancer, pyriform fossa was the commonest site (87%). Squamous cell carcinoma (99.21%) was the most common histological diagnosis. Conclusion: Pharynx was more frequent site than larynx for cancers. Supraglottic region was the most common site for laryngeal and pyriform sinus was the most common site for hypopharyngeal cancers. Nasopharyngeal cancer affected younger age group. Common histological diagnosis was squamous cell carcinoma. Flexible Endoscopic Biopsy (FEB) was highly sensitive. Bangladesh Medical Res Counc Bull 2023; 49(1): 63-69

Multimodality Diagnosis of Laryngeal Cancer in “Dharmais” National Cancer Hospital (DNCH)

Background: Almost 95% of laryngeal cancers are squamous cell carcinoma. Most of them come from the supraglottic and glottic regions. Globally from 1990 to 2017, there was an increase in the incidence of laryngeal cancer by 58.67%. Patients with suggestive grievances of laryngeal cancer symptoms are usually advised to do a further examination. The use of multimodality diagnosis is helpful for the diagnosis of cancer. Diagnostic procedures in diagnosing laryngeal cancer can be made by history and physical examination, clinical (laryngoscopy), and supporting examination (radiology and biopsy). This study aims to determine the distribution of the demographic (gender, age, domicile, marital status, and educational level), clinical distribution (voice changes, respiratory disorders, pain, dizziness, cough, lump on the neck, and others), and modalities of diagnosis (anamnesis, clinical examination, radiology, and biopsy) in laryngeal cancer.Methods: Descriptive study and a routine data-based study was conducted by collecting data on cancer patients who were diagnosed with laryngeal cancer from 2003 to 2007 by the microscopic either in Dharmais National Cancer Hospital (DNCH) or other hospitals. The study sample was 53 out of a total of 68 cases of laryngeal cancer who had been diagnosed with malignancy histopathologically at DNCH or in other hospitals with epithelial or non-epithelial types with completed medical records. Results: The glottic region is the most common subsite, that is, 52.8%, and squamous cell carcinoma (SCC) is the most common histopathological type of laryngeal cancer. In most of the cases, either males or females presented with a change in the voice of 68.8% and 80% respectively. In 6 out of 12 cases have not been examined microscopically before, while 7.5%.of the cases have done the diagnostic procedure completely in DNCH. Conclusions: The most common subsite and histopathological type of laryngeal cancer is glottis and SCC. The most common clinical feature in both sexes is voice changes. Most cases have not been examined according to the standard diagnosis procedure completely.

A CLINICAL STUDY OF PREVALENCE OF LARYNGEAL CANCER IN ELDERLY AND ITS ASSOCIATION WITH SMOKING AND ALCOHOL

Laryngeal Cancer refers to cancerous tumor that develops in Larynx, for example, glottis, supraglottic region and subglottis. The purpose of this present study was to investigate the prevalence of Laryngeal Cancer in elderly patients attending a tertiary care centre. A detailed survey was performed to analyze whether Laryngeal Cancer is associated with smoking or alcohol. The study revealed that Laryngeal Cancer is more common in elderly individuals who smoke and drink alcohol. Avoidance of alcohol intake and smoking will be a milestone to reduce the incidence of Laryngeal Cancers and associated mortality.

Surgical treatment of laryngeal amyloidosis: a systematic review.

The aim of this review was to study the surgical management of laryngeal amyloidosis and estimate the rate of recurrence after surgery. A systematic review searching PubMed and EMBASE was performed. A qualitative synthesis of data regarding the surgical management of LA and a quantitative analysis of the recurrence rate after surgery was conducted. This systematic review included 14 retrospective studies, one of whom is retrospective controlled. A total of 515 subjects were included, the mean age ranged from 43.3 to 58years with a male-to-female ratio of 1:1.3. All cases had a localized laryngeal amyloidosis. The supraglottic region was the most affected laryngeal site and multiple sites were commonly involved. Surgical treatment consists of endoscopic excision using laser, cold or powered instruments. Open surgery is required for severe primary case or revision surgery. Surgical complications such as granulomatosis scar tissue formation, tracheostomy, laryngotracheal stenosis, pneumothorax and concomitant malignancy were developed in 17.5% of patients. The time onset to diagnosis varied from 1months to 15years and the duration of follow-up from 3months to 25years. The rate of recurrence was 28.4% (95% CI 24.5-32.6) and the timing of recurrences ranged from 3months to 10years. The recurrence rate after primary surgery for laryngeal amyloidosis is high. A tailored surgical treatment based on the disease extension and a long-term follow up are recommended.