Upper Aerodigestive Tract Research Articles

Active upper aerodigestive tract hemorrhage in patients with head and neck cancers: the “dot-in-sludge” sign

Active extravasation into the upper aerodigestive tract is a dramatic and potentially life-threatening complication in patients with head and neck cancers. It prompts presentation to the emergency room and subsequent urgent imaging to identify the source of hemorrhage. Imaging of these patients may be complicated by treatment-altered anatomy, posing a challenge to the emergency radiologist who needs to rapidly identify the presence of active hemorrhage and the potential source vessel. This retrospective review summarizes the clinical and imaging findings of 6 oropharyngeal and oral cavity squamous cell cancer (SCC) patients with active upper aerodigestive tract hemorrhage. Most patients had advanced stage disease and prior radiation therapy. All CECT or CTA exams on presentation demonstrated the “dot-in-sludge” sign of active extravasation, as demonstrated by a “dot” of avidly enhancing extravasated contrast material layered against a background “sludge” of non-enhancing debris in the lumen of the upper aerodigestive tract. Common sources of hemorrhage included the lingual, facial, and superior thyroidal arteries. Familiarity with these findings will help radiologists increase their accuracy and confidence in interpreting these urgent, complex examinations.

Current possibilities and challenges in the treatment of laryngopharyngeal reflux

Laryngopharyngeal reflux (LPR) is characterized by backflow of gastric or gastroduodenal content and gases into the upper aerodigestive tract, which can damage the mucus membranes of the larynx and pharynx. It is associated with avariety of symptoms such as retrosternal burning and acid regurgitation, or other unspecific symptoms such as hoarseness, globus sensation, chronic cough, or mucus hypersecretion. Due to the lack of data and the heterogeneity of studies, diagnosis of LPR is problematic and challenging, as recently discussed. Moreover, the different therapeutic approaches are also discussed controversially in the face of the poor evidence base, and include pharmacologic and conservative dietary measures. Hence, in the following review, the available options for treatment of LPR are critically discussed and summarized for daily clinical use.

Convergent dysbiosis of upper aerodigestive microbiota between patients with esophageal and oral cavity squamous cell carcinoma.

The bidirectional association between primary esophageal squamous cell carcinoma (ESCC) and oral cavity squamous cell carcinoma (OSCC) suggests common risk factors and oncogenic molecular processes but it is unclear whether these two cancers display similar patterns of dysbiosis in their upper aerodigestive microbiota (UADM). We conducted a case-control study to characterize the microbial communities in esophageal lavage samples from 49 ESCC patients and oral rinse samples from 91 OSCC patients using 16S rRNA V3-V4 amplicon sequencing. Compared with their respective non-SCC controls from the same anatomical sites, 32 and 45 discriminative bacterial genera were detected in ESCC and OSCC patients, respectively. Interestingly, 20 of them were commonly enriched or depleted in both types of cancer, suggesting a convergent niche adaptation of upper aerodigestive SCC-associated bacteria that may play important roles in the pathogenesis of malignancies. Notably, Fusobacterium, Selenomonas, Peptoanaerobacter and Peptostreptococcus were enriched in both ESCC and OSCC, whereas Streptococcus and Granulicatelia were commonly depleted. We further identified Fusobacterium nucleatum as the most abundant species enriched in the upper aerodigestive SCC microenvironment, and the higher relative abundances of Selenomonas danae and Treponema maroon were positively correlated with smoking. In addition, predicted functional analysis revealed several depleted (eg, lipoic acid and pyruvate metabolism) and enriched (eg, RNA polymerase and nucleotide excision repair) pathways common to both cancers. Our findings reveal a convergent dysbiosis in the UADM between patients with ESCC and OSCC, suggesting a shared niche adaptation of host-microbiota interactions in the pathogenesis of upper aerodigestive tract malignancies.

Is Following a Cancer-Protective Lifestyle Linked to Reduced Cancer Mortality Risk?

Objectives: This study investigates the association between a cancer protective lifestyle (defined based on the revised World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) cancer prevention recommendations) and mortality in Switzerland. Methods: Based on the cross-sectional, population-based National Nutrition Survey, menuCH (n = 2057), adherence to the WCRF/AICR recommendations was assessed via a score. Quasipoisson regression models were fitted to examine the association of adherence to the WCRF/AICR recommendations with mortality at the Swiss district-level. Spatial autocorrelation was tested with global Moran's I. Integrated nested Laplace approximation models were fitted when significant spatial autocorrelation was detected. Results: Participants with higher cancer prevention scores had a significant decrease in all-cause (relative risk 0.95; 95% confidence interval 0.92, 0.99), all-cancer (0.93; 0.89, 0.97), upper aero-digestive tract cancer (0.87; 0.78, 0.97), and prostate cancer (0.81; 0.68, 0.94) mortality, compared to those with lower scores. Conclusion: The inverse association between adherence to the WCRF/AICR recommendations and mortality points out the potential of the lifestyle recommendations to decrease mortality and especially the burden of cancer in Switzerland.

'Toxic Masculinity': What Is Known about the Role of Androgen Receptors in Head and Neck Squamous Cell Carcinoma.

Head and neck squamous cell carcinoma (HNSCC), the most prevalent cancer in the head and neck region, develops from the mucosal epithelium of the upper aerodigestive tract. Its development directly correlates with alcohol and/or tobacco consumption and infection with human papillomavirus. Interestingly, the relative risk for HNSCC is up to five times higher in males, so it is considered that the endocrine microenvironment is another risk factor. A gender-specific risk for HNSCC suggests either the existence of specific risk factors that affect only males or that females have defensive hormonal and metabolic features. In this review, we summarized the current knowledge about the role of both nuclear and membrane androgen receptors (nAR and mARs, respectively) in HNSCC. As expected, the significance of nAR is much better known; it was shown that increased nAR expression was observed in HNSCC, while treatment with dihydrotestosterone increased proliferation, migration, and invasion of HNSCC cells. For only three out of five currently known mARs-TRPM8, CaV1.2, and OXER1-it was shown either their increased expression in various types of HNSCC or that their increased activity enhanced the migration and invasion of HNSCC cells. The primary treatments for HNSCC are surgery and radiotherapy, but targeted immunotherapies are on the rise. On the other hand, given the evidence of elevated nAR expression in HNSCC, this receptor represents a potential target for antiandrogen therapy. Moreover, there is still plenty of room for further examination of mARs' role in HNSCC diagnosis, prognosis, and treatment.

Emergency Tracheostomy: Indications, Techniques and Complications in 67 Cases at the Omar Bongo Ondimba Army Training Hospital

Introduction: Tracheotomy is the temporary or permanent surgical opening of the cervical trachea followed by the placement of a cannula. Objective : to recall the indications, techniques and complications of emergency tracheotomy. Materials and method : This was a retrospective descriptive study conducted in the ENT and CCF department of HIAOBO, involving 67 medical records of hospitalized patients in whom a tracheostomy was performed in emergency from January 2010. to December 2019. Results : The study involved 51 men (76%) and 16 women (24%), a ratio of 3.18 . The average age was 45.85 years with extremes of 5 and 78 years. Laryngeal dyspnea was the reason for consultation in 86.57% of cases. The indications were malignant tumors of the upper aero-digestive tract in 54% of cases, difficult extubation in intensive care patients in 12% of cases, laryngeal papillomatosis in 12% of cases, inflammatory pathology in 7 cases, traumatic pathology 4 cases, extrinsic tracheal compression, muscle disease and laryngo -tracheal stenosis in 1 case each. Tracheotomy was performed under general anesthesia in 73% of cases and under local anesthesia in 27% of cases. Complications were observed in (16.42%). Conclusion : Emergency tracheotomy is a survival gesture. Mastery of the technique, the right choice of equipment, perfect knowledge of the anatomical relationships of the trachea, and postoperative care help to minimize complications.

WITHDRAWN: Extremely high sex disparities in adult premature mortality in Estonia 1995–2014: Is a stricter alcohol and tobacco policy needed?

To quantify relative sex disparities in cause-specific adult premature mortality in Estonia and to determine for which causes of death the inequalities are the highest; subsequently, to provide some guidance to public health policy-makers, considering the relatively liberal national alcohol policy. The analyses were based on individual death records of 1995–2014 and ages of 20–69 years, and involved the calculation of overall and cause-specific age-standardized mortality rates, average annual percentage changes of mortality, and cause-specific men to women mortality rate ratios. Overall adult premature mortality has decreased considerably during 1995–2014, but no reduction was observed with respect to the high relative sex disparities. In circulatory disease mortality the disparities widened significantly with time. Extremely high mortality rate ratios were observed for cancer of the upper aero-digestive tract and lung cancer. There was a stable, more than five-fold male excess mortality from external causes. A four-fold male disadvantage was evident for alcohol poisoning and mental disorders due to alcohol. Even though adult premature mortality has markedly decreased over time, there has been no success in diminishing high sex differences in mortality patterns, many of which were related to smoking and excessive drinking of alcohol, both more prevalent among men. Estonia needs a comprehensive and consistent alcohol policy while maintaining and further developing anti-tobacco measures.

Oncoguía de carcinomas escamosos de las vías aerodigestivas superiores 2023

Cancer of the upper aerodigestive tract includes a heterogeneous group of neoplasms. About 90% are squamous cells and rank sixth in incidence worldwide. Smoking, alcohol intake, and human papillomavirus infection are the main risk factors. Given the suspected diagnosis, histopathological confirmation by biopsy is required. Tomography is the primary imaging method for TNM staging. Management requires a multidisciplinary team with close communication between the different members. In general, we can divide the treatment according to the stage at diagnosis into: early, locally advanced, and recurrent or metastatic disease. Surgery is the best curative treatment option in early disease with the use of adjuvant radiotherapy and chemoradiotherapy in highrisk patients. When organ preservation is the objective and in unresectable tumors (common in locally advanced stages of the disease), chemoradiotherapy is an option. Induction chemotherapy is controversial; however, in patients with high tumor volume or if the initiation times of radiotherapy treatment are prolonged (mainly in the larynx), it could be an alternative. The recurrence of the disease is frequent. Even though the presentation with metastatic disease is rarer, the treatment objective will be palliative. Immunotherapy has improved overall survival in the first and second lines of treatment of recurrent or metastatic disease. Chemotherapy in combination with cetuximab (either first or second line) continues to be useful in these patients. The treatment decision will depend on the expression of PDL1 and the clinicopathological characteristics of the case.

A CASE REPORT OF MIGRATORY FISH BONE PIERCING LEFT LOBE OF THE THYROID

Fish bone as a foreign body in the throat is common and frequently seen in emergency departments. In most cases, the bone is stuck in the tonsils or oropharynx, some go further to the laryngopharynx, and in rare cases they may go furthest. The authors report a rare case of a fish bone that migrated to the thyroid gland [1, 13&14] Fish bones as swallowed foreign bodies can be managed by direct removal using headlight or require an endoscopic approach. Some even need open surgery. Some bones may penetrate the mucosa of the upper aerodigestive tract and migrate to neck soft tissues and organs. In such cases, patient complaints are of unusual presentation for swallowed foreign bodies, and patients may suffer different complications that require a more aggressive management [2].

Does Gingival Carcinoma in the Elderly Correspond to a Distinct Entity?

Introduction: Age-related processes in the oral mucosa increase the risk of cancer. The gingiva is the most common localization in the upper aerodigestive tract in the elderly. The aim of this study was to compare the patient and the tumor characteristics, treatments, disease-free survival, and overall survival for gingival squamous cell carcinoma in patients less than and older than 70 years of age.

Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma in Older Patients: Are New Agents Bringing New Hope?

Head and neck cancer is a broad family of diseases, most of which are of squamous cell origin, affecting the epithelial mucosa lining the upper aerodigestive tract. They often recur or are progressive despite multimodality treatment approaches, resulting in a poor prognosis. Given the progressive aging of the global population, the probability to plan an active and eventually toxic treatment for an older patient, with either curative or palliative intent, can no longer be considered as an uncommon occurrence. A crucial point in offering a systemic treatment to older patients with head and neck squamous cell carcinoma is that they are underrepresented in randomised clinical trials, and evidence-based guidelines are lacking, while, from a clinical point of view, these patients may have varying grades of resilience to anticancer treatments due to differences in their health, social and/or economic status. Our aim is to draw attention to the older patient population suffering from recurrent and/or metastatic head and neck squamous cell carcinoma and to address some open questions, such as possible differences in epidemiology and biology compared with their younger counterparts; to highlight frailty and its components by discussing how to measure and use it to personalise treatment; to evaluate which outcomes should be best achieved in the older adult setting; finally, in the era of immunotherapy, to examine whether there are differences to be addressed when considering new treatments for older patients.

Evolution of the Incidence of Oral Cavity Cancers in the Elderly from 1990 to 2018.

To describe the evolution of the incidence of oral cavity cancers (OCC) among elderly patients in France between 1990 and 2018 and to compare it to the incidence of other cancers sharing the same main risk factors. The incidence of cancers in mainland France from 1990 to 2018 was estimated from incidence data observed in every cancer registry of the Francim network. Incidence was modeled by a 2-dimensional penalized spline of age and year of diagnosis, associated with a random effect corresponding to the registry. The elderly population was divided into two groups: 70-79 years old and ≥80 years old. There was a 72% increase in the number of OCC cases in women over 70 years of age between the periods 1990-1999 and 2010-2018. As for men, there was a stabilization in the number of cases (+2%). Over the same period, for laryngeal and hypopharyngeal cancers, there was a decrease in incidence in elderly men and an increase in elderly women, although less marked than for OCC. Since the 1990s, the incidence of OCC has been increasing in elderly subjects in France, particularly in women. Population aging and growth or alcohol and tobacco consumption alone do not seem to explain this increase, which is not observed in the same proportions for other upper aerodigestive tract cancer subsites sharing the same main risk factors.

Epidemiology, diagnosis, symptoms and TNM classification of head and neck cancers

Head and neck cancers occur predominantly by transformation of squamous cells lining the mucous membranes of the upper aerodigestive tract and affect one of the most complex regions of the human body. Head and neck cancers are very common, with more than half a million new cases annually, and have a mortality rate of around 50%, and early diagnosis can improve treatment outcomes and increase the life expectancy of those affected. In this paper, we review the epidemiology, the main symptoms, the diagnostic methods, highlighting the few genetic markers identified so far, and the TNM classification of each type of upper aerodigestive cancer.

Predictive factors and risk analysis of recurrent laryngeal nerve invasion in papillary thyroid carcinoma ≤ 1 cm.

The recurrent laryngeal nerve (RLN) may be involved by papillary thyroid carcinoma ≤ 1 centimeter (PTC ≤ 1 cm). Current study investigated the predictive factors of RLN invasion in PTC ≤ 1 cm, the risk factors of disease recurrence in RLN invaded cases and the results of surgical management for RLN invasion. Data of 374 PTC ≤ 1 cm patients were retrospectively collected. We performed univariate and multivariate analysis to identify predictive factors of RLN invasion and risk factors of disease recurrence. The abilities of factors in predicting RLN invasion were evaluated. Surgical outcomes and recurrence free survival (RFS) of patients were analyzed. A total of 28 patients suffered RLN invasion, among which seven had disease recurrence. Preoperative vocal cord palsy (VCP), gross extrathyroidal extension, larger tumor size and tumor on the dorsal side of thyroid were verified as predictive factors of RLN invasion. RLN involved patients had poorer RFS, but better than those who also had upper-aerodigestive tract invasion. Upper-aerodigestive tract invasion, lateral neck lymph nodes metastasis (LNM) and BRAF V600E mutation were independent risk factors of disease recurrence in RLN invaded cases. Tumor shaving showed better RLN function preservation without increasing recurrent risk. Current study confirmed the rarity of RLN invasion in PTC ≤ 1 cm. Various aggressive features were verified as predictive factors of RLN invasion. Tumor shaving showed superiority in preserving nerve function without increasing recurrent risk. Special attentions should be paid for disease recurrence when RLN invasion accompanied by upper-aerodigestive tract invasion, lateral neck LNM or BRAF V600E mutation.

An evaluation of an innovative screening program based on risk criteria for early diagnosis of head and neck cancers.

Head and neck cancer represents 3% of all cancers and is the cause of 5% of the deaths caused by cancer. The purpose of this study is to evaluate the implementation of a screening program to diagnose the early phase of the head and neck oncological processes. We have studied 324 asymptomatic patients who had at least one major risk factor (habitual consumption of tobacco or alcohol) or two minor risk factors: family history of head and neck cancer of the upper aerodigestive tract, occupational exposure, poor oral hygiene and history of Human Papillomavirus or chronic inflammatory processes of the aerodigestive tract. Family and personal head and neck oncological medical history, ENT exploration, performance of CT scans or biopsies and program procedures were analyzed. The most usual referral criteria for being sent to a specialist was being a smoker (98.1%). 10.5% reported family histories of head and neck cancer, 9.9% reported occupational exposure, 7.1% were referred due to poor oral hygiene and 5.9% were referred for gastroesophageal reflux disease. Although being asymptomatic was a requirement for inclusion, we verified that, after the anamnesis, 9.6% of the patients had some symptom to which they did not give importance to 119 patients (36.7%) presented a lesion that potentially could become malignant, located in the larynx and hypopharynx (25%) and in the oral cavity and oropharynx (10.8%). Eighteen patients (5.56%) presented more than one lesion. The detection rate of neoplasia was 1.2% and the detection rate of pre-neoplastic lesions was 4.6%. There did exist a statistically significant ratio between the detection of pre-neoplastic lesions and occupational exposure to carcinogenic agents (p = 0.006), poor oral hygiene (p = 0.01) and gastroesophageal reflux disease (p = 0.007). Samples were taken for a pathological anatomy study in 30 patients (9.25%). In order to follow up the patients, 22.8% were controlled at hospital medical consultations, 11.1% were examined at outpatient consultation and 66% were given appointments for follow-up visits. The use of this screening program could be a tool for the early diagnosis of malignant head and neck tumors and to foster healthy habits for cancer prevention.

A study of wound healing process in post total laryngectomy patients: Serial case reports

Laryngeal carcinoma is a malignancy on larynx that may occur in glottic, supraglottic and subglottic. Larynx plays role in coordination of upper aerodigestive tract such as breathing, verbal and swallowing. This reported as the third most common malignancy in the ENT-HN department. Total laryngectomy is a procedure that performed on T3 and T4 lesions. The most common complication is prolonged of the wound healing process. The process is very complex consist of four overlapping phases that involve multifactorial divided into local and systemic factors. Local factors include oxygenation and infection, while systemic factors are age, gender, psychological stress, nutrition, chronic disease and immunocompromise conditions. In this case, seven patients underwent total laryngectomy and contributing factors of wound healing process were observed in each patient until 14th postoperative day. Some of important factors might contributed to the wound healing process in some patients such as psychological stress, nutrition and chronic disease such as diabetes mellitus and hypertension.

Impact of Electronic Cigarettes on the Upper Aerodigestive Tract: A Comprehensive Review for Otolaryngology Providers.

The use and effects of electronic (e)-cigarettes (e-cigs) are particularly relevant for otolaryngology providers as tobacco plays a major role in benign and malignant diseases of the upper aerodigestive tract. This review aims to (1) summarize the recent policies regarding e-cigs and important patterns of use and (2) serve as a comprehensive resource for clinical providers on the known biologic and clinical effects of e-cigs on the upper aerodigestive tract. PubMed/MEDLINE. We conducted a narrative review on (1) general information on e-cig use and informative findings in the lower respiratory system and a comprehensive review on (2) the effects of e-cigs on cell and animal models and the clinical implications of these products on human health as is relevant to otolaryngology. Although e-cigs are likely less harmful than conventional cigarettes, preliminary research on e-cigs suggest several deleterious effects including in the upper aerodigestive tract. Due to this, there has been increased interest in restricting e-cig usage, particularly among the adolescent population, and caution in recommending e-cigs to current smokers. Chronic e-cig use is likely to have clinical implications. It is critical for otolaryngology providers to be aware of the rapidly changing regulations and use patterns regarding e-cigs and how e-cigs influence human health, particularly with regards to the upper aerodigestive tract, to accurately council patients regarding potential risks and benefits of use.

Evaluation of quality of life in posttreatment upper aerodigestive tract cancer patients.

Cancers of the upper aerodigestive tract constitute approximately 4% of all malignancies. Posttreatment cancer patient faces serious adversities that affect the quality of life. Out of the various scales available to measure the quality of life, we chose the quality of life-oral cancer (QOL-OC), which was developed and evaluated by Nie et al. in 2018. The aim of our study was to assess the quality of life in posttreatment upper aerodigestive tract cancer patients in a tertiary care center and also to check the reliability and validity of the questionnaire QOL-OC. We communicated with 89 patients who were pathologically tested positive for upper aero digestive tract cancer from January 2019 to December 2019. The most prevalent adversity was found to be altered salivary flow, followed by diet and difficulty while eating. The QOL-OC was found to be a highly valid and reliable questionnaire. The study points out regarding the prevalence of various adversities in post treatment cancer patients, a discussion has also been made suggesting the importance of multidisciplinary approach that should be provided in such patients. Finally, the study also concludes regarding the generalizability of the questionnaire QOL-OC.

Management of Traumatic Foreign Bodies of the Upper Aerodigestive Tract in Children with Limited Diagnostic Resources at the Pediatric University Hospital of Central African Republic of Bangui

Management of Traumatic Foreign Bodies of the Upper Aerodigestive Tract in Children with Limited Diagnostic Resources at the Pediatric University Hospital of Central African Republic of Bangui

Antibiotic Use in Patients Undergoing Complex Clean-Contaminated Head and Neck Surgery: A Prospective Study.

Oncological surgery of the upper aerodigestive tract is a complex procedure and often includes neck dissection and flap reconstruction. It can be complicated by severe surgical site infection (SSI) leading to flap necrosis, delayed wound healing, and increasing mortality and morbidity. The purpose of this study is to perform a systematic descriptive analysis and to evaluate the effect of our adapted antibiotic regimen strategy on postoperative outcomes. A prospective cohort analysis of 47 patients undergoing major clean-contaminated head and neck surgery was conducted at the Cervicomaxillofacial Surgery Department (Saint-Pierre Hospital), between 2019 and 2022. The patients were divided into two groups: group I, which received a short-term postoperative antibiotic regimen for 24 h, and group II, which received a more extended postoperative antibiotic course for more than 24 h. Antibioprophylaxy amoxicillin and clavulanate were administered intravenously 30-60 min before making the incision. The antibiotic regimen was continued after surgery. The prognostic significance of the antibiotic regimen on postoperative outcomes, including clinical signs of infection and biological markers such as white blood cells count, and C-reactive protein levels was evaluated using univariate analysis. Eighteen patients developed SSIs. All of these infections were grade 2 and were treated with antibiotics. After univariate analysis, only a history of hypothyroidism seems to be a predictor of SSI (P = 0.038). No significant difference was found in terms of onset and hospital stay when we compared the patients who received antibiotics for 24 h or more. Moreover, the rate of multidrug-resistant bacteria was not different in both groups. Our results suggest that postoperative antibiotics for more than 24 h do not confer benefit in terms of SSI. Oncological patients undergoing complex clean-contaminated head and neck surgery are often suffering from infectious complications and, despite the absence of guidelines, practicians should consider these findings in their decision-making.