RESUMO
BACKGROUND: Neurogenic tumors of the larynx are rare, with few cases having been reported in the literature. Schwannomas are responsible for 0.1% of all benign tumors of the larynx. They arise in the sheaths of the peripheral, autonomic, and cranial nerves. The objective of this report is to describe a case of a bulky laryngeal schwannoma, the surgical procedure for its removal, and the long-term patient follow-up. CASE PRESENTATION: A 19-year-old Brazilian woman presented to our institution with a complaint of progressive dyspnea over the preceding year, as well as dysphonia, dysphagia for solids, and globus pharyngeus. Direct rigid laryngoscopy showed a supraglottic tumor obstructing approximately 90% of the larynx. With the symptoms progressing to severe dyspnea, an emergency tracheostomy was performed. After infusion of intravenous contrast, magnetic resonance imaging revealed a mass lesion with intense, heterogeneous contrast enhancement along the posterior wall of the hypopharynx, blocking all of the lumen and measuring 2.8 cm and 2.2 cm at its largest diameters. The image suggested a neoplastic lesion. The patient underwent open surgery for tumor resection. Her postsurgical recovery was uncomplicated. Histopathology and immunohistochemistry revealed the tumor to be a laryngeal schwannoma. CONCLUSION: The definitive diagnosis of laryngeal lesions can be difficult, and histopathology plays a pivotal role. Laryngeal schwannomas are rare; however, tumors can become large and may ultimately lead to airway obstruction.
Assuntos
Neoplasias Laríngeas , Laringe , Neurilemoma , Adulto , Brasil , Epiglote/diagnóstico por imagem , Epiglote/cirurgia , Feminino , Humanos , Neoplasias Laríngeas/diagnóstico por imagem , Neoplasias Laríngeas/cirurgia , Laringectomia , Laringoscopia , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Rotação , Adulto JovemRESUMO
Dorsal displacement of the soft palate (DDSP) usually occurs in athletic adult horses. Congenital DDSP in foals secondary to the persistent frenulum of the epiglottis is rarely observed. The aim of this report was to describe a case of a seven-day-old female neonate Quarter Horse presenting dysphagia, milk reflux through the nostrils and mouth, and expiratory dyspnea since 4 days. Thoracic auscultation was indicative of aspiration pneumonia. Diagnosis of DDSP associated with local inflammation was made after endoscopic examination of upper respiratory tract. Radiographic examination was performed to rule out hypoplasia of the epiglottis. No clinical improvement was observed after anti-inflammatory treatment with flunixin meglumine. Oral endoscopy under general anesthesia revealed that the displacement of the soft palate was caused by a persistent frenulum of the epiglottis. Using a 30° rigid endoscope and a curved laparoscopic scissors, the frenulum was transected. After surgery, no dysphagia or dyspnea at rest was observed. However, discreet respiratory noise persisted during exercise for 5 days postoperatively. After discharge, the owner reported that the animal was completely normal during exercise. The animal is currently 3 years old and is developing a normal athletic performance. Persistent frenulum of the epiglottis should be considered while examining neonates with nasal milk reflux associated with expiratory dyspnea. This case report emphasizes the importance of the differential diagnosis for DDSP and for DDSP secondary to the persistent frenulum of the epiglottis in neonatal foals. It also underlines the importance of oral endoscopic examination for diagnosis.
Assuntos
Doenças dos Cavalos , Condicionamento Físico Animal , Animais , Endoscopia/veterinária , Epiglote/cirurgia , Feminino , Doenças dos Cavalos/diagnóstico , Cavalos , Recém-Nascido , Palato Mole/cirurgiaRESUMO
RESUMO Objetivo investigar o possível impacto da angulação do osso hioide na segurança da deglutição de pacientes submetidos à laringectomia supracricóidea. Métodos série de casos de 13 adultos, entre 48 e 79 anos, majoritariamente homens (n=11), submetidos à laringectomia supracricóidea em pós-operatório inferior ou igual a dez meses. Realizaram videofluoroscopia da deglutição de 5 ml de líquido fino, 5 ml de alimento pastoso e sólido, em livre oferta. A medida do ângulo do osso hioide foi definida por duas linhas: uma tangente à margem superior do corpo do osso hioide e uma tangente ao ponto mais inferior de sua margem inferior, paralela ao plano horizontal da imagem. O desfecho de aspiração durante o exame seguiu a escala desenvolvida por Rosenbek et al. (1996). Resultados Dos 13 pacientes, 5 apresentaram aspiração silente e 8 não apresentaram aspiração. Dos 5 indivíduos com aspiração, apenas 1 manteve preservadas ambas as cartilagens aritenoides em sua reconstrução e a angulação do osso hioide foi abaixo de 60º, em todos os casos. Dos 8 indivíduos sem aspiração laringotraqueal, a maioria (n=5) apresentava as duas cartilagens aritenoides em sua reconstrução e a angulação do osso hioide foi acima de 60º, em todos os casos. Conclusão uma angulação maior que 60º do osso hioide parece favorecer a proteção das vias aéreas inferiores e promover maior segurança do mecanismo de deglutição.
ABSTRACT Purpose to investigate the possible impact of hyoid bone angulation on swallowing safety in patients undergoing supracricoid laryngectomy. Methods the case series comprised 13 adults, between 48 and 79 years-old, male in its majority (n=11), within ten months or less post-supracricoid laryngectomy and cricohyoidoepiglottopexy. All volunteers were submitted to videofluroscopy at rest and during swallowing of 5 ml of thin fluid, 5 ml of pureed consistency and dry solid food. Images were captured in lateral view. The hyoid angle was taken at rest and defined by two lines: a tangent to the upper margin of the body of the hyoid bone and a horizontal line, tangent to the lowest point of its lower margin. The aspiration was assessed using the scale developed by Rosenbek et al. (1996). Results five cases had silent aspiration and eight had no aspiration. In the group with silent aspiration, only one individual had both arytenoid cartilages preserved, while all individuals had the hyoid bone angle below 60º. In the group without aspiration, five individuals had both cricoarytenoids preserved, while all cases had the average hyoid bone angle above 60º. Conclusion the hyoid bone being at an angle greater than 60º seemed to increase the protection of the lower airways, promoting a safer swallowing mechanism.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Transtornos de Deglutição/diagnóstico por imagem , Osso Hioide/fisiopatologia , Laringectomia/efeitos adversos , Laringectomia/reabilitação , Carcinoma de Células Escamosas , Neoplasias Laríngeas/cirurgia , Estudos Transversais , Cartilagem Cricoide/cirurgia , Epiglote/cirurgiaRESUMO
INTRODUCTION: Laryngomalacia (LM) is the first cause of stridor in infants. 10 to 20% of patients with LM may require surgery due to the development of severe symptoms. Supraglottoplasty is the most commonly performed surgery for severe LM. However, it is insufficient for the rostrocaudal displacement of the epiglottis against the posterior pharyngeal wall. CASE SUMMARY: We report a case of a 2-month-old infant with severe laryngomalacia with a remarkable collapse of the epiglottis towards the glottis with secondary obstruction of the airway, alteration in swallowing and failure to thrive. The patient was treated satisfactorily through epiglottopexy by an external puncture. During a follow-up of 2 years, the patient has been asymptomatic, without any adverse event. DISCUSSION: Glottic obstruction from posterior epiglottic collapse is the most severe type of laryngomalacia, generating severe respiratory symptoms and failure to thrive. Epiglottopexy by external puncture is a new technique, certainly affordable since it does not require special instruments and it can be performed in medical centers through suspension laryngoscopy. It can be achieved alone or in combination with traditional supraglottoplasty.
Assuntos
Obstrução das Vias Respiratórias/cirurgia , Epiglote/cirurgia , Doenças da Laringe/cirurgia , Laringomalácia/complicações , Punções/métodos , Obstrução das Vias Respiratórias/etiologia , Humanos , Lactente , Doenças da Laringe/complicações , Laringoscopia , Masculino , Prolapso , Sons Respiratórios/etiologiaRESUMO
INTRODUCTION: Cardiovascular disease is the main cause of mortality worldwide. In women, its incidence increases at the sixth decade of life, coinciding with postmenopause. Whether this effect is due to menopause-related hormonal changes is not known. OBJECTIVE: To evaluate the differences in cardiovascular risk in pre- and postmenopausal women by means of the Globorisk risk scale, the triglyceride/high-density lipoproteinsHDL cholesterol (Tg/HDL-C) ratio and metabolic syndrome (MS) criteria. METHOD: Cross-sectional study that included 408 women from 40 to 60 years of age; anthropometric measurements and biochemical determinations were performed. The participants were classified as premenopausal and postmenopausal. Cardiovascular risk was assessed using the MS criteria, the Globorisk risk calculator and the Tg/HDL-C ratio. RESULTS: Postmenopausal women showed a significant increase in waist circumference, total cholesterol and triglycerides Tg in comparison with premenopausal women. Significant associations were found between hormonal state and Globorisk-measured cardiovascular risk (OR = 2.50; 95 % CI = 1.67-3.74) and the Tgtriglyceride/HDL-C ratio (OR = 1.66; 95 % CI = 1.09-2.52). CONCLUSION: Cardiovascular risk factors have a higher prevalence in postmenopause. The Globorisk scale and Tg/HDL-C ratio identify cardiovascular risk in postmenopausal women.
INTRODUCCIÓN: La laringectomía subtotal supracricoidea asociada con cricohioidoepiglotopexia es la técnica quirúrgica conservadora más eficiente para preservar las funciones laríngeas de los pacientes con carcinoma localmente avanzado de la laringe. La complicación más temida de esta intervención es la aspiración en el momento de la deglución y la neumonía secundaria; existen diversas formas de evaluar la aspiración y el grado de esta. Presentamos una novedosa forma de identificar incluso pequeñas cantidades de aspiración traqueobronquial. MÉTODO: Se incluyeron pacientes sometidos a laringectomía subtotal y cricohioidoepiglotopexia por cáncer laríngeo; todos evaluados con trago radiactivo posoperatorio. Con base en la sintomatología y resultado del gammagramma se decidió prolongar el tiempo de alimentación por sonda. RESULTADOS: Se incluyeron 37 pacientes, cuatro habían recibido radioterapia; la tasa de aspiración fue de 29.7 %; 50 % de los pacientes que habían recibido radioterapia presentó aspiración y 18 % de los pacientes con aspiración requirió prolongación del tiempo de alimentación por sonda nasogástrica; ninguno necesitó laringectomía total por aspiración que no permitiera la deglución. CONCLUSIONES: La evaluación posoperatoria de pacientes sometidos a laringectomía subtotal con trago radiactivo permite identificar líquido aspirado al árbol bronquial, incluso en cantidades mínimas, y planear el momento para iniciar la deglución.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Deglutição/fisiologia , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Aspiração Respiratória/etiologia , Carcinoma de Células Escamosas/patologia , Cartilagem Cricoide/cirurgia , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Epiglote/cirurgia , Humanos , Osso Hioide/cirurgia , Neoplasias Laríngeas/patologia , Aspiração Respiratória/epidemiologiaRESUMO
Vallecular cyst is more frequent in neonatal life, but could be present in adults. Frequently it is asymptomatic although some people has foreign body sensation upon swallowing and obstructive problems to sleep. The best treatment for these cases is complete resection, as recurrence is usual with any cyst remnant wall causing re-accumulation. We present the case of a patient with symptomatic vallecular cyst treated with transoral robotic surgery. The technique confirmed the advantages related with tridimensional vision close to the cyst, associated with multi-articulated 5 mm EndoWrist® instruments that made real safe and efficient surgery.
Assuntos
Cistos/cirurgia , Endoscopia , Epiglote/cirurgia , Doenças da Laringe/cirurgia , Procedimentos Cirúrgicos Robóticos , Cistos/diagnóstico por imagem , Epiglote/diagnóstico por imagem , Humanos , Doenças da Laringe/diagnóstico por imagem , Masculino , Pessoa de Meia-IdadeRESUMO
Se presenta el caso de una paciente recién nacida de término portadora de un síndrome de Pierre Robin asociada a laringomalacia severa que requirió resolución quirúrgica para estabilización de su vía aérea superior Se presenta la experiencia clínica en el uso de microdebridador para realización de supraglotoplastía como una novedosa alternativa en el tratamiento quirúrgico de este tipo de pacientes y se realiza revisión de la literatura respecto de esta técnica.
Pierre Robin syndrome is a triad formed by micrognathia, and cleft palate glossoptosis. His association with laryngomalacia is not set however determining the coexistence of these two diseases and their severity is of utmost importance as they condition the prognosis of a patient with Pierre Robin syndrome. Currently one of the surgical techniques used in patients with severe laryngomalacia, is assisted endoscopic microdebrider supraglottoplasty. In the ENT unit of the Hospital Luis Calvo Mackenna, this procedure is being implemented in order to give our patients a safe and effective treatment option for their pathology.
Assuntos
Humanos , Feminino , Recém-Nascido , Síndrome de Pierre Robin/cirurgia , Desbridamento/instrumentação , Laringomalácia/cirurgia , Laringoscopia/métodos , Microcirurgia/instrumentação , Síndrome de Pierre Robin/complicações , Obstrução das Vias Respiratórias/etiologia , Epiglote/cirurgia , Laringomalácia/complicaçõesRESUMO
We conducted a prospective study of 11 patients with laryngeal cancer who underwent supracricoid laryngectomy with cricohyoidoepiglottopexy. Our goal was to evaluate their postoperative voice and swallowing function and to ascertain the impact that surgery had on patient-perceived quality of life. Postoperative assessments were made by auditory perception analyses, objective voice analyses, the Voice Handicap Index questionnaire, the Quality of Life in Swallowing Disorders questionnaire, and videofluoroscopy. Following surgery, 8 patients experienced severe dysphonia and 3 experienced moderate dysphonia. Also, 5 patients experienced mild to severe dysphagia whereas 6 patients experienced normal or near-normal swallowing function. Postoperative acoustic measurements were higher than expected, and spectrographic evaluation revealed the presence of high-grade noise without predominant concentration over the spectrum. Some association with the grade of dysphonia and self-perception of voice handicap was observed. With regard to swallowing, 5 patients (45.5%) showed a decrease in laryngeal remnant elevation and a slight or moderate degree of stasis in the oropharynx. Overall, patients reported good quality of life regarding both voice and swallowing. No relationship between the functional swallowing and the number of preserved arytenoid cartilages was observed.
Assuntos
Cartilagem Cricoide/cirurgia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/psicologia , Epiglote/cirurgia , Osso Hioide/cirurgia , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Complicações Pós-Operatórias/etiologia , Qualidade de Vida/psicologia , Distúrbios da Voz/etiologia , Qualidade da Voz , Idoso , Terapia Combinada , Feminino , Seguimentos , Humanos , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/radioterapia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Satisfação do Paciente , Complicações Pós-Operatórias/psicologia , Estudos Prospectivos , Radioterapia Adjuvante , Processamento de Sinais Assistido por Computador , Espectrografia do Som , Distúrbios da Voz/psicologiaAssuntos
Humanos , Criança , Adulto , Deglutição , Transtornos de Deglutição , Traqueostomia , Prega Vocal , Epiglote , Epiglote/cirurgia , Traqueostomia/métodosRESUMO
OBJECTIVE: We undertook this study to report the possibility of salvage of vertical partial hemilaryngectomy with imbrication laryngoplasty (PVHLIL) to supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) in a patient with recurrent glottic carcinoma. CLINICAL CASE: A 68-year-old patient with recurrent glottic squamous cell carcinoma (T1aN0) was treated with imbricated partial laryngectomy. Transoperative histopathological report demonstrated vocal cord free surgical margins anterior at 1 cm and 0.4 cm posterior. The patient was evaluated trimonthly and at 16-month follow-up presented with tumor activity on the posterior third of the left false vocal cord, close to the arytenoids, which still conserved mobility. Biopsy was performed and confirmed recurrence of squamous cell carcinoma. SCPL with CHEP was performed with a satisfactory postoperative evolution with tracheotomy decannulation at day 7. Physiological phonation and retirement of nasogastric tube were accomplished at day 15, as well as reinitiation of oral feeding. Histopathological report showed a moderately differentiated squamous cell carcinoma. Functional evaluation with PVHLIL is a clear voice alteration; however, patients do not require permanent tracheostomy, and a close to normal biopsicosocial integration after SCPL + CHEP is possible. CONCLUSIONS: PVHLIL is an excellent treatment option for selected glottic tumors staged T1 or T2. Close follow-up must be given to allow the possibility of organ conservation either with radiotherapy or surgery. When recurrence occurs, SCPL + CHEP must be considered according to the established criteria for this procedure. Total laryngectomy must be considered as the last option, with the only purpose being a normal quality of life.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Recidiva Local de Neoplasia/cirurgia , Idoso , Cartilagem Aritenoide/cirurgia , Carcinoma de Células Escamosas/patologia , Cartilagem Cricoide/cirurgia , Disfonia/prevenção & controle , Epiglote/cirurgia , Seguimentos , Glote/cirurgia , Humanos , Neoplasias Laríngeas/patologia , Masculino , Esvaziamento Cervical , Qualidade de Vida , Terapia de Salvação/métodos , Qualidade da VozRESUMO
OBJECTIVE: We undertook this study to report the possibility of salvage of vertical partial hemilaryngectomy with imbrication laryngoplasty (PVHLIL) to supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) in a patient with recurrent glottic carcinoma. CLINICAL CASE: A 68-year-old patient with recurrent glottic squamous cell carcinoma (T1aN0) was treated with imbricated partial laryngectomy. Transoperative histopathological report demonstrated vocal cord free surgical margins anterior at 1 cm and 0.4 cm posterior. The patient was evaluated trimonthly and at 16-month follow-up presented with tumor activity on the posterior third of the left false vocal cord, close to the arytenoids, which still conserved mobility. Biopsy was performed and confirmed recurrence of squamous cell carcinoma. SCPL with CHEP was performed with a satisfactory postoperative evolution with tracheotomy decannulation at day 7. Physiological phonation and retirement of nasogastric tube were accomplished at day 15, as well as reinitiation of oral feeding. Histopathological report showed a moderately differentiated squamous cell carcinoma. Functional evaluation with PVHLIL is a clear voice alteration; however, patients do not require permanent tracheostomy, and a close to normal biopsicosocial integration after SCPL + CHEP is possible. CONCLUSIONS: PVHLIL is an excellent treatment option for selected glottic tumors staged T1 or T2. Close follow-up must be given to allow the possibility of organ conservation either with radiotherapy or surgery. When recurrence occurs, SCPL + CHEP must be considered according to the established criteria for this procedure. Total laryngectomy must be considered as the last option, with the only purpose being a normal quality of life.
Assuntos
Humanos , Masculino , Idoso , Carcinoma de Células Escamosas/cirurgia , Laringectomia/métodos , Neoplasias Laríngeas/cirurgia , Recidiva Local de Neoplasia/cirurgia , Carcinoma de Células Escamosas/patologia , Cartilagem Aritenoide/cirurgia , Cartilagem Cricoide/cirurgia , Disfonia/prevenção & controle , Epiglote/cirurgia , Seguimentos , Glote/cirurgia , Esvaziamento Cervical , Neoplasias Laríngeas/patologia , Qualidade de Vida , Terapia de Salvação/métodos , Qualidade da VozRESUMO
OBJECTIVE: To evaluate the clinical and polysomnographic evolution of patients with severe laryngomalacia who underwent supraglottoplasty. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: Seven children with severe laryngomalacia. MAIN OUTCOME MEASURES: The patients were evaluated with a questionnaire given to their parents and with polysomnographic examination before and 3 months after surgery. The clinical data of respiratory and swallowing symptoms as well as the parameters of minimum oxygen saturation and respiratory disturbance index were evaluated after bilateral supraglottoplasty and compared with the preoperative data. RESULTS: Two patients had pharyngolaryngomalacia and required tracheotomy. Four patients had a marked improvement of respiratory and deglutition symptoms. Polysomnographic data showed a significant improvement in the respiratory disturbance index after surgery (P<.05) but not in the minimum oxygen saturation level. However, this improvement was only partially achieved in 3 patients, in whom there were associated airway or neurologic changes. No serious surgical complications were observed. CONCLUSION: Supraglottoplasty led to a marked improvement in all 5 patients without pharyngolaryngomalacia, but the 2 patients with pharyngolaryngomalacia required tracheotomy.
Assuntos
Doenças das Cartilagens/cirurgia , Glote/cirurgia , Doenças da Laringe/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Cartilagem Aritenoide/cirurgia , Doenças das Cartilagens/complicações , Doenças das Cartilagens/diagnóstico , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/cirurgia , Epiglote/cirurgia , Feminino , Humanos , Lactente , Cartilagens Laríngeas/cirurgia , Doenças da Laringe/complicações , Doenças da Laringe/diagnóstico , Laringoscopia , Masculino , Polissonografia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/etiologiaRESUMO
BACKGROUND: Supracricoid laryngectomy with cri-cohyoidoepiglottopexy (CHEP) is a conservative surgical procedure indicated in selected cases of advanced glottic carcinoma. METHODS: This study is a review of our experience with 43 patients with T3/T4 glottic squamous cell carcinoma who underwent CHEP in our institution. All but two patients underwent selective neck dissections. All patients were staged on the basis of the 2002 TNM classification. Rates of recurrence and death were estimated by the Kaplan-Meier method. RESULTS: The 5-year disease-specific survival and 5-year relapse-free survival rates were 78% and 83%, respectively. Neck metastases were found in three patients. Cartilage invasion occurred in 11 cases. The average length of hospital stay was 5.7 days. The mean time of enteral feeding tube was 33.8 days, and the mean time for tracheotomy was 29.6 days. Overall, normal swallowing was achieved in 74.4% of patients. Eleven patients had mild and major complications. Laryngeal stenosis emerged as the most frequent major complication. Three patients (6.9%) had local recurrences. Two patients (4.6%) had neck metastases. CONCLUSIONS: On the basis of this study, over a 7-year period with 43 patients with advanced glottic cancer, a successful on-cologic outcome is confirmed.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Glote/patologia , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Cartilagem Aritenoide/cirurgia , Carcinoma de Células Escamosas/mortalidade , Cartilagem Cricoide/cirurgia , Intervalo Livre de Doença , Epiglote/cirurgia , Feminino , Seguimentos , Glote/cirurgia , Humanos , Neoplasias Laríngeas/mortalidade , Laringectomia/efeitos adversos , Laringoestenose/etiologia , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Recidiva Local de Neoplasia , Complicações Pós-Operatórias/etiologia , Radioterapia Adjuvante , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
A Laringomalácia é a causa mais comum de estridor na infância, com resolução espontânea até os 2 anos de idade na maioria dos casos. Cerca de 10 por cento dos casos (laringomalácia severa) necessitam de intervenção cirúrgica. O diagnóstico é estabelecido com o exame de videonasofibroscopia, na qual se observa encurtamento da prega ariepiglótica, e/ou excesso de mucosa das aritenóides, e/ou queda da epiglote no sentido ântero-posterior. A etiologia ainda permanece desconhecida. OBJETIVO: Verificar as principais alterações clínicas e anatômicas assim como identificar os principais parâmetros clínicos no acompanhamento e na indicação cirúrgica de pacientes portadores de laringomalácia. FORMA DE ESTUDO: Estudo de coorte transversal. MATERIAL E MÉTODO: Foram incluídos neste estudo 22 crianças com diagnóstico de laringomalácia do ambulatório de otorrinolaringologia pediátrica da UNIFESP-EPM, entre janeiro de 2001 a dezembro de 2003, assistidas pelo mesmo examinador. RESULTADOS: Das 22 crianças com diagnóstico de laringomalácia, duas (9,1 por cento) apresentavam laringomalácia severa com depressão torácica (tórax escavado). O estridor inspiratório e o encurtamento das pregas ariepiglóticas foram encontrados em todos pacientes. A polissonografia, nenhuma criança apresentou evento respiratório significativo durante o sono. As duas crianças com laringomalácia severa foram submetidas à supraglotoplastia com secção das pregas ariepiglóticas. CONCLUSÃO: O estridor respiratório e o encurtamento das pregas ariepiglóticas fazem parte preponderante do quadro clínico. A polissonografia não mostrou ser um parâmetro importante, nem para o acompanhamento clínico nem para a indicação cirúrgica, ao contrário da falta de ganho de peso e da presença de tórax escavado. A secção cirúrgica das pregas ariepiglóticas é efetiva e com baixo índice de morbidade.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Endoscopia/métodos , Epiglote/cirurgia , Glote/cirurgia , Doenças da Laringe/cirurgia , Laringoscopia/métodos , Estudos de Coortes , Estudos Transversais , Epiglote/anormalidades , Seguimentos , Tórax em Funil/diagnóstico , Glote/anormalidades , Doenças da Laringe/diagnóstico , Doenças da Laringe/etiologia , Polissonografia , Sons Respiratórios/diagnóstico , Apneia Obstrutiva do Sono/diagnóstico , Resultado do Tratamento , Aumento de PesoRESUMO
INTRODUCTION: Metastases to Delphian lymph node is rarely present in laryngeal malignancy. This report describes its frequency in patients with glottic cancer undergoing supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP). MATERIAL AND METHODS: Fourteen patients (13 male and 1 female) with a mean age of 58 years underwent a SCPL with CHEP and functional bilateral neck dissection (levels II-V) searching for the Delphian lymph node. Four patients were in stage I, five in stage II, four in stage III, and one in stage IV. Surgical margins and Delphian lymph nodes were searched for in each partial laryngectomy sample. RESULTS: The mean follow-up was 9 months. The right-side dissection yielded an average of 18 lymph nodes and the left-side dissection yielded an average of 22 lymph nodes, with no metastatic disease on the ultimate examination. Only one patient (7%) revealed a carcinoma-positive Delphian lymph node, and 6 months later a metastatic lymph node was found on the same side as the primary tumor. The patient underwent standard radiation therapy (66 Gy) targeted to larynx and lymph node areas, as well as to the supraclavicular region (20 Gy). DISCUSSION: Bilateral functional dissection is indicated in the presence of Delphian lymph node metastatic spread. Post-operative radiation therapy may occasionally be used as an adjuvant treatment in cases with positive Delphian lymph node in spite of a negative functional dissection in partial laryngectomies due to other possible node spread routes. Bilateral functional dissection should be chosen based on tumor site and size.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Glote , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Adulto , Idoso , Carcinoma de Células Escamosas/secundário , Cartilagem Cricoide/cirurgia , Epiglote/cirurgia , Feminino , Humanos , Osso Hioide/cirurgia , Neoplasias Laríngeas/patologia , Metástase Linfática , Masculino , Pessoa de Meia-IdadeRESUMO
UNLABELLED: Laryngomalacia is the most frequent cause of stridor in childhood, and in most of the cases, spontaneous resolution occurs by the age of 2 years. Approximately 10% of the cases (severe laryngomalacia) require surgery. This condition is of unknown etiology and its diagnosis is made by fiberoptic laryngoscopy, which shows shortening of the aryepiglottic folds, and/or redundant arytenoid mucosa, and/or anterior-posterior epiglottic prolapse. AIM: Our objective was to verify the main clinical and anatomical affections and to highlight the clinical parameters for clinical follow-up and surgical indication in patients with laryngomalacia. STUDY DESIGN: Transversal cohort study. MATERIAL AND METHOD: Twenty-two children diagnosed with laryngomalacia in the Pediatric Otorhinolaryngology of UNIFESP-EPM, from January 2001 to December 2003, whose clinical and surgical follow-up were performed by the same examiner, were enrolled in this study. RESULTS: Out of twenty-two evaluated children, 2 (9.1%) presented with severe laryngomalacia and pectus excavatum (funnel chest). At polysomnography, no child presented any significant respiratory event during sleeping. Those two children with severe laryngomalacia were submitted to supraglottoplasty with resection of the aryepiglottic folds. CONCLUSION: We concluded that stridor and shortening of the aryepiglottic folds are preponderant in children with laryngomalacia. The polysomnographic exam did not prove to be a good parameter for clinical follow-up, neither for surgical indication. The most important parameters were pectus excavatum and failure to thrive. Supraglottoplasty is effective with low rate of morbidity.
Assuntos
Epiglote/cirurgia , Glote/cirurgia , Doenças da Laringe/cirurgia , Laringoscopia/métodos , Estudos de Coortes , Estudos Transversais , Epiglote/anormalidades , Feminino , Seguimentos , Tórax em Funil/diagnóstico , Glote/anormalidades , Humanos , Lactente , Recém-Nascido , Doenças da Laringe/diagnóstico , Doenças da Laringe/etiologia , Masculino , Polissonografia , Sons Respiratórios/diagnóstico , Apneia Obstrutiva do Sono/diagnóstico , Resultado do Tratamento , Aumento de PesoRESUMO
This study assessed the functional results in patients treated primarily through supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP). Fifteen patients with a diagnosis of epidermoid carcinoma of the glottis region admitted to the Instituto Nacional de Cancerología (México) between June 2001 and September 2002 were studied. Three patients were at stage I, five at stage II, six at stage III, and one at stage IV. Both cricoarytenoid units were preserved in 12 patients, and only one in three. Each case was assessed through the clinical grading postoperative aspiration (CGPA) scale, the performance status scale for head and neck cancer (PSS-HNC), and the Karnofsky Performance Scale (KPS). Likewise, voice quality of the patients was assessed regarding tone and intensity using the SpeechViewer version 1 (IBM) and data were obtained with the Cool Edit 2000 software. Twelve patients received phoniatric rehabilitation and three were left without rehabilitation. The average time for decannulation was 12 days and 23 days for removal of the nasogastric catheter. The degree of aspiration was 0 in four patients and one in 11. According to PSS-HNC, the mean for normalcy in the diet was 95 and the mean for those eating in public was 91. Intelligibility reached an average of 90. Karnofsky's assessment was related to the disease and not to the treatment, as it remained at 100 per cent in most patients and was never below 80 per cent. The mean intensity of quality of voice was -18 dB below normal; however, the mean frequency was 243.7 Hz. SCPL and CHEP allows the preservation of the basic function of the larynx; however, a clear alteration in voice occurs after the procedure, although normal frequency is kept when both arytenoids are preserved. Likewise, preservation of both arytenoids shortens the time needed for cannula and feeding catheter removal. PSS-HNC, Karnofsky, and CGPA assessments demonstrated that patients can reach an almost normal bio-psycho-social integration. It is recommended that all patients be subjected to phoniatric rehabilitation.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Laríngeas/cirurgia , Laringectomia/reabilitação , Qualidade de Vida , Adulto , Idoso , Carcinoma de Células Escamosas/reabilitação , Cartilagem Cricoide/cirurgia , Epiglote/cirurgia , Feminino , Glote , Indicadores Básicos de Saúde , Humanos , Osso Hioide/cirurgia , Neoplasias Laríngeas/reabilitação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inteligibilidade da Fala , Qualidade da VozRESUMO
OBJECTIVES: To assess whether supracricoid laryngectomy with cricohiodoepiglottopexy could successfully reach the cure and preserve the voice in glottic laryngeal cancer, we studied 27 patients with T2/T3 squamous cell carcinoma of the larynx treated in our institution with cricohiodoepiglottopexy. STUDY DESIGN: A retrospective analysis has been carried out between 1995 through 1997. We classified 11 patients as T2N0M0 and 16 patients as T3N0M0. Nineteen patients had bilateral selective lateral neck dissection, 3 patients had unilateral lateral neck dissection, and 5 patients had undissected neck. Survival was analyzed under the Kaplan-Meyer method. RESULTS: Five patients had postoperative complications, 2 were treated with a total laryngectomy. The remaining 25 patients kept the normal airway, swallowing, and speech. None of the patients in the neck dissection group had neck metastasis. Two patients had recurrences, 1 with local recurrence was treated with a total laryngectomy and is alive without disease; the other patient had neck recurrence, was treated with radical neck dissection plus radiotherapy, and is dead of the disease. One patient had a second tumor in oropharynx treated with palliative radiotherapy and is dead of the disease. Three years disease-free survival was 75% for T2 and 79% for T3. CONCLUSIONS: This technique is useful in the treatment of selected cases of T3/T2 glottic cancer regarding the extent of disease. The incidence of complications in need of a complete laryngectomy does not compromise the functionality of this technique. The survival is comparable to patients who submitted to total laryngectomy and near-total laryngectomy, regarding the extent of the lesion.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Cartilagem Cricoide/cirurgia , Epiglote/cirurgia , Glote/cirurgia , Osso Hioide/cirurgia , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Adulto , Idoso , Carcinoma de Células Escamosas/mortalidade , Intervalo Livre de Doença , Feminino , Humanos , Incidência , Neoplasias Laríngeas/mortalidade , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias/epidemiologia , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate transcutaneous fine needle aspiration biopsy of the preepiglottic space for staging supraglottic squamous cell carcinoma. STUDY DESIGN: We studied 28 patients who underwent total or horizontal supraglottic laryngectomy as their main therapy modality due to supraglottic squamous cell carcinoma, followed in some cases by adjuvant radiation therapy. All the patients underwent transcutaneous fine needle aspiration. RESULTS: The cytopathologic examination of the material obtained by aspiration was compared to the histopathologic analysis of the laryngectomy specimens; the efficiency was 96.4%. The method did not cause any morbidity. CONCLUSION: Transcutaneous fine needle aspiration biopsy of the preepiglottic space is useful for preepiglottic space evaluation, with a high correlation with histopathologic results and no morbidity.