Selective deep lobe parotid surgery for benign tumors

Conclusions: Deep-lobe tumor parotidectomy decreases the incidence of parotidectomy post-surgical complications, preserves parotid function, and has a good esthetic appearance. Objective: The existing surgical technique in the parotidectomy of deep-lobe benign tumors can be improved. Methods: Fourteen surgical operations were performed (2004–2015) for selective deep lobe parotidectomy for patients with primary benign parotid tumors. The patients with deep-lobe benign tumors were operated on with the method of superficial lobe preservation, which included methylene blue staining of the gland and intra-operative facial nerve detection. Results: During follow-up, no cases of tumor recurrence, permanent facial nerve injury, postparotidectomy depression, or Frey’s syndrome was found.     

Parapharyngeal space tumors: Fifty-one cases managed in a single tertiary care center

Conclusions: Pre-operative planning for parapharyngeal tumors must include meticulous analysis. Factors such as tumor size, distance to cranial base, and relation to neurovascular structures must guide the selection of a surgical approach. Objective: To summarize experience in diagnosis and surgical management of parapharyngeal tumors, analyzing the frequencies of various tumoral types, clinical presentation, choice of surgical approach and outcomes. This study also compares the results with the most relevant case series in the literature. Methods: A retrospective review was performed of the records of 51 patients treated by the team, from 1984–2012. Only primary tumors were included, excluding invasion from adjacent spaces and metastatic disease. All patients underwent imaging studies and surgical resection of the neoplasm. Cytological analysis and arteriography were used on an individualized basis. Surgical excision was performed via different approaches, predominantly through a cervicoparotid route. Results: Benign neoplasms were predominant (80%), and the most frequent tumor was pleomorphic adenoma. FNAC had a 100% accuracy to differentiate benign vs malignant tumors. The most common post-operative sequel was compromise of a cranial nerve, and three patients presented local complications after surgery. After follow-up, only three of 41 patients with benign tumors had recurring disease.     

Analysis of failure following transoral laser surgery for early glottic cancer

This study aimed at clarifying further the clinical behavior of early glottic cancer following transoral laser surgery and to determine, using retrospective analysis, whether the site of tumor involvement along the vocal fold has prognostic significance. The study included all patients treated with transoral laser surgery, for early glottic cancer (T1/T2N0M0) between May 1998 and January 2012 in a university affiliated tertiary care medical center. Data on demographics, site and extent of disease, treatment and outcome were collected and analyzed. Patients with insufficient data and/or follow-up of <2 years were excluded from the study. One-hundred and twenty-one patients were eligible for the study. Mean follow up time was 6.7 years (range 2–12 years). Overall recurrence rate following primary transoral laser surgery was 16.5 %. Histological grade was associated with higher recurrence rate (p = 0.008). Anterior commissure involvement was associated with reduced disease-free survival and tumors extending to the middle third of the true vocal fold were associated with lower recurrence rate. As per the results, anterior extension of glottic tumors is associated with higher recurrence rate compared to middle vocal fold extension, presumably due to earlier detection, better visualization and different biological behavior pattern of middle vocal fold tumors. Patients with higher grade tumors should be closely monitored for disease recurrence.     

High case volume of radiation oncologists is associated with better survival of nasopharyngeal carcinoma patients treated with radiotherapy: a multifactorial cohort analysis

Clin. Otolaryngol. 2011, 36 , 558–565 Objectives: The relationship between physician case volume and patient outcome in patients with head and neck cancers such as nasopharyngeal carcinoma treated by radiotherapy is unknown. This study was designed to investigate the association between the case volume of radiation oncologists and the survival of patients with nasopharyngeal carcinoma. Design: Retrospective cohort study. Setting: Based on nationwide claims data (National Health Research Insurance Database) in the years 2002–2008. Participants: Newly diagnosed patients with nasopharyngeal carcinoma receiving curative radiotherapy in the year 2003. Main outcome measures: Overall survival until 2008. We used the running log‐rank test to decide the optimal threshold for categorising the case volume of radiation oncologists. The characteristics of patients, their treatments and contact with health service providers were considered as co‐explanatory variables. The log‐rank test and Cox regression were performed. Sensitivity analyses were carried out regarding major study assumptions. Results: Five hundred and sixty‐two patients with nasopharyngeal carcinoma newly diagnosed in 2003 were identified as the study cohort. The 5‐year overall survival was better among patients treated by high‐volume (≥6 patients in year 2002) radiation oncologists than by low‐volume (<6 patients in year 2002) radiation oncologists (77%versus 64%, P = 0.0007). The adjusted hazard ratio of death was 0.65 (95% confidence interval, 0.48–0.91) upon multivariate analysis. Patients aged at least 65 years also had a lower survival rate than those younger than 65 years old (adjusted hazard ratio of death: 2.81, 95% confidence interval: 1.94–4.08).The physician case volume and patient outcome effect remained the same after sensitivity analyses. Conclusions: Patients with nasopharyngeal carcinoma treated by high‐volume radiation oncologists have better survival compared with those treated by low‐volume radiation oncologists. Further studies are needed to verify our findings with similar cancer cohorts treated by modern radiotherapy techniques or other types of radiotherapy.     

Cross-linked hyaluronan versus collagen for injection treatment of glottal insufficiency: 2-year follow-up

Objectives—To evaluate the long-term (24 months) clinical performance (vocal fold function) and safety of hylan B gel as compared with bovine cross-linked collagen in the treatment of patients with glottal insufficiency.

Material and Methods—In a prospective trial, 70 patients with glottal insufficiency due to unilateral vocal fold paresis (n=35) or atrophy (n=35) were randomized to received either hylan B gel (n=47) or collagen (n=23) injections into 1 vocal fold. Forty-two of the patients were examined 24 months after treatment. Evaluations were made based on patients’ subjective ratings, digitized videostroboscopic measurements, maximum phonation time and phonation quotient.

Results—The patients’ self-ratings were significantly improved in both the hylan B gel and collagen groups. Videostroboscopic measurements of glottal closure were significantly improved for both groups. The hylan B gel group showed a trend towards less resorption at the injected vocal fold edge in comparison with the collagen group (p=0.05). No serious adverse events were observed. Twenty-eight patients dropped out of the study after 12 months: 18 had been re-injected or operated on with medialization laryngoplasty due to insufficient voice and 10 had either died of causes unrelated to the study or refused to attend follow-up.

Conclusions—No long-term side-effects were found for either the hylan B gel or collagen groups after injection treatment. Both treatments resulted in significantly improved voice as rated by the patients and significantly improved glottal closure. Some resorption was noted for both substances, and ≈25% of the patients chose re-treatment 2 years after the initial treatment.     

Computergesteuerte Hochpräzisionsbestrahlung

The irradiation of tumors in the brain is challenging due to the proximity of radiation sensitive critical structures and the tumors to be treated. In addition, irradiation above a certain level can cause irreversible damage to nerve tissue. The irradiation of benign and malignant brain tumors requires precise techniques to preserve critical structures while simultaneously administering a high radiation dose for maximum effectiveness. Therefore, stereotaxy, as a subspecialty of neurosurgery, has developed various irradiation techniques, e. g., intracerebral application of interstitial brachytherapy (SBT; stereotactic brachytherapy) and stereotactic radiosurgery (SRS). Due to the development of computer-controlled radiation techniques (e.?g., Cyberknife) over the last 20 years, SRS has gained increasing importance.     

The role of partial parotidectomy for benign parotid tumors: A case-control study

Objective: To evaluate the results and complications after partial parotidectomy vs superficial parotidectomy, as primary treatment of benign parotid tumors. Study design: Case-control study. Setting: University hospital. Subjects and methods: A case-control study is presented on parotidectomy, comparing a group of 25 patients treated by partial parotidectomy vs a similar group of 25 patients treated by superficial parotidectomy. All patients had primary benign parotid tumors, were matched by sex and age, and had a minimum follow-up of 4 years. Independent variables included sex, age, medical history, intra-operative variables (surgical time, estimated blood loss, type of drainage, use of collagen), fine-needle aspiration cytology, computed tomography findings, and final histopathological diagnosis. Outcome measures were early and late complications, such as facial nerve paralysis, seroma, sialocele, Frey syndrome, and recurrence. Results: Partial parotidectomy resulted in less early and late complications than superficial parotidectomy, with similar recurrence rates. Temporal facial paresis was found in 4% of partial surgeries, vs 12% of superficial parotidectomies, a significant difference. Three months after surgery, only one patient has a persistent marginal nerve paresis. In contrast, sialocele was more common after partial parotidectomy (28% vs 16%), a significant difference. Conclusions: Partial parotidectomy achieves less early and late complications than superficial parotidectomy, with similar recurrence rates.     

Neck masses secondary to heterotopic salivary gland tissue: a 25-year experience

OBJECTIVES: The aim of this study is to review salivary tumors arising from heterotopic salivary inclusions in the periparotid and cervical lymph nodal tissues over a 25-year span. METHODS: A retrospective chart review revealed 24 patients with asymptomatic neck masses treated between 1976 and 2001, whose pathology demonstrated heterotopic salivary tissue or neoplasms arising from heterotopic salivary tissue. RESULTS: Nine cases were benign periparotid lymph nodes with heterotopic salivary inclusions, 3 of which had multimodal involvement. Fifteen cases of heterotopic salivary tumors were identified. The benign tumors were predominantly Warthin's tumor (8) with 1 pleomorphic adenoma. Malignant tumors included mucoepidermoid (3), acinic cell (2), and adenocarcinoma (1). Patients were treated by a superficial parotidectomy, neck dissection, or simple excision depending on site and preoperative workup. Adjuvant radiation therapy was included for high-grade malignancies. Among the 15 tumor patients, follow-up ranged from 1 month to 17 years. Nine patients are alive and disease-free, 5 are deceased, and 1 was lost to follow-up. CONCLUSIONS: Heterotopic salivary tissue in periparotid and upper cervical nodes is a more common occurrence than historically recognized. Tumorigenic changes arise from heterotopic nodal inclusions, and although infrequent, should be considered in the differential diagnosis for isolated neck/periparotid masses and parotid Warthin's tumor. Suggested management, after a thorough clinical exam/needle aspiration biopsy, includes an imaging survey of the parotid gland and neck lymphatics with an appropriate resection to include a simple excision, parotidectomy, neck dissection, and/or irradiation as indicated. Isolated low-grade malignant lesions/benign lesions are adequately managed by excision or parotidectomy alone. High-grade malignant lesions require more extended surgery with possible irradiation.     

The impact of positive resection margins in partial laryngectomy for advanced laryngeal carcinomas and radiation failures

Clin. Otolaryngol. 2010, 35 , 402–408 Objectives: To investigate the prognostic significance of positive margin and disease course in partial laryngectomy for advanced laryngeal carcinoma and radiation failure. Design: Retrospective case control study. Setting: A major tertiary referral centre. Participants: Patients who underwent partial laryngectomy for advanced laryngeal carcinoma or for radiation failure with at least 2 years of follow-up . Main outcome measures: Margin status versus primary treatment and salvage treatment versus disease-free survival and overall survival. Results: Twenty nine patients with sufficient follow-up data were found. Twelve patients had histological positive margin. Five of the 12 patients with a histological positive margin failed surgery as did four patients with clear margins. A positive margin had no effect on disease-free survival (P = 0.287) but was associated with poorer overall survival (P = 0.051). Of 11 patients treated primarily with surgery, recurrence was documented in one of eight with a positive margin and none of three with clear margins. Of 18 patients who underwent surgery secondary to radiation failure, recurrence was documented in all four with a positive margin and 4 of 14 with negative margins. Extended frontolateral resection, performed only in radiation failures, was associated with worse disease-free survival. Conclusions: Non-irradiated patients with involvement of a single margin after partial laryngectomy may be spared total laryngectomy if adjuvant radiation is administered. Patients who fail radiation should undergo radical partial laryngectomy, with conversion to total laryngectomy in those with a positive margin.     

Quantitative analysis of videokymography in normal and pathological vocal folds: a preliminary study

Videokymography (VKG) captures high-speed images of the vocal folds independently of the periodicity of the acoustic signal. The aim of this study was to preliminarily assess a software package that can objectively measure specific parameters of vocal fold vibration. From August 2009 until December 2010, we prospectively evaluated 40 subjects (Group A, 18 normal subjects; Group B, 14 patients with benign lesions of the middle third of the vocal fold, such as polyps and cysts; Group C, 8 patients treated by endoscopic excision of vocal fold benign lesions) by videoendoscopy, videolaryngostroboscopy, and VKG. A VKG camera was coupled to a 70° telescope and video was recorded during phonation. Images were objectively analyzed by a post-processing software tool (VKG-Analyser) with a user-friendly interface developed by our group. Different parameters were considered, including the ratio between the amplitude of the vibration of one vocal fold with respect to the contralateral (R _amp), the ratio between the period of one vocal fold vibration and the opposite one (R _per), and the ratio between the duration of the open and closed phase within a glottal cycle (R _oc). Mean values for R _amp, R _per, and R _oc in Group A were 1.05, 1.04, and 1.35, respectively; in Group B were 1.63, 0.92, and 0.97, respectively; and in Group C were 1.13, 0.91, and 1.85, respectively. Quantitative analysis of videokymograms by the herein presented tool, named VKG-Analyser, is useful for objective evaluation of the vibratory pattern in normal and pathologic vocal folds. Important future developments of this tool for the study of both physiologic and pathologic patterns of vocal fold vibration can be expected.     

The effect of midline crossing of lateral supraglottic cancer on contralateral cervical lymph node metastasis

Conclusion: The degree of midline crossing of lateral supraglottic cancer does not significantly change its rate of contralateral cervical metastasis. The rate of occult metastasis is too high to take the risk of contralateral regional recurrence. We support routine bilateral neck dissection even in lateral supraglottic cancers with no or minimal midline crossing. Objectives: Data on the rate of contralateral cervical metastasis of laterally located supraglottic cancer, the effect of its degree of midline crossing on contralateral cervical metastasis, and its treatment are still controversial. Methods: This was a retrospective cohort, chart review involving 305 surgically treated patients with T1–3 squamous cell carcinoma of the supraglottic larynx. In all, 184 patients had bilateral neck dissection; 86 N0 contralateral necks were followed up. Thirty-five patients who needed postoperative radiation therapy because of the primary tumor or ipsilateral neck dissection specimen also received radiation therapy to the contralateral neck. The degree of midline crossing at the epiglottis was measured on a laryngectomy specimen with a ruler and expressed as ‘no,’ ‘<5 mm’ or ‘≥5 mm.’ Results: The rates of occult and overall contralateral metastasis in our series were 16% and 28%, respectively. There was no statistically significant difference between contralateral neck metastasis and recurrence rates in the neck dissection, follow-up, and irradiation groups according to the degree of midline crossing.     

Changing etiology of vocal fold immobility

Hypothesis: Vocal fold immobility is a sign of underlying disease. When the etiology remains unclear, evaluation may become time consuming and costly, and directed work-up imperative. This study examined the hypothesis that the etiologies of vocal fold immobility are changing, with extralaryngeal malignancies and nonthyroidectomy surgical trauma having become more common causes. Methods: A retrospective review of consecutive patients with vocal fold immobility who had an adequate workup to determine the etiology. Results: Three hundred ninety-seven cases with a determined etiology were identified, yielding 280 unilateral and 117 bilateral immobilities. The largest single category in unilateral immobility was nonlaryngeal malignancy—69 patients (24.7%)—80% of which were pulmonary or mediastinal, followed by 67 patients (23.9%) with immobility secondary to surgical trauma. Thyroidectomy accounted for only 8.2%. The leading cause of bilateral immobility was surgical trauma—30 patients (25.7%)—21 (18%) of whom had thyroidectomy. Acute and chronic intubation injuries accounted for 21 unilateral (7.5%) and 18 bilateral (15.4%) cases. Conclusions: These data indicate a changing etiology of vocal fold immobility, with growing percentages of extralaryngeal malignancies and surgery-related injuries. These findings have implications for the timing and method of management based on anticipated outcome.     

Videostrobokymographic Analysis of Benign Vocal Fold Lesions

Objectives—Videostrobokymography (VSK) has recently been introduced. The aim of this study was to analyze vibratory patterns and objective parameters in various benign vocal fold lesions using VSK and to examine the efficacy of VSK in clinical applications.

Material and Methods—Using VSK, we analyzed the vibration patterns of normal vocal folds, various benign lesions such as nodules, polyps, cysts and Reinke's edema and cases of unilateral vocal fold paralysis. We also calculated the objective parameters open quotient and asymmetric index and compared them with their mean values in normal controls.

Results—In nodules, polyps and cysts, the open quotient at the site of the lesion was similar to the mean value in the normal controls; however, on the other parts of the vocal folds, it was much larger than the normal mean value. In Reinke's edema, irregular and asymmetric vibrations were observed. The posterior area of the vocal folds showed larger open quotients than the anterior area. In unilateral vocal fold paralysis, irregular vocal fold vibration and incomplete closure of the vocal folds were documented. Much larger asymmetric indices were calculated for unilateral vocal fold paralysis than in normal controls or for other lesions. The asymmetric index may be a good quantitative parameter of vibration in patients with vocal fold paralysis.

Conclusion—This study demonstrated that VSK could generate clear quantitative documentation of fine vibrations of vocal folds in many different types of benign lesion. VSK has the potential to be an effective tool for the quantitative analysis of vibratory patterns of vocal folds in clinical settings.     

Chondronecrosis of the larynx following use of the laryngeal mask airway

This case describes the development of laryngeal chondronecrosis after use of the laryngeal mask airway (LMA). A 69‐year‐old male with prior laryngeal irradiation underwent total knee replacement with general anesthesia via LMA. Postoperatively, he developed laryngeal chondronecrosis, bilateral vocal fold immobility, and aspiration, necessitating tracheostomy and gastrostomy placement. He improved with hyperbaric oxygen therapy, intravenous antibiotics, and endoscopic repair of a residual fistula. Vocal fold motion returned and he was decannulated. Chondronecrosis of the larynx may occur with the use of the LMA, and caution should be used in patients with a history of prior laryngeal irradiation. Laryngoscope, 125:946–949, 2015     

Definitive re-irradiation using intensity-modulated radiation therapy in cancers of the head and neck,focusing on rare tumors

Purpose: To analyze the outcomes following re-irradiation for local recurrence of rare head and neck tumors.

Material and methods: We retrospectively analyzed 11 patients who had received intensity-modulated radiation therapy (IMRT) for recurrent tumors in the head and neck except for laryngopharynx.

Results: Primary tumor sites included the maxillary sinus, nasal cavity, and external ear canal in six, three, and two patients, respectively. The median follow-up times were 13 (range, 3–54) months. The median survival time was 17 months with 1- and 2-year survival rates of 63.64 and 39.77%, respectively. Among 11 patients, five experienced local failure in the follow-up period. The 1- and 2-year local control rates were 58 and 47%, respectively. Patients who had received a radiation dose of ≥3?Gy per fraction showed significantly better local control than those receiving less (p?=?.0419). One patient experienced Grade 3 facial pain as acute toxicity. Late toxicities included radiographic findings of partial central nervous system necrosis in three patients and Grade 3 osteonecrosis and Grade 3 facial nerve disorder in one patient.

Conclusions: Re-irradiation of rare head and neck tumors using IMRT for loco-regional recurrence may be an acceptable treatment option.     

Cochlear implantation in irradiated tympanojugular paraganglioma

Objective: Indications for cochlear implantation have extended progressively over the years both from an audiological and clinical point of view, including the introduction of cochlear implants (CI) for hearing rehabilitation following skull base surgeries and neurotological procedures. In the past, cochlear implantation has been used for hearing rehabilitation in radiation-induced sensorineural hearing loss in nasopharyngeal and tonsillar carcinoma with successful outcomes. Here we describe a similar outcome following total deafness after tympanojugular paraganglioma irradiation, which is also the first such report in literature. Design: The irradiated ear of this patient was implanted with a CI through standard posterior tympanotomy. Study sample: A 26 year old male with multiple paragangliomas with bilateral deafness, secondary to surgery on one ear and radiotherapy for the opposite ear. Results: After a follow-up of 48 months, no local complications have occurred and the hearing results have remained stable with 100% sentence recognition. Conclusions: Bilateral and multiple paragangliomas are rare tumors. Despite the modality of treatment, the hearing is almost always compromised. In these patients, cochlear implantation offers a new perspective for hearing restoration. This report demonstrates that cochlear implantation can be effectively performed after tympanojugular paraganglioma irradiation with long-lasting, satisfactory results, even in the presence of residual tumor.     

T3 Supraglottic Cancer: Treatment Results and Prognostic Factors

Objective—A retrospective study was performed in order to analyze the treatment results and prognostic factors in patients with T3 supraglottic carcinoma and to differentiate between the treatment results obtained for T3 transglottic carcinoma and T3 pure supraglottic carcinoma. Material and Methods—Thirty-two patients who underwent surgery with or without postoperative radiation therapy between 1990 and 2000 were studied. Neck dissection was performed in 27 patients and 24 received postoperative radiation therapy. Results—The 3-year overall survival rate was 81.7%. The 3-year overall survival rates for T3 pure supraglottic carcinoma and T3 transglottic carcinoma were 91.7% and 73.2%, respectively (p<0.05). Univariate analysis revealed a prognostic significance for vocal cord fixation. T3 transglottic carcinoma was significantly correlated with vocal cord fixation. Conclusions—We suggest that surgery, either alone or in combination with postoperative radiation therapy, provides acceptable cancer control and survival rates for patients with T3 supraglottic carcinoma. Vocal cord fixation detected during preoperative fiberoptic laryngoscopy is a significant prognostic factor. T3 transglottic cancer needs more aggressive management.     

A 20‐year retrospective study of tonsil cancer incidence and survival trends in South East England: 1987–2006

Clin. Otolaryngol. 2011, 36 , 325–335 Background: There has been an increasing incidence of tonsil cancer worldwide. Documenting these changes is crucial to cancer prevention and control measures, resource allocation and understanding disease aetiology. Objective: To analyse the changing epidemiology of tonsil cancer in South East England over a 20‐year period between 1987 and 2006. Design: A retrospective, quantitative study using secondary anonymised data obtained from the Thames Cancer Registry, London. Data were analysed using spss v.17 and survival analyses with Kaplan–Meier and Cox regression. Setting: This study was conducted in South East of England comprising London, Kent, Surrey and Sussex counties with an average population of 12 million. This population increased from 10.7 to 11.8 million (a 10% increase) between 1987 and 2006. Participants: All patients with tonsil cancer in South East England registered with the Thames Cancer Registry (ICD‐10 code C09) between 1987 and 2006. A total of 1794 patients’ data were analysed. Ethical Considerations: Ethical approval was granted by the Kent Research Ethics Committee. Main outcome measures: Data were analysed for demographic trends including gender, age at diagnosis, yearly incidence and survival. Results: Tonsil cancer incidence has increased significantly from 0.60 to 1.45 per 100 000 in the 20 years (P < 0.001). This increase is mainly amongst men and age groups 40–59 years with a significant reduction in age at diagnosis by 2 years from 61.6 years in the first decade to 59.6 years in the second decade (P < 0.001). Survival was worse in men, older age groups and in the presence of synchronous tumours (P < 0.001). There has been a statistically significant increase in median survival times from tonsil cancer by about 3 years from 2.7 years in the first decade to 5.7 years in the second decade of this study (P < 0.001). Conclusions: Tonsil cancer incidence has increased in the 20 years of this study in South East England, especially amongst men and age groups 40–59 years. There has also been significant reduction in the mean age at diagnosis and an increase in median survival times for tonsil cancer. Further studies are needed to explain these trends.     

72例咽旁隙肿瘤的临床诊治

目的 分析并总结咽旁隙肿瘤的临床特点、手术方法及预后情况。方法 回顾性分析南京医科大学第一附属医院2012年11月—2022年11月收治的咽旁隙肿瘤患者的临床资料,排除影像学资料不全及失访的患者共筛选到72例,其中男36例,年龄27~72岁,平均年龄（46.06±1.72）岁;女36例,年龄21~77岁,平均年龄（53.67±4.88）岁。所有患者均根据术前查体及影像学检查制定手术方案,经口径路27例,颈侧径路45例。术后随访2～135.9个月,中位随访时间54.38个月。统计分析临床、影像及手术资料。结果 72例患者术后病理为良性肿瘤63例,其中上皮源性肿瘤29例,神经源性肿瘤30例,其他组织来源良性肿瘤4例;4例复发,其中2例神经鞘瘤,2例多形性腺瘤,余59例恢复良好;恶性肿瘤9例,其中鳞状细胞癌5例,恶性梭形细胞瘤1例,恶性淋巴瘤1例,滑膜肉瘤1例;3例复发。尽管良性咽旁隙肿瘤经口内镜手术存在囊内分块切除的情况,但相比整块切除的患者并未增加复发风险（P=0.381）。结论 咽旁隙肿瘤位置深在,临床结构复杂,良性肿瘤预后可,恶性肿瘤易复发转移,预后较差。根据术前查体和影像学检查制定手术径路至关重要。手术以颈侧开放径路为主要方式,内镜辅助径路需严格把握适应证,肿物长径较大时在包膜完整的情况下作囊内分块切除是可行的。     

Malignant transformation in non-irradiated juvenile laryngeal papillomatosis

A spontaneous cancer transformation of non-irradiated juvenile papillomas has been observed in a very small number of cases. We report on six more patients with juvenile laryngeal papillomatosis developing into a squamous-cell carcinoma. Three patients had childhood papillomatosis and three patients adult onsets of their papillomas. The average duration between onset of papillomatosis and cancer diagnosis was 33 years, while the average age at time of diagnosis of a laryngeal cancer was 50 years. All patients were cigarette smokers, but none of them had received prior irradiation. The typical histological picture of tumors showed an infiltrating keratinizing squamous carcinoma besides remaining benign papillomas within the larynx. Our study again illustrates the risk of malignant transformation of juvenile papillomatosis in long-lasting cases. Therefore, regular extensive biopsies and careful histopathological examination are required. The role of smoking as a co-factor in the development of carcinoma ex-papilloma is still not clear. Received: 14 April 1999 / Accepted: 24 April 1999