Posterior glottic pathology

In infants and children, pathology in the posterior glottis is usually congenital or acquired due to endotracheal intubation. Diagnostic errors and omissions are less likely to occur with an anaesthetic technique where no endotracheal tube is used, where the posterior commissure and arytenoids are deliberately separated by a laryngoscope and where movements of the vocal cords and arytenoids are carefully assessed.     

Posterior glottic stenosis

Posterior glottic stenosis in children is not uncommon and must be differentiated from vocal cord paralysis when there is posterior glottic fixation. Procedures aimed at increasing the airway lumen by tissue excision have not been uniformly successful. Chronic aspiration and poor voice results have been reported. Expansion of the posterior glottis yields excellent results. Tracheotomy decannulation without aspiration and return of vocal cord mobility in children who have vocal cord fixation with achievement of a functional voice can be expected from widening the laryngeal framework. Scar incision without excision reduces the denuded laryngeal surface. The laryngeal framework is widened by anterior and posterior cricoid split and by stenting. Posterior cartilage grafting reduces scar tissue build-up and the duration of stenting.     

Posterior glottic stenosis and bilateral vocal fold immobility: diagnosis and treatment

Posterior glottic stenosis and bilateral vocal fold immobility cause obstruction of the airway at the glottis. Presentation of this problem may vary according to the cause. Full evaluation of the status of the larynx is crucial with regard to the mobility of the arytenoid cartilage and innervation of the laryngeal musculature. There are many techniques for surgically treating this condition, each with advantages and disadvantages. The surgeon should be familiar with a variety of these procedures and be able to adapt to each patient's situation.     

Posterior iliac donor sites. Should they be considered more often?

Spongy bone grafts are characterised by their resistance to infection and their great osteogenic potential. These qualities are valuable in facio-maxillary surgery. The anterior superior iliac crest, the usual donor site for cortico-spongy bone grafts is unsuitable for the removal of large quantities of spongy bone. The posterior iliac crest, which is used by orthopaedic surgeons, is a rich donor site for spongy bone, which is not generally used by facio-maxillary surgeons. The abundance and quality of the bone obtained, the simplicity of the postoperative course and the relative absence of pain of this site make it a good indication. The change in the operative position should not constitute an obstacle to its use.     

Accessory salivary tissue and deceptive ectopia

Histopathologic diagnosis in three patients presenting with a cervicofacial salivary tumoral mass was respectively an inflamed accessory salivary glands, two small islets of ectopic salivary glands and an ectopic salivary duct.     

Stage II glottic carcinoma: prognostic factors and management

Three hundred thirty-six patients with squamous cell carcinoma of the glottic larynx treated at the University of Virginia Medical Center from 1960 through 1977 were reviewed. Seventy patients with T2N0M0 disease, grouped according to the criteria of the American Joint Committee on Cancer, 1978, form the basis of this report. The 5-year actuarial survivals, recurrences, salvages, and prognostic factors were examined. Treatment was radiation, surgery, or a combination of radiation and surgery. Impaired vocal cord mobility in Stage II glottic squamous cell carcinoma is the crucial significant prognostic factor in predicting response to therapy, survival, and response to salvage therapy for recurrences. The 90% 5-year recurrence-free rate with freely mobile cords is comparable to that achieved with Stage I lesions. Impaired mobility resulted in a 5-year recurrence-free rate of 73%, which is comparable to that of T3N0 lesions. We support the concept of reclassifying Stage II disease into Stage IIa (mobile cords) and Stage IIb (impaired mobility). Based on this review and those reported in the literature, we recommend radiation therapy for Stage IIa disease. Surgery results in fewer recurrences and in longer survival than irradiation when the vocal cords are not freely mobile (Stage IIb).     

Osteolytic sinusitis and pneumomediastinum: deceptive otolaryngologic complications of cocaine abuse

Recreational cocaine abuse via intranasal "snorting," "free-base" smoking, "body-packing," or intravenous injection can be lethal. Increasing illicit use of cocaine hydrochloride and the misuse of legal over-the-counter (OTC) nasal drugs are known causative agents of nasal septal perforation with loss of taste and smell. Although 2 to 3 mg/kg is the recommended maximum dose for topical anesthesia, cocaine snorters may use 1,000 mg or more daily on a "run." Furthermore, the newer route of smoking the extracted volatile "free-base" form of the adulterated street drug provides a plasma concentration producing the same physiological and subjective effects of intravenous cocaine. Presented are two cases exemplifying unusual complications of cocaine abuse: 1. total nasal septal bony and cartilaginous necrosis with resultant saddle-nose deformity and osteolytic sinusitis secondary to chronic intranasal "snorting" and 2. tracheobronchial rupture with pneumomediastinum secondary to smoking "free-base" cocaine.     

Congenital perilymphatic fistula: an overlooked diagnosis?

Congenital perilymphatic fistula (CPLF) often is the sole cause of sensorineural hearing loss in children that is both progressive and subtle and, therefore, can elude detection by physicians. A 3-year prospective study of 244 children with sensorineural hearing loss of unknown etiology demonstrated that at least 6% (15/244) had CPLF. Close audiologic monitoring and radiologic imaging of the temporal bone of children with sensorineural hearing loss are recommended to detect CPLF.     

Supraglottic versus glottic laryngeal cancer: epidemiological and pathological aspects.

Between 1979 and 1988, 432 cases of previously untreated laryngeal cancers were histologically diagnosed at the Institute of Pathological Anatomy of the University of Trieste. Of these cases, 192 were supraglottic and 182 glottic cancers. The overall crude incidence was 31.06 0/0000 in males and 2.29 0/0000 in females, with a male/female ratio of 10.2:1 for supraglottic cancers vs. 20.4:1 for glottic cancers. Our incidence values for laryngeal cancer, and supraglottic lesions in particular, are similar to those recorded in France, Spain and other areas of Italy, i.e. in nations where wine production and consumption is very high. The 3-year adjusted survival rate was 45.7% for supraglottic and 83% for glottic cancer patients. Subjects with supraglottic cancer often had a poor prognosis because of the high frequency of cervical lymph node involvement, recurrences and visceral metastases; cancers of the aryepiglottic folds presented the worst clinical evolution.     

T3 glottic cancer: Options and consequences of the options

This report is a review of 106 Stage III glottic cancers treated surgically from January 1971 through December 1980. For analysis of recurrence and cause of death, the patients were assigned to four subgroups us well as considered as n single group. The subgroups were T₃, N₍₎, transglottic, all T₃ glottic cancers regardless of prior treatment, and all T₃ glottic cancers without prior treatment. Of the entire group, 8% either were not dead or had died of something other than cancer; 91% of patients with T₃, N₍₎ cancers without prior treatment either were alive or had died of another cancer. In the other subgroups the survivorship was between 80% and 91% with the exception of those with transglottic cancers. The findings in this study are discussed in light of the current controversies related to the stage of disease, particularly the issue of radical radiation with surgery for salvage for T₃ glottic cancer.