Retrograde balloon dilation of complete cervical esophageal and hypopharyngeal strictures

OBJECTIVES: To evaluate and describe retrograde endoscopic dilation of 100% strictures of the cervical esophagus and hypopharynx. METHODS AND MATERIALS: All patients who presented to the senior author (Y.D.) from September 1997 to September 2003 with strictures of the cervical esophagus and hypopharynx were retrospectively reviewed. RESULTS: Six patients with 100% strictures of the cervical esophagus and hypopharynx were available for review. Eighty-three percent of these patients were successfully treated endoscopically with the outlined technique. All were able to handle their secretions successfully, and four were no longer dependent on a gastrostomy tube. CONCLUSIONS: Retrograde dilation of complete strictures of the hypopharynx and cervical esophagus appears to be safe, reliable, and associated with a high rate of ultimate success. It should be considered a first-line treatment prior to open approaches, which may be reserved for failures.     

U-shaped free jejunal transplantation: improved technique and indications

Reconstruction of the oropharynx and the hypopharynx is difficult due to their wide diameters. We report eight cases of circumferential pharyngolaryngectomies for epidermoid carcinomas of the hypopharynx extended to the oropharynx and classified T4. Reconstruction was performed with a U-shaped free jejunal transplantation. This specific technique consists of a side to side anastomosis between two loops of jejunum. It facilitates reconstruction at the level of the oropharynx and diminishes postoperative complications.     

Myxofibrosarcoma of the hypopharynx

Myxofibrosarcoma is common in the extremities, but rare in the head and neck region. Hypopharyngeal myxofibrosarcoma has not been reported previously. We report the first case of a patient with myxofibrosarcoma of the hypopharynx. We examined this patient once a month after the operation, and there has been no local recurrence and no distant metastasis. Sarcomas are rare in the hypopharynx, but we have to bear in mind their possibility. Though a low-grade myxofibrosarcoma is a low-grade malignancy, complete resection should be done. We have to pay more attention planning the treatment for neoplastic diseases.     

应用颈阔肌肌皮瓣修复下咽腔瘢痕狭窄

目的：探讨带蒂颈阔肌肌皮瓣转移术修复下咽腔狭窄术。方法：对本组10例下咽腔瘢痕狭窄患者应用带蒂颈阔肌肌皮瓣转移行下咽腔重建术。结果：本组术后9例顺利拔除气管套管，恢复正常的呼吸、发声和吞咽功能，随访1-3年手术效果巩固。结论：带蒂颈阔肌肌皮瓣转移修复下咽腔瘢痕狭窄术，操作简单易行，并发症少，具有较高的成功率和较好的远期疗效，此肌瓣是理想的下咽腔重建材料，值得临床推广应用。     

喉内窥镜在喉咽部异物诊治中的应用

目的探讨90°喉内窥镜在喉咽部异物诊治中的应用。方法对102例有喉咽部异物史行常规间接喉镜检查未发现异物的患者,采用外径8?mm 90°喉内窥镜连接影像显示系统进行检查和治疗。结果102例中98例喉咽有异物,均在喉内窥镜下用异物钳成功取出。4例未发现异物,经X线诊断为食管异物,行食管异物取出术时发现异物位于食管入口。结论喉内窥镜光线充足、视野清晰、操作方便,可有效地减少隐蔽性喉咽异物的漏诊,是一种安全、有效、患者易接受的诊疗方法。     

Novel application of a rigid curved larygno-pharyngoscope for examination and treatment of hypopharyngeal lesions

In endoscopic laryngo-pharyngeal surgery (ELPS), a rigid curved laryngo-pharyngoscope, which was invented by Dr. Sato et al., is necessary to obtain excellent surgical view of both hypopharynx and even the entrance of the esophagus. We have used this instrument for the examination and treatment of several diseases other than cancer located in the hypopharynx, such as difficult-to-find buried fish bones, retropharyngeal abscess, and congenital pyriform sinus fistula. In the result, we could acquire better view of hypopharynx and completed the intended procedure safely, especially for uncovering difficult-to-find fish bone buried in the mucosa. Even in the cases hardly to operate under this instrument, just use for detailed observation of the lesion was available. A rigid curved laryngo-pharyngoscope provides a wide and clear view of a challenging space, the hypopharynx. We recommend using this technique in cases such as difficult-to-find buried fish bones or retropharyngeal abscesses while avoiding a neck incision.     

View from beneath: pathology in focus. Synovial sarcoma of hypopharynx.

Synovial sarcoma of the hypopharynx is a rare neoplasm. To date only 23 cases of synovial sarcoma of the hypopharynx have been reported in the literature. An additional case in an 18-year-old male is presented. This is the first case of synovial sarcoma in the hypopharynx to be reported in Singapore. The presentation was that of a mass in the hypopharynx; progressive dysphagia, intermittent hoarseness and gradual airway compromise. A CT scan was valuable in determining the site of origin and extent of the lesion. Histopathology was diagnostic. Treatment comprised of wide surgical excision of the tumour and post-operative radiotherapy.     

Carcinoma of the hypopharynx and cervical esophagus in young adults

Squamous cell carcinoma of the hypopharynx and cervical esophagus usually presents in the late-middle-aged and elderly. When diagnosed in young adults, the disease process is often thought to be more aggressive and have a worse long-term outcome. Four hundred ninety patients presented to the Christie Hospital and Manchester Royal Infirmary between 1981 and 1990 with squamous cell carcinoma of the hypopharynx and cervical esophagus. Of this group, 24 patients (5%) received their diagnosis before the age of 45. A comparison is made with a control group of 156 (32%) patients who presented between the ages of 60 and 69 years. Analysis of tumor and nodal staging at presentation demonstrates no statistically significant difference between the 2 age groups. There is a higher incidence of a combination of smoking and alcohol abuse in the older age group, but it is of no statistical significance. There is no difference in 5-year survival results between the 2 groups. We conclude that patients with squamous cell carcinoma of the hypopharynx and cervical esophagus who receive their diagnosis under the age of 45 show no difference in tumor stage or long-term outcome when compared with a control group encompassing the mean age of presentation.     

Nonepithelial malignant neoplasms of the larynx and hypopharynx]

OBJECTIVES: Nonepithelial Malignant Neoplasms of the larynx and hypopharynx are rare. Their clinical features, diagnosis and treatment were discussed. METHODS: From 1985 to 1996, 23 cases of nonepithelial malignant neoplasms of the larynx and 3 cases of hypopharynx were diagnosed. There were 21 males and 5 females. Age of the patients ranged from 16 to 65 years. Laryngeal tumours included 11 cases of sarcomas, 1 extramedullary plasmocytoma, 9 lymphomas and 2 malignant melanomas. Hypopharyngeal tumours included 1 leiomyosarcoma and 2 malignant melanomas. Extensive resection was the first treatment for 21 patients. Then, according to their histopathologic features, irradiation or/and chemotherapy were chosen. RESULTS: Follow-up period was from 6 months to 10 years. There were 12 patients survived for 4 to 10 years, including 6 cases of laryngeal sarcomas, 2 supraglottic lymphomas, 2 malignant melanomas of the larynx, 1 malignant melanoma and 1 leiomyosarcoma of the hypopharynx. CONCLUSIONS: Characteristics for these tumours were: 1. usually covered by intact mucosa; 2. laryngeal tumours rarely metastasize to the cervical lymph nodes; 3. difficulties in histopathological diagnosis, and immunohistochemistry is helpful to differentiation and determination.     

Hypopharyngeal inverted papilloma

A case of inverted papilloma of the hypopharynx is described. Review of the literature failed to reveal any previous case reports of inverted papilloma of the hypopharynx.     

Localized enlargement of the thyroid gland presenting as a pyriform sinus mass

Mass lesions of the hypopharynx and pyriform sinus are usually malignant neoplasms. Benign tumors do occur but are uncommon. In a review of the literature, no case of impingement of a thyroid mass upon the hypopharynx and pyriform sinus was found. An unusual case of localized enlargement of the superior pole of the thyroid gland which impinges on the hypopharynx and pyriform sinus is presented.     

24-h-pH-Metrie des Hypopharynx

Monitoring of pH of the esophagus is a routine diagnostic procedure, whereas until now pH-monitoring of the hypopharynx has been used only for scientific research. In the present study a critical evaluation scale was used to record the results of 112 patients who underwent pH monitoring to determine possible reflux. Since high refluxes often remain unnoticed clinically, further study is required in certain cases. The extent of reflux in the esophagus may not represent pathological changes in the hypopharynx. In such cases 24-h pH monitoring of the hypopharynx can be a useful diagnostic procedure and may also help detect the pathogenesis of "gastric laryngitis".     

Hypopharyngeal squamous cell carcinoma in a child

Squamous cell carcinoma of the hypopharynx is extremely rare in children. We present a 13-year-old girl with squamous cell carcinoma of the hypopharynx whose father was a coal-miner and a heavy smoker.     

Collision tumor of a hypopharyngeal adenoidcystic carcinoma and a laryngeal squamous cell carcinoma

INTRODUCTION: Malignancies in head and neck cancer are mainly squamous cell carcinomas. Adenoid cystic carcinomas are rare lesions of this site. Laryngeal adenoid cystic carcinoma is estimated to occur in 0.1 - 0.7 % of all laryngeal carcinomas. Adenoid cystic carcinomas are rarely located in the hypopharynx. To our knowledge there is no case report of adenoid cystic carcinoma of the hypopharynx as part of a collision tumor of the larynx. CASE REPORT: A 47-year-old male patient was diagnosed with an adenoid cystic carcinoma of the hypopharynx and a squamous cell carcinoma of the larynx. Because of local extension of both tumors laryngectomy and partial pharyngotomy with bilateral neck dissection was performed followed by radiation therapy. Clinical aspects as well as histomorphological and immunohistochemical criteria of both tumor entities are discussed. DISCUSSION AND CONCLUSIONS: Immunohistochemical characteristics showed two different carcinoma entities in the larynx and hypopharynx. Only by complete histological investigation of a carcinoma those rare cases of a collision tumor can be detected. Both tumor entities need to be considered for therapy strategy and oncological follow-up planning.     

Management of hypopharyngeal and cervical oesophageal perforations

BACKGROUND: Perforations of the hypopharynx and the cervical oesophagus are infrequent severe situations, which may even be life-threatening for patients. METHODS: We review seven cases of intraluminal perforations of the hypopharynx or cervical oesophagus treated at our department between 1999 and 2001. RESULTS: In this series of patients, foreign bodies were the main cause of perforation. In four cases, the treatment was surgical by means of a cervicotomy and/or thoracotomy and drainage; in the other three cases, conservative treatment was applied. In some cases, the morbidity was considerable but there were no mortalities. CONCLUSIONS: The treatment of perforations of the hypopharynx and the cervical oesophagus must be individualized and multidisciplinary. The early diagnosis of these perforations is an important factor for prognosis.     

The autonomic innervation in the pharynx. A study by the horseradish peroxidase tracer method

Autonomic innervation of the mucosa in the pharynx was investigated by the horseradish peroxidase retrograde tracer method. The pharynx was divided into three regions, the epipharynx, mesopharynx, and hypopharynx. The epipharynx was sympathetically innervated by the fibers originating in the ipsilateral superior cervical ganglion and parasympathetically innervated by the fibers originating in the bilateral pterygopalatine ganglia. The mesopharynx and hypopharynx were sympathetically innervated by the fibers originating in the superior cervical, middle cervical, and stellate ganglia but not innervated by the pterygopalatine ganglion. The sympathetic innervation of the mesopharynx and hypopharynx was considered bilateral and predominant in the ipsilateral side. Comparing these two regions, the hypopharynx showed a tendency to be more innervated by the middle cervical and stellate ganglia.     

Superficial extending carcinoma of the hypopharynx: Report of 26 cases of an underestimated carcinoma

Advanced ulcerating and infiltrating tumors are commonly found in the hypopharynx, whereas early well-defined lesions are rarely diagnosed. The pathologic reports of 242 uniformly studied surgical specimens after total pharyngolaryngectomy for cancer of the hypo-pharynx were reviewed. The histologic analysis of 26 cancers (10.7%), which were recorded as having an entire or predominant superficial type of spreading, demonstrated that also in the hypopharynx a “superficial extending carcinoma” (SEC) may occur. SEC of hypopharynx was pathologically defined as a poorly or moderately differentiated squamous cell carcinoma, generally located in the pyriform sinus, which spreads superficially. It was limited to the mucosa (2.9%), but more frequently early infiltrated the underlying muscle or gland structures (6.2%), regardless of the presence of lymph node metastases or lymph vessels invasion. Although the concept that SEC of the hypopharynx may be an expression of a generalized disease of the mucosa must be carefully considered in surgical management, it appeared that this carcinoma in its “pure” intramucosal form may be associated with a good prognosis and a long survival.     

Hypopharyngeal small cell carcinoma: a case report

We report a 67-year-old woman with small cell carcinoma of the hypopharynx, a very rare entity with few reports. Our treatment consisted of carboplatin (CBDCA) and etoposide (VP-16) in the same way as small cell carcinoma of the lung is treated. This achieved a complete response. Our case suggests that chemotherapy with carboplatin and etoposide is effective for small cell carcinoma of the hypopharynx.     

Surgical treatment of carcinoma of the hypopharynx and cervical esophagus: substitution by the colon and stomach]

Thirty-one cases with hypopharyngeal carcinoma and 4 cases with esophageal carcinoma in cervical segment were treated surgically from April 1984 to April 1989. In 6 cases, while preserving the larynx, the hypopharynx and the esophagus were resected and reestablished by the colon. In 29 cases, total laryngectomy was also performed and 4 had their hypopharynx and esophagus substituted by the colon and 25 by the stomach. According to UICC (1982), there were 11 cases in stage II, 15 in stage III and 9 in stage IV. The mean 3-year and 5-year survival rates were 62% and 32% respectively. In fatal cases, 4 cases had recurrences at the site of pharyngeal anastomoses and 11 had metastases in the neck.     

Double primary synchronous and metachronous cancer of the larynx and hypopharynx with dissimilar histology. Five case reports and review of the literature

Five cases of double primary synchronous and metachronous cancers of the larynx and hypopharynx with dissimilar histology encountered at the Section of Pathology of the Department of Otolaryngology of Padua University from 1966 through 1979 are reported. The pathogenesis of these double primary malignancies is discussed, and in particular stress is laid on the perhaps not purely coincidental association of squamous cell and oat cell carcinoma of the larynx and hypopharynx. Furthermore, a thorough review of the literature is made on the reported cases of two primary simultaneous or metachronous malignancies of the larynx and hypopharynx of different histological type.