Long-term results of organ preservation in chondrosarcoma of the cricoid

Chondrosarcoma of the larynx is rare. The posterolateral lamina of the cricoid cartilage is the site most commonly involved. Although the symptomology, radiological and histopathological diagnostic features are well known, the condition continues to be diagnosed late and recurrences after excision are common. In general, radical surgical excision can result in long-term remission, although prognosis is related to the histopathological grade of the tumor. While a conservative surgical approach in low-grade tumors is justified, unexplained hoarseness, unilateral vocal cord paralysis and dyspnea requires CT scan examination. Received: 26 September 1998 / Accepted: 26 February 1999     

Function preservation surgery in patients with chondrosarcoma of the cricoid cartilage

Chondrosarcoma is a rare laryngeal neoplasm that is most commonly encountered in the cricoid cartilage and is optimally treated by surgical excision. It is typically a slow-growing malignancy with well-defined margins and a minimal risk of metastasis; however, radiographic imaging studies often appear ominous if the clinician correlates these findings to the biological behavior of epithelial cancer. Furthermore, the fact that the neoplasm's epicenter is usually under the cricoarytenoid joint can lead to airway and voice deficits before and after operation. Although many surgeons opt for function-sparing resection approaches, it is commonplace for some surgeons to injudiciously perform total laryngectomy as the initial treatment because of the rarity, large size, location, and appearance of these tumors on imaging studies. A retrospective review was done on 10 cases of cricoid chondrosarcoma to gain insight into the treatment strategies designed to preserve laryngeal function while minimizing the risk of local recurrence. We performed surgical resection in 8 of the 10 patients; 2 underwent endoscopic removal and 6 underwent transcervical partial laryngectomy. All are free of disease with good voice and swallowing function. One patient developed a limited recurrence and required a second transcervical partial laryngectomy. Function-sparing surgical treatment of chondrosarcomas of the cricoid cartilage can usually be achieved. Surgeons should carefully modify the core principles of epithelial cancer surgery techniques, adjusting to the different biological behavior of laryngeal chondrosarcomas.     

The anterior cricoid split in puppies

The acute and long-term effects of the anterior cricoid split on the subglottis of puppies intubated from 7 to 14 days are documented. The anterior cricoid split acutely increased the intralumenal cricoid surface area in puppies with intubation-induced airway injury. An intense inflammatory response with mucosal ulceration and granulation tissue is elicited by 14 days of intubation by using the canine model of induced subglottic stenosis developed by Supance et al. [19]. When animals intubated for 14 days underwent an anterior cricoid split on day 7, the airway appears essentially normal by day 14. The split cricoid cartilage maintained a 'U' configuration following the procedure. The region of deficient cartilage anteriorly is bridged by fibrous tissue with normal epithelium lining the lumenal surface. Splitting the cricoid cartilage anteriorly increased the intralumenal area and no long term complications resulted from the procedure. The mechanisms by which the anterior cricoid split expands the airway intralumenal area while maintaining airway support have been reviewed.     

原发性颅底软骨肉瘤CT和MRI诊断

目的分析原发性颅底软骨肉瘤的CT和MRI表现,探讨CT和MRI在颅底软骨肉瘤中的诊断价值。方法搜集经病理组织学证实的9例颅底软骨肉瘤,全部病例均行CT和MRI平扫及增强。结果 9例CT平扫表现为等或略低密度的分叶状或类圆形软组织肿块,伴有不同程度的钙化,且形态不规则,呈散在沙粒样或弧形及粗糙团块状,同时合并骨质破坏;增强后病灶呈非均匀强化。MRI检查T1WI呈等低信号混杂影,T2WI呈高低信号混杂影,肿瘤内钙化在T1WI、T2WI均为无信号区,增强扫描明显不均匀性强化。结论颅底软骨肉瘤有较特有的CT和MRI影像学表现,是诊断颅底软骨肉瘤的有效方法 。     

Post cricoid lymphangioma

A 69-year-old female patient presented with symptoms characteristic of globus pharyngeus and barium swallow examination was normal. Her symptoms persisted and pharyngoscopy was undertaken; a post-cricoid polyp was found and removed. Histological examination revealed this to be a lymphangioma. Histological appearances, pathogenesis and treatment are discussed. The case illustrates that persisting symptoms presenting as globus pharyngeus should be further investigated to exclude rare lesions.     

The clinical relevance of the submucosal cricoid cleft

PURPOSE: Although fairly uncommon and sometimes difficult to diagnose, laryngeal clefts have been well-defined in the literature. The submucosal cleft variant has been described anatomically, but not clinically. We describe a series of patients with a submucosal cricoid cleft variant and its clinical relevance. METHODS: This is a case series of patients presenting with submucosal cricoid. A submucosal cricoid cleft is defined as a dehiscent posterior cricoid plate with an intact mucosal bridge. RESULTS: Eight patients presented during a 4 year period from October 2002 to September 2006. Patient ages ranged from 6 days to 15 years, with a mean age of 40 months. Four patients (50%) had a submucosal cricoid cleft only while four children presented with a laryngotracheal cleft in addition to the submucosal cricoid cleft. Six patients were diagnosed with subglottic stenosis and had tracheotomies. Four patients (50%) failed laryngotracheal reconstruction (LTR) prior to submucosal cricoid cleft diagnosis. Two patients had their submucosal cricoid cleft diagnosed during initial airway reconstruction surgery. Two patients were diagnosed after feeding difficulties. The submucosal cricoid cleft was felt to be an important factor contributing to the failure of previous laryngotracheal reconstruction. Almost all of the patients (7/8) had co-morbidities. Two patients needed revision airway surgery, both successful. Four of the six patients with a tracheostomy have been decannulated. CONCLUSION: Because of the subtle nature of its clinical presentation, submucosal cricoid cleft can be a challenging diagnostic entity, and the results of surgical reconstruction may be compromised if the cleft is undiagnosed.     

Congenital cricoid stenosis

A case of congenital cricoid stenosis in a 9-year-old girl was reported. The stenosis was confirmed by direct laryngoscopy and laryngotracheograms performed through the tracheostoma. The excess cartilaginous tissue was removed under a midline incision of the cricoid cartilage (cricoidplasty). Seventeen cases of cricoid stenosis reported since 1960 were studied and the clinical entity was discussed. On the basis of the embryology of the larynx, the mechanism of origin of this malformation was also discussed. Although cricoid stenosis was a fatal malformation before 1968, it is now a curable disease using an emergency treacheostomy and a cricoidplasty.     

Unusual CT appearance of a thyroglossal duct cyst carcinoma

This is the first report to describe the CT appearances of a solid midline cervical mass that proved to be a papillary carcinoma associated with a thyroglossal duct cyst.     

Pharyngolaryngectomy for post cricoid carcinoma

Radical resection after unsuccessful radiotherapy for post cricoid carcinoma may provide longterm cures even in patients who have cervical node involvement. The best palliation is achieved by visceral replacement of the pharynx but this carries a significant mortality rate. In patients with tumors considered too extensive for radiotherapy, successful short term palliation can be achieved with pharyngolaryngectomy and left colon replacement.     

The influence of ageing on wound healing of the cricoid.

In young and adult rabbits the effects of one anterior or two bilateral splits of the cricoid were studied. Interruption of the cricoid ring elicits wound healing of the cut edges and induces changes in form and size of the separated parts of the cricoid (indirect effect). It was demonstrated that with increasing age i) the wound healing capacities of the hyaline cartilage is highly diminished or lost and ii) the induced remodelling, involving the total ring in young animals, is in the adult stage confined to the posterior part. Moreover, the observations suggest that dividing the cricoid ring in an anterior and posterior part at a young age can result in a stimulation of growth of the anterior part, in comparison with unoperated control animals.     

The anterior cricoid split. Clinical experience with extended indications

A recommended approach to postextubation infant subglottic stenosis secondary to subglottic edema employs the recently described anterior cricoid split (ACS) procedure. This technique provides an expanded subglottic airway with minimal paratracheal dissection and does not require concomitant tracheotomy. We applied this procedure in managing extubation difficulty in pediatric as well as neonatal patients. Five of ten patients in our series did not fulfill the traditional criteria for ACS. Relief of stridor and avoidance of tracheotomy were accomplished in nine of ten patients. One patient in whom mechanical ventilation was reinstituted developed an interesting complication. In properly selected infants with subglottic airway compromise, the ACS appears to be an effective adjunct in facilitating extubation.     

The anterior cricoid split: the Children's Hospital of Philadelphia experience

The anterior cricoid split procedure (ACS) is an alternative to tracheotomy in selected infants with subglottic stenosis. From February 1983 to October 1987, 26 children underwent ACS at the Children's Hospital of Philadelphia. All children had subglottic stenosis. Six children had previously undergone tracheotomy. A successful outcome, allowing extubation or decannulation, correlated only with decreased pre-operative intubation time and was achieved in 73% of these patients. A failed ACS had little adverse affect on the subsequent management of these children.     

Porous hydroxylapatite-perichondrium graft in cricoid reconstruction

Composite grafts of hydroxylapatite-perichondrium were used for reconstructing defects in the cricoid of young rabbits. The alloplastic material showed no signs of resorption; it was firmly attached to the surrounding tissues by ingrowing connective tissue; only a moderate foreign body reaction was observed. The perichondrium formed new cartilage around the hydroxylapatite.