Epiglottis is not essential for successful swallowing in humans

Controversy has continued for well over 100 years regarding the role of the epiglottis in deglutition. We describe the effect of isolated epiglottectomy on swallowing success in a case series of 3 adult human subjects with isolated epiglottectomy due to trauma, surgery, or cancerous erosion. The patients were 42, 51, and 70 years of age, and swallowing was analyzed objectively with videofluoroscopy. All subjects exhibited successful swallowing with all food types: thin liquid, puree, and solid food. Specifically, the patient with traumatic epiglottectomy exhibited rapid swallowing success, the patient with surgical epiglottectomy exhibited a short period of dysphagia due to postoperative edema, followed by swallowing success, and the patient with epiglottectomy due to cancerous erosion of the entire epiglottis exhibited long-term adaptation, with successful swallowing maintained. We conclude that the epiglottis is not essential for successful swallowing in humans, because individuals can readily adapt to isolated epiglottectomy and avoid tracheal aspiration.     

A case of pleomorphic adenoma of the epiglottis: Bilateral vocal-cord paralysis after YAG laser surgery

Pleomorphic adenoma of the larynx is a rare disorder, and until recently has been treated mainly by approaches involving pharyngotomy. We encountered a case of pleomorphic adenoma originating from the laryngeal surface of the epiglottis and removed it using a YAG laser through a suspension laryngoscope. This case was complicated by delayed-onset bilateral vocal-cord paralysis, the causes of which are also discussed.     

Carcinoma arising in a pleomorphic adenoma of the epiglottis

Despite the abundance of minor salivary glands within the larynx, pleomorphic adenomas are rarely found. It is therefore not surprising that there are few reports of malignant mixed tumours in this site. We describe a case of carcinoma arising in a pleomorphic adenoma of the epiglottis which, to our knowledge, has not been described previously. The patient underwent a horizontal partial laryngectomy and functional neck dissection and is well one year postoperatively. We feel this represents a suitable approach to treatment for this rare tumour.     

Diathermy epiglottectomy: endoscopic technique

Endoscopic epiglottectomy is usually performed using a surgical laser. Epiglottectomy may be indicated for the treatment of benign or malignant lesions and for the relief of airway obstruction caused by a floppy epiglottis. We present four patients who had endoscopic partial epiglottectomy using monopolar diathermy to treat a floppy epiglottis. All the four patients were male in their sixth and seventh decades with snoring and/or obstructive sleep apnoea syndrome (OSAS) due partly or wholly to a floppy epiglottis. Diathermy epiglottectomy is easily carried out using the laryngoscope, laryngeal instruments and curved rotating microdissection monopolar scissors (used in laparoscopic surgery). This was found to be safe and effective with minimal morbidity. It requires no elaborate preparation and could be performed in hospitals that have no laser facilities. It may be performed in conjunction with other procedures e.g. uvulopalatopharyngoplasty (UPPP) if necessary.     

Acquired laryngomalacia: epiglottis prolapse as a cause of airway obstruction.

Epiglottis prolapse during inspiration is an unusual cause of upper airway obstruction. It occurs primarily in patients who have lost pharyngeal airway support because of previous surgery or after head injury and coma. Eight cases of epiglottis prolapse are presented. One patient had epiglottis prolapse after resection of floor of mouth cancer and another after laryngeal fracture. The rest of the cases were seen in patients recovering from head injury and coma. Videolaryngoscopy shows the larynx to assume an ovoid shape within the pharynx. There is loss of the usual anterior to posterior pharyngeal and laryngeal dimension. The epiglottis is in a more horizontal position at rest. During inspiration, the epiglottis prolapses into the endolarynx, causing subtotal airway obstruction. Laryngeal obstruction due to epiglottis prolapse can prevent decannulation in the head-injured and can be the cause of obstructive sleep apnea. Endoscopic carbon dioxide laser epiglottectomy was successful in management of these cases.     

Chondrosarcoma of the epiglottis: report of a case treated with CO2 laser epiglottectomy

Chondrosarcoma of the larynx is a rare slow-growing malignant tumour with approximately 240 cases reported in the literature: the cricoid cartilage is the most commonly affected site (72-75%), in rare case was described of epiglottis (1-2%). We report a case of a chondrosarcoma of the epiglottis treated with CO2 laser epiglottectomy. The patient was referred with dysphonia, dysphagia and halitosis that started four months before. Indirect laryngoscopy revealed a large smooth mass with a roundish appearance and a pearly-grey colour, as big as a nut, apparently arising from the laryngeal surface of the epiglottis, causing obliteration of the piriform fossa. The definitive histopathological report showed microscopically, the tumour was low-grade (grade I) chondrosarcoma. A literature review regarding chondrosarcomas of the epiglottis is presented. The diagnosis, histology and treatment of these tumours are discussed. In particular we examine the controversy of conservative surgery vs. total laryngectomy. A conservative surgical approach is typically appropriate in light of this tumour's low-aggressive nature.     

Erworbene Laryngomalazie der Epiglottis

Reports on acquired traumatic laryngomalacia appear only rarely in the literature. We report a case of a 47-year-old patient with breathlessness after a transcervical approach to the spine during general anesthesia with intubation. Laryngostroboscopy revealed a smooth and, during inspiration, retroflexed epiglottis at the posterior pharyngeal wall. Additionally, dynamic magnetic resonance imaging for the first time showed hypermobility of the upper edge of the epiglottis. After partial laser epiglottectomy, the patient's complaints disappeared.     

Epiglottic dysfunction after isocyanate inhalation exposure

Epiglottic dysfunction due to environmental exposure is a well-known entity. The most common causes of epiglottic dysfunction include trauma (thermal, chemical, and blunt), infection, allergy, neoplasm, and neurologic disorders. We report an unusual case of epiglottic dysfunction due to isocyanate inhalation exposure and review the literature concerning this subject. Following inhalation exposure to diphenylmethane diisocyanate, our patient developed persistent repeated airway obstruction during inspiration. Fiberoptic rhinolaryngoscopy showed that the epiglottis obstructed the glottic airway during each inspiratory cycle. The epiglottic dysfunction was also well demonstrated by barium contrast cineradiography. Total epiglottectomy resulted in resolution of the patient's upper airway obstructive symptoms. Histologically, marked inflammatory changes of the epiglottis were noted, including a focal infiltrative pattern, focal fibrosis, edema, and reactive changes.     

会厌多形性腺瘤1例

患者,男,43岁,因声嘶伴咽部梗阻感1年于2013年1月28日入院。患者无吞咽及呼吸困难。电子喉镜检查提示：会厌喉面左侧游离缘处可见巨大白色球形新生物。表面光滑,界清（图1）。于1月31日在全身麻醉下行支撑喉镜下会厌新生物切除术,术中见会厌喉面左侧游离缘处直径约1．5cm黄白色球形新生物,表面光滑,界清,质中偏韧。     

A case of floppy epiglottis in adult: a simple surgical remedy

A new operative technique for the treatment of floppy epiglottis is introduced in this report. Though its diagnosis is not so difficult by close observations using a flexible fiberscope, it is likely to be treated as an asthma attack or a paradoxical vocal cord movement. In previous reports of upper airway obstruction caused by adult floppy epiglottis: epiglottis prolapse during inspiration, the cause of this condition has been divided broadly into two categories: idiopathic cases and secondary cases. Partial or total epiglottectomy has been usually reported for the treatment of the relief of airway obstruction caused by a floppy epiglottis. It is very difficult to decide adequately how much volume of epiglottis to cut without postoperative sequelae. A V-shaped partial epiglottidectomy is described for its treatment. This technique is very easy, simple, and effective.     

Carcinoma ex pleomorphic adenoma of the palatal minor salivary gland with extension into the nasopharynx

Carcinoma ex pleomorphic adenoma presenting in the nasopharynx is extremely rare. We present a case of carcinoma ex pleomorphic adenoma occupying the nasopharynx and the soft palate in a 51-year-old woman. To the best of our knowledge, this is the first reported case of carcinoma ex pleomorphic adenoma in the nasopharynx.     

An unusual case of airway obstruction

An unusual case of airway obstruction is presented. A 56 year old woman was admitted with stridor. She gave a history of intermittent upper airway obstruction of four years' duration. Examination revealed gross hypertrophy of the lingual tonsils extending to involve the valleculae and the entire epiglottis. Histological examination confirmed the presence of normal lymphoid tissue. The patient underwent epiglottectomy and cryosurgery to the lingual tonsils with complete resolution of symptoms. A review of the literature is presented and the investigative and treatment modalities are discussed.     

Pleomorphic adenoma of the lateral side of the tongue

Pleomorphic adenoma is histopathologically the commonest tumor found in the major salivary glands. Pleomorphic adenoma originating from the tongue is very rare: only 26 cases have been reported in the world literature since 1960, only 2 of which originated from Ebner's gland. Herein we report the case of a 54-year-old female with pleomorphic adenoma of the tongue. The tumor was in contact with the molars. A partial glossectomy was performed with a surgical margin, as the preoperative pathological finding in the tissue specimen taken from the tumor was epithelial hyperplasia. The postoperative pathological diagnosis was pleomorphic adenoma with hyperplasia. It is unclear whether the teeth being in contact with the tumor caused tumorigenesis in this case. This case suggests that pleomorphic adenoma of the tongue originating from Ebner's gland should be considered in the differential diagnosis of lesions of the tongue.     

Clear cell carcinoma arising in pleomorphic adenoma of the minor salivary gland

Malignant change arising in pleomorphic adenoma of the salivary glands is uncommon, with a reported incidence of 2-10 per cent. Only one case where a pleomorphic adenoma became a clear cell carcinoma appears to have been published in the English literature. An additional case of clear cell carcinoma arising in pleomorphic adenoma of a minor salivary gland is reported and the relevant literature discussed.     

Pleomorphic adenoma of the external auditory canal in Japan, with a case report.

A rare case of a 51-year-old female with a pleomorphic adenoma, measuring 0.9 x 0.7 x 0.6 (cm3), originating from the right external auditory canal (EAC), was reported. The authors discussed the 7 reported cases of EAC pleomorphic adenoma in Japan, comparing them with pleomorphic adenomas occurring in the nasal cavity and the parotid gland. It is currently too early to conclude that pleomorphic adenoma in the EAC does not tend to recur or shows a marked tendency toward canceration. The best possible treatment for EAC pleomorphic adenoma at present seems to be, as in cases of tumors in other sites, surgical resection together with removal of a sufficient range of surrounding normal tissue, followed by careful long-term postoperative observation of the clinical course.     

Adenocarcinoma ex pleomorphic adenoma of the head and neck: Report of five cases

OBJECTIVE: Adenocarcinoma ex pleomorphic adenoma is a rare tumor, and thus the management of the tumor has not been established. METHODS: The retrospective review of the clinical records at Okayama University was performed. RESULTS: We present five cases of adenocarcinoma ex pleomorphic adenoma of the head and neck, including a rare case with nasopharyngeal adenocarcinoma ex pleomorphic adenoma. There was no response to chemotherapy with nedaplatin and 5-FU, but the nasopharyngeal adenocarcinoma ex pleomorphic adenoma showed a remarkable regression after the administration of docetaxel. CONCLUSION: The combination therapy that includes docetaxel may be a promising treatment for adenocarcinoma ex pleomorphic adenoma of the head and neck.     

Immunohistochemical study of pleomorphic adenoma of the nasal septum.

A rare case of pleomorphic adenoma of the nasal septum is reported. A 48-year-old man complaining of nasal obstruction and nasal bleeding was referred to our hospital for treatment of a left nasal tumor. The tumor, including the nasal septum, was resected by the modified Denker operation and lateral rhinotomy. The tumor was firm, parenchymatous, pedunculated, and 24 x 22 x 14 mm in size. Pathological examination revealed pleomorphic adenoma with slight cellular atypism. Immunohistochemical observations suggested that characterization of this tumor might be similar to pleomorphic adenoma of the parotid gland.     

Benign pleomorphic adenoma of the soft palate metastasizing to the sphenoid sinus

A benign pleomorphic adenoma is the most common tumor of the salivary glands. This tumor has the potential to metastasize to bone, the head and neck region, visceral organs and skin. Although there a few reports about a benign pleomorphic adenoma metastasizing to the maxillary sinus in the paranasal sinuses, there are no reports about a metastatic benign pleomorphic adenoma in the sphenoid sinus. We report here on a case of a benign pleomorphic adenoma of the soft palate that metastasized to the sphenoid sinus, and we briefly review the relevant clinical literature.     

Agenesis of the unilateral parotid gland associated with pleomorphic adenoma of the contralateral parotid gland

Congenital absence of the parotid gland is extremely infrequent. We present here a case of unilateral parotid gland agenesis with pleomorphic adenoma of the contralateral parotid gland. Even though pleomorphic adenoma is the most common tumour of the parotid gland, to our knowledge this is the first case of these two conditions being seen together.     

Pleomorphic adenoma of the tongue base

INTRODUCTION: Pleomorphic adenoma is the most common lesion of minor salivary glands but is exceptional in the tongue base. REPORT CASE: We report the case of a 70-year-old woman with pleomorphic adenoma of the tongue base. The patient consulted for difficult swallowing, which developed over 4 months. Physical examination and computed tomography revealed a cystic tumour located in the right side of tongue base. The tumor was removed by transoral resection. The histological examination demonstrated a pleomorphic adenoma. DISCUSSION: We will discuss the diagnostic and therapeutically modalities of pleomorphic adenoma of the tongue base with a review of the literature.