Rekonstruktionsverfahren zum Wiederaufbau des Hypopharynx nach Tumorexstirpation

Die funktionellen Ergebnisse nach Rekonstruktion der Hypopharynxhinterwand bezeichneten Steinhart und Iro als zufriedenstellend. Nur in einem Fall bestand noch nach 12 Monaten eine Aspiration und eine deutliche Einschr?nkung der oralen Nahrungsaufnahme.     

Patienten mit Malignomen des Oro- und Hypopharynx sowie Larynx

The necessity of a long-time, closely monitored, well-structured, personal and time-consuming aftercare consultation is still discussed controversially. Based on the analysis of our oncological patients with tumours of the pharynx and larynx in the period from 1999–2000 we want to emphasize that aftertreatment is of vital importance. Besides the main focus of oncology on the early detection of recurrent tumours, distant metastases and second primary tumours as well as a fast interdisciplinary and mostly multimodal treatment planning, consultation is also a central point of reference and coordination site for rehabilitation, psycho-oncology and quality assurance of treatment. Last but not least consultation serves for purposes of continuous data collection and oncological epidemiology.     

Rezidive bei Plattenepithelcarcinomen des Oro- und Hypopharynx und der Supraglottis

Summary Eighty recurrent carcinomas of patients with primary carcinomas of the tonsils, of the hypopharynx and the supraglottis were analysed. The average-time of recurrence was 15.1 months. After irradiation alone (n=31) the tumor occurred within 12 months. After primary resection with clear margins (n=29) the carcinoma recurred within 23 months. If the margins of resection were not clear, cancer recurred within only 8 months. In 12% there was a manifestation of the relapse in the mucous membranes of the upper respiratory tract. For interpretation we discuss an inversion of the lymphatic flow.

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Erscheint ausführlich in Laryngol Rhinol Otol     

Intrathorakale und extrathorakale Rekonstruktion des Hypopharynx und zervikalen Ösophagus mit Deltopektorallappen

Ohne Zusammenfassung     

Rekonstruktion des Speiseweges durch Anteile des Larynx und der Halstrachea nach Resektion des Hypopharynx und des Halsoesophagus wegen eines ausgedehnten Carcinoms mit Halslymphknotenmetastasen

Ohne Zusammenfassung     

Stimmlippenminderbeweglichkeit und ipsilaterale Raumforderung im Hypopharynx

Chronic lymphocytic leukemia (CLL) is the most common form of leukemia in the Western World. It belongs to the low-grade non-Hodgkin lymphomas and is characterized by clonal reproduction of mature small-cell non-functional B-lymphocytes. CLL affects men somewhat more often than women and the average age at onset is over 50 years. In addition to regional lymph node swelling, typical symptoms include hepatosplenomegaly, leukocytosis and skin disorders such as eczema and pruritus. Manifestations in the oropharynx or hypopharynx are rare but should be kept in mind in the differential diagnosis.     

Die Rekonstruktion eines stenosierten Hypopharynx durch einen Halsschwenklappen

Summary Cervical flaps have found a broad area for its use in the plastic-reconstructive surgery in the head and neck region. By patients demonstrations the use of such a cranially based flap will be explained after removal of an extensive hypopharyngeal and postcricoidal stenosis. This is a two staged operation. This way it is possible to close the hypopharyngeal opening three weeks after the primary surgery.     

F. B. in Hypopharynx—An unusual presentation

Case of F. B. in rignt pyriform fossa reported for its unusual presentation     

Contralateral Hemilaryngotracheal Flap Reconstruction of the Hypopharynx in Pyriform Carcinoma Resection

Objectives: To simplify the approach and reconstruction for advanced hypopharyngeal cancer, a modified technique—laryngotracheal fissure approach and laryngotracheal flap reconstruction—is presented. Study Design: Prospective. Methods: From August 1991 to December 1995, 44 consecutive patients with advanced hypopharyngeal cancer, mostly involving pyriform sinus, were operated on with this technique. The functional and oncologic results and complications were evaluated. Results: Reconstruction was completed by using the laryngotracheal flap in 75% of patients, while the other 25% required ddditional patch-on pectoralis major myocutaneous flaps. Pharyngoesophageal stenosis occurred in one patient after radiotherapy and pharyngocutaneous fistula was noted in two. No local recurrence was noted. Seven cervical metastases developed in the follow-up period and six over the contralateral neck not treated surgically. The 5-year Kaplan-Meier disease-free survival was 46.8%. Conclusions: The authors' experience indicates that this is a simplified, radical treatment for most advanced hypopharyngeal cancer, with high applicability, good oncologic results, and low complication.     

Endoskopische und zyto-histomorphologische Möglichkeiten der Krebsfrüherkennung im Hypopharynx

Summary Hypopharyngeal carcinomas are usually diagnosed in stage 3 and 4 and, even when subjected to combined radiological and surgical therapy, have a very poor prognosis. An improvement in this lamentable therapeutic and diagnostic situation can be expected only from early detection. Therefore, for the detection of precancerous and early stages of hypopharyngeal carcinoma, the proven techniques employed for early detection and grading of precancers and early carcinomas in the larynx were employed.Within the framework of this prospective study, a total of 328 patients have been examined since the beginning of 1978. Following the completion of a computer-compatible questionnaire covering pre-history, symptoms and smoking and drinking habits, a complete endoscopic investigation of the head and neck regions was carried out. For the examination of the pharynx and larynx, the v. Stuckrad zoom endoscope has proved its value, since, with it, even concealed regions of mucosa, as in the hypopharynx, can be reliably inspected. Thus, the visual early detection of very minute and early changes of the mucosa is also possible in this area. Cytological material is obtained from the various topographical regions, stained in accordance with Papanicolaou and evaluated. In the case of suspicious findings (Pap. III) an endoscopic-cytological check is carried out, or tissue biopsy taken for histomorphological work-up.The analysis of the cytological findings showed that, in particular, six cases with Pap. III, manifesting no visible changes in the mucosa of the hypopharynx, were of interest. Since multiple check cytological examinations indicated the moderate dysplasia, these patients were classed as being at particular risk and are now being monitored endoscopically and cytologically, every 3 months.In the examination of etiologically high-risk groups and patients with precancerous conditions of the upper airways and alimentary tract, cytologically suspicious cases indicating dysplasia or early tissue changes in the mucosa, may be more frequently expected in the hypopharynx, too. Only long-term observation will reveal how a cytological finding with dyscaryosis (Pap. III), in the presence of a clinically and endoscopically normal mucosa is to be classified.

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Mit Unterstützung der Deutschen Forschungsgemeinschaft (SFB 118)     

Pathologische Schluckmuster nach Tumorchirurgie in Oro- und Hypopharynx Analyse mittels differenzierter Schluckpassage

Dysphagia is a common complaint following surgical intervention in the oral cavity and hypopharynx, often leading to prolonged postoperative recovery. Videofluoroscopy allows detailed visualization of deglutition, demonstrating the morphology as well as the functional aspects. Therefore, videofluoroscopy provides the basis for further therapeutic management. We discuss the pathology of deglutition in 19 patients recovering from tumor surgery of the oro- and hypopharynx. In most cases the results demonstrated severe impairment of both the oral and pharyngeal phase of deglutition. Our data emphasize the importance of the oral phase of deglutition for preparation and initiation of the following phases.     

Limited Surgery for Cancer of the Larynx and Hypopharynx: Options and Consequences

We reviewed surgical options for laryngeal preservation (limited surgery) in laryngeal and hypopharyngeal cancers and the consequences of the options. Of 44 patients with laryngeal cancer, 11 (25%) received limited surgery and 33 (75%) received total laryngectomy. The survival rates were 91% for the limited surgery group and 73% for the total (radical) surgery group. Of 31 patients with hypopharyngeal cancer, 7 (23%) received limited surgery and 24 (77%) received total laryngopharyngectomy. The survival rates were 53% for the limited surgery group and 40% for the total (radical) surgery group. The survival rates associated with limited surgery were thus better than those for total (radical) surgery for cancers of both the larynx and hypopharynx. This was attributed to the limited surgery group comprising well-selected patients with confined lesions. Organ preservation surgery should be technically simple, reliable in terms of its functional impact and, above all, should not jeopardize the patient's survival. Supracricoid subtotal laryngectomy with cricohyoidoepiglottopexy or cricohyoido-pexy has great potential for laryngeal preservation and will become the major limited surgery modality for treating cancer of the larynx. Limited surgery, however, needs to be performed with great care and is indicated only for very well-selected patients with cancer of the hypopharynx.     

经支撑喉镜平阳霉素注射治疗喉咽巨大血管瘤12例临床研究

目的：探讨经支撑喉镜平阳霉素注射治疗下咽及喉部巨大血管瘤的方法及疗效。方法：12例下咽及喉部巨大血管瘤患者术前行多导睡眠监测,在全身麻醉下常规行气管切开术,经口插入支撑喉镜进入咽喉部声门区,经长管针行血管瘤体内注射平阳霉素（每3周注射1次,总剂量〈50mg）。结果：治愈10例,显效2例。术后经多导睡眠监测显示患者缺氧较术前明显改善。经1年以上的随访,未见复发。结论：该方法治疗下咽及喉部巨大血管瘤风险小、安全性高、喉功能保存好、治疗彻底,能改善患者缺氧,提高其生活质量,是治疗咽喉巨大血管瘤的一种理想方法。     

Comparison of Clinical Evaluation and Computed Tomographic Diagnostic Accuracy for Tumors of the Larynx and Hypopharynx

Ninety-five patients with laryngeal and hypopharyngeal cancer were examined and staged preoperatively by clinical evaluation (CE) and computed tomography(CT). The CE and CT staging were compared to each other and to the pathologic(PT) staging of the tumors. The CT staging showed high accuracy in staging transglottic (88%), supraglottic (68%), and oropharyngeal tumors invading the larynx (68%) when compared to the PT findings. The CT staging was less effective in evaluating glottic tumors (46%), both overstaging (12%) and understaging (20%) cases. Combined CE-CT evaluation showed higher accuracy in staging all tumors (84%) compared to CE alone (52%) or CT alone (68%). The findings suggest that combined CE-CT should be used to evaluate laryngeal and hypopharyngeal tumors. Laryngoscope, 106:589-594, 1996