The Role of Neck Dissection in the Treatment of Supraglottic Laryngeal Cancer

Objectives - Vestibular compensation, the recovery that follows unilateral vestibular deafferentation (UVD), is a model for central nervous system plasticity. Recovery from the static symptoms of UVD may involve temperature-dependent processes that modulate the immediate effects of UVD and/or the capability of the central nervous system to undergo adaptive plasticity. In this study we investigated changes in oculomotor and postural vestibular symptoms resulting from low body temperature during UVD. Material and methods - To study the effect of low temperatures at the time of UVD on vestibular compensation, we compared the rate of compensation and peak values for postural [roll head tilt (RHT) and yaw head tilt (YHT)] and oculomotor [spontaneous nystagmus (SN)] symptoms in three groups of guinea pigs. Animals in Group 1 (n=6) were maintained at 38°C throughout unilateral labyrinthectomy (UL). Animals in Group 2 (n=6) were not temperature-controlled and animals in Group 3 (n=4) were cooled with ice to 25°C throughout UL. Results - Cooled animals showed significantly higher rates of SN upon recovery from anaesthesia and took a significantly longer time to compensate. Cooled animals were also slower to compensate for postural symptoms (RHT and YHT), with 2 animals showing no compensation for RHT 52 h after UL. Conclusion - Hypothermia (25°C) during UVD surgery exacerbates postural and oculomotor symptoms following UL and significantly slows recovery.     

喉功能保留外科相关的喉功能解剖

目的 了解喉功能的解剖学基础,为喉癌、下咽癌手术保留喉功能提供解剖依据.方法 对4例成年男性尸体喉部的环杓关节相关肌肉、神经及血管进行解剖观察,根据肌肉的起止点与肌纤维方向分析各肌肉的作用.结果 甲杓肌位于喉腔内,环杓后肌、环杓侧肌、杓横肌及杓斜肌位于喉软骨支架的后外周面;在相关肌肉的作用下,以环杓关节面为核心,杓状软骨可以完成旋转与滑动运动;环杓后肌与环杓侧肌可以开大、缩小声门,对保证正常的喉功能有更重要的作用;喉返神经于气管食管沟内自下而上支配环杓后肌、环杓侧肌、杓横机、杓斜肌及甲杓肌等肌肉;喉下动脉自甲状腺下动脉发出后走行于环杓后肌的背侧,供血于环杓关节相关组织.结论 一侧完整的环杓关节及功能正常的环杓后肌与环杓侧肌是保留喉功能喉部分切除术的最基本条件.     

喉部分切除术后患者的嗓音功能观察

目的 研究喉癌患者喉部分切除术后嗓音功能情况及变化趋势,以探讨不同术式与患者术后嗓音质量的关系.方法 应用计算机嗓音声学测试系统(Dr.Speech Science for Windows软件,美国泰亿格公司产品)对30例正常对照者及55例喉部分切除术患者(其中喉声门上水平部分切除术组20例,喉垂直部分切除术组18例,喉扩大垂直切除术组17例),于术后5年内不同时间进行嗓音声学测试,并对所测得的平均基频(F0)、基频微扰(jitter)、振幅微扰(shimmer)、标准化噪声能量(NNE)、第一共振峰频率(F1)、第二共振峰频率(F2)进行比较分析.结果 三种术式F0均较正常对照组低,jitter、shimmer、NNE均较正常对照组高.jitter、shimmer、NNE数值由低到高排列依次为喉声门上水平部分切除术组、喉扩大垂直切除术组、喉垂直部分切除术组.喉声门上水平部分切除组/a:/、/i:/、/u:/的第一共振峰频率明显高于正常对照组.结论 喉水平部分切除术后嗓音功能恢复最佳,而喉垂直部分切除术后最差.嗓音声学分析可作为评价喉癌术后发声质量的定量指标,有助于针对性地指导患者术后嗓音康复训练.     

Review of Segmental and Marginal Resection of the Mandible in Patients with Oral Cancer

This paper reviews the medical literature of the last decade to ascertain the criteria used to assess mandibular invasion by cancer of the oral cavity and to suggest how best to evaluate the mandible with a view to surgical management. It is generally agreed that patients with mandibular invasion should be treated surgically, but the extent of mandibular resection required remains a controversial matter and the accurate preoperative determination of neoplastic invasion of the mandible remains a challenge for head and neck surgeons. The relative reliability of preoperative orthopantomography, (OPG) bone scanning, computed tomography (CT) and magnetic resonance imaging (MRI), and of peroperative periosteal stripping and direct inspection in clinical assessment for mandibular surgery, is discussed. The histological patterns of tumor invasion and the most common routes of tumor entry in the mandible are described and the influence of variables such as prior radiotherapy and an edentulous vs a dentate state in relation to perineural invasion are also discussed. Finally, a comparison is drawn between the reported outcome of marginal vs segmental resection procedures and a decision-making algorithm is proposed. In selected cases, marginal mandibulectomy can ensure satisfactory tumor control, with a favorable effect on the morbidity associated with mandibular surgery.     

喉癌患者染色体对致突变剂诱发畸变的敏感性研究

采用平阳霉素作为诱变剂，对２８例喉癌患者和２３例正常人做外周血淋巴细胞染色体对诱变剂敏感性研究，结果显示喉癌患者的染色体总畸变率、每细胞染色单体断裂率（ｂ／ｃ值）和细胞畸变率分别为１．９８％±０．０５％，０．５７％±０．３５％和４２．８％±１２％。正常人则分别为０．９４％±０．０４％，０．２８％±０．１２％和２７％±１２％。经统计学处理，喉癌患者组与正常人组的差异有高度显著性。并结合实验结果探讨了染色体对致突变剂的敏感性与患喉癌风险的关系。     

喉癌组织中微小RNA-129-2基因甲基化程度的研究

目的研究喉癌肿瘤组织中微小RNA-129-2基因(MiR-129-2)的甲基化程度及其与患者临床分级和癌组织病理分化程度的关系。方法应用Methyl-ProfilerTM DNA甲基化PCR系统对12例喉癌肿瘤组织和6例癌旁组织进行甲基化分析。结果喉癌组织中MiR-129-2高甲基化率为66.7%(8/12),癌旁组织中MiR-129-2高甲基化率为0(0/6),两组比较差异有统计学意义(P<0.05)。喉癌患者临床分级与MiR-129-2高甲基化率差异无统计学意义(P>0.0 5)。病理分化程度与MiR-1 2 9-2高甲基化率差异无统计学意义(P>0.0 5)。结论 MiR-1 2 9-2基因在喉癌组织中甲基化水平升高,MiR-1 2 9-2高甲基化水平可能与喉癌发生的病理机制有关。     

Management of a Laryngeal Venous Malformation With Nd:YAG Laser and Bleomycin Sclerotherapy

Literature describing neodymium:yttrium-aluminum-garnet (Nd:YAG) photocoagulation and sclerotherapy for laryngeal venous malformations (VMs) is sparse. Here we present a case in which an extensive laryngeal VM in a 28-year-old female was managed through a combination of four serial Nd:YAG laser photocoagulation sessions and four bleomycin injections over the course of 2 years. The treatment plan resulted in resulted in noticeable lesion ablation, mucosalization, and significant improvement in symptoms. To our knowledge, this case is the first instance of bleomycin injection specifically into a laryngeal VM reported in the English medical literature. Laryngoscope, 130:2199–2201, 2020     

Preservation of Hearing in Bilateral Acoustic Neurinomas by Deliberate Partial Resection

With the aim of preserving hearing, 20 acoustic neurinomas in 17 patients with neurofibromatosis 2 were intentionally submitted to an incomplete (80%) tumour removal. In 12 cases this was an operation on the last hearing ear with total deafness of the contralateral ear. If an auditus existed in both ears the better hearing ear was selected for the primary intervention. Early audiological controls evidenced residual hearing in 19 of the 20 cases operated on by the enlarged middle fossa approach, which was utilized inspite of the tumour diameters being between 1 and 6 cm in the cerebello-pontine angle. The oncologic and functional follow-up over 1 to 7 years showed different patterns of slow progression of hearing loss and of persistent auditory function over 2 to 7 years. Facial nerve function was excellent in 16 of the 18 controlled cases. Continued CT or MRT imaging revealed no signaling in 2 cases, constant tumour sizes in 10 cases and slow progression in 3 cases. With regard to the importance of an auditory communication in the younger adult, the described treatment modality appears to be the first choice method.     

Laryngeal rhabdomyoma: unusual case of dysphonia. Review of the literature

Rhabdomyomas of the larynx are extremely rare benign tumors. Only 25 have been well documented until now. These tumors display a low growing pattern. Diagnosis is based on immunocytochemical studies and electron microscopy. Three histological types are distinguished: adult, fetal and fetal myxoidal or genital. Surgery is the treatment of choice. A new case, adult type, is presented and the literature reviewed.     

喉癌癌周浸润细胞的表现型和临床预后的关系

应用免疫组化ＡＢＣ法及甲苯胺兰和ＨＥ染色对８２例喉癌切除标本癌周浸润的Ｔ淋巴细胞，Ｂ淋巴细胞，巨噬细胞，郎格罕细胞，肥大细胞和嗜酸性粒细胞的浸润程度、分布特点进行了观察。同时结合临床随访对与临床预后有影响的八个临床、病理学指标及六类浸润细胞进行多因素逐步Ｌｏｇｉｓｔｉｃ回归分析。结果发现喉癌局部有不同程度的上述细胞浸润。除Ｂ淋巴细胞以外各类细胞的浸润程度对临床预后（５年存活率）均有一定影响（Ｐ＜０．０１）。通过多因素分析认为嗜酸性粒细胞的浸润程度是影响预后的最重要因素（Ｐ＝０．００３），其次为Ｔ淋巴细胞（Ｐ＝０．００５）和肿瘤组织学分级（Ｐ＝０．０３３）。说明癌周浸润细胞在宿主局部抗肿瘤免疫反应中起重要作用。     

Laryngeal tuberculosis: report of a case

The larynx as a site of tuberculosis represents less than 1% of the total of this disease. Primary tuberculous laryngitis is even more rare. The authors report a case of an 89 year-old man presenting with swallowing disorders (dysphagia and overspill) consulting for suspected laryngeal carcinoma. Finally, the diagnosis was laryngeal tuberculosis. The outcome was favourable with appropriate treatment, obtaining complete healing without any after-effects. The diagnosis of tuberculosis must cross the clinician's mind, even when there are no general symptoms.     

Laryngeal sarcoidosis: apropos of a case]

The authors report an unusual case of laryngeal sarcoidosis. After having explained it, they describe the elements of diagnosis about this rarely isolated pathology, its complications and treatment as well.