Incidentally Found Killian-Jamieson Diverticulum During Thyroidectomy: A Case Report.

The aim of this case study is to demonstrate the very rare coincidental existence and management of a Killian-Jamieson diverticulum (KJD) during thyroid surgery. A 57-year-old woman was referred to our clinic with a malignant thyroid nodule and the complaint of a sore throat. There were no suspicions concerning a diverticulum on examining her with flexible laryngoscopy or ultrasound imaging. During the right central neck dissection, we noticed a 3 × 3 cm KJD and resected it while preserving the recurrent laryngeal nerve. After the successful operation, we questioned the patient and learned that for 1 year she had an occasional complaint of dysphagia. Postoperatively, there was no vocal cord palsy or hypocalcemia, and there was no pharyngoesophageal leak after oral alimentation. There was no recurrence or complaint for KJD or papillary carcinoma for 8 years follow-up. Nonspecific symptoms like a sore throat should be investigated, and patients should be questioned for all aerodigestive symptoms. If necessary, further investigation should be undertaken for a differential diagnosis.

Evaluation of laryngeal vascular changes with image1 s enhancement system in reference to the European laryngological society guideline.

OBJECTIVES: To assess the feasibility of using Image1 S™ endoscopic enhancement system for discrimination of the vascular patterns in laryngeal lesions. DESIGN: Forty patients presenting with benign, dysplastic and malignant laryngeal lesions were examined with Image1 S system. The vascular patterns were classified by a group of authors according to the European Laryngological Society (ELS) guideline, as perpendicular or longitudinal, in all lesions. The relationship between the vascular patterns and the pathological results was statistically analysed. Endoscopic images of the lesions were evaluated through an online survey by a group of otolaryngologists with different levels of clinical expertise and asked them to choose a diagnosis and a vascular pattern. The vascular pattern evaluations of the participants were compared to the authors' evaluations to determine the interobserver reliability. The final diagnostic judgements of the participants were compared with the definitive histopathological diagnoses. SETTING: Tertiary university hospital. PARTICIPANTS: Forty patients with laryngeal lesions and thirty otolaryngologists with different clinical experience levels. MAIN OUTCOME MEASURES: The study evaluates the usefulness of the Image1 S system for the detecting the vascular patterns associated with benign, dysplastic, and malignant lesions and measures the level of accuracy and inter observer agreement in detecting the final histopathology. RESULTS: Histopathological examination diagnosed 12 patients as benign, 12 dysplastic and 16 malignant. Using Image1 S, the vascular patterns were longitudinal in 11 lesions, perpendicular in 28 lesions and undetectable in 1 lesion. With white light, longitudinal pattern was observed in 14 lesions, perpendicular in 21 lesions and undetectable in 5 lesions. The correlation between the vascularisation pattern and the pathological diagnosis was found to be significant (p < .001). The qualitative evaluation of the vascular patterns by the two groups of observers showed significant reliability (κ = 0.63, p < .001). The agreement with the final diagnoses was also significant (κ = 0.56, p < .001). CONCLUSIONS: Image1 S endoscopic enhancement system with spectral modes provides an improved visibility of the vascular patterns defined by the ELS in laryngeal lesions. ELS classification can reliably distinguish benign lesions from suspected ones and can be applied even by less-experienced clinicians but the final diagnosis needs experience and should be confirmed with histopathology.

Functional and Oncological Outcomes of Open Partial Laryngectomy vs. Transoral Laser Surgery in Supraglottic Larynx Cancer.

OBJECTIVE: The aim of the presented study was to evaluate the outcomes of open partial laryngectomy (OPL) versus transoral laser surgery (TLS) in patients operated on for supraglottic laryngeal carcinoma based on functional parameters (duration of hospitalization, oral nutritional status and duration of transition to oral feeding, weaning status and duration after tracheotomy, and postoperative voice results) and oncological results (overall survival rate, disease-specific survival rate, recurrence, and presence of second primary tumors) in both groups. METHODS: All laryngeal carcinoma patients who had undergone either OPL or TLS in the period from January 2012 to March 2017 in our center and were followed-up at least for 36 months were included in the study. Statistical analyses were carried out using the t-test and the Mann-Whitney U test to compare the means, and the Kaplan-Meier test for survival analysis. RESULTS: Fifty patients (44 males and 6 females) met the study criteria, of whom 31 had undergone OPL and 19 TLS. Patients that underwent TLS had less tracheotomy needs, needed shorter hospitalization periods, and transitioned to oral feeding earlier, compared to those that underwent OPL. There were no significant differences between the two groups based on oral feeding rates and voice outcomes. The impact of TLS and OPL on organ preservation in supraglottic laryngeal cancer were comparable. For local recurrences, repeated endolaryngeal laser surgeries and adjuvant treatments could be used in the TLS patient group. There were no significant differences between the two groups based on overall survival rate and disease specific survival rate. CONCLUSION: Although no significant differences were found in our study between the two surgical procedures in terms of oncological outcomes, TLS appeared to produce better functional outcomes in supraglottic laryngeal carcinoma than OPL.